What Is the Schizophrenia Spectrum?

Schizophrenia spectrum and other psychotic disorders is the category of mental health conditions in which psychosis is the primary symptom. Psychosis involves hallucinations (sensory experiences that are not real) and/or delusions (persistent false beliefs that are not based in reality).

While all people who have schizophrenia spectrum disorder experience psychosis, psychosis is a symptom for other conditions as well.

In the previous edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), there were distinct subtypes of schizophrenia, a central condition in this category.

In the current edition (DSM-5), these different types of schizophrenia were removed in favor of a broader definition of schizophrenia.

What Is Schizophrenia? 

Schizophrenia is a complex and long-term mental illness that affects a person's ability to think clearly, determine reality, manage emotions, relate with others, and function well cognitively.

The symptoms of schizophrenia fall into three main categories.

Positive Symptoms (Psychotic Symptoms)

Positive symptoms reflect things that are present that should not be, namely:

• Hallucinations: Seeing, hearing, smelling, tasting, or feeling (through touch) things that are not there
• Delusions: False beliefs that don't change even when the person is presented with evidence that they are false. This can present as extreme paranoia or irrational fears.
• Thought disorder: Unusual thinking or disorganized speech

Negative Symptoms

Negative symptoms, on the other hand, are characteristics that should be present but are not. These might include:

• Loss of motivation
• Disinterest or lack of enjoyment in daily life
• Social withdrawal and reduced speaking
• Difficulty showing emotions
• Difficulty planning, beginning, and sustaining activities
• Displaying a “flat affect" (difficulty expressing emotions using facial expression or voice tone)

Cognitive Symptoms

These include problems with attention, concentration, and memory, such as:

• Problems with processing information to make decisions
• Difficulty using information immediately after learning it
• Difficulty focusing or paying attention

A healthcare provider or mental health expert will evaluate these symptoms to help inform a diagnosis of schizophrenia or another psychotic disorder.

Diagnosis 

The DSM-5 is a reference book published by the American Psychiatric Association. It is considered the standard in the diagnosis of mental health conditions, outlining criteria that must be met for a diagnosis of a specific condition.

A diagnosis of schizophrenia is typically made after the first episode of psychosis. Under the criteria found in the DSM-5, a person must persistently have two or more of the following symptoms (at least one being in the top three) to receive a diagnosis:

• Delusions
• Hallucinations
• Disorganized speech
• Disorganized or catatonic behavior
• Negative symptoms

Decreased level of functioning in the areas of work, interpersonal relationships, or self-care must also be present.

Spectrum of Schizophrenia Disorders

Schizophrenia is just one of several conditions that fall under the spectrum of psychotic disorders. These conditions share similar symptoms but are classified differently based on certain factors, such as the length of the psychotic symptoms and the presence of mood disorder characteristics.

Other psychotic disorders include:

• Schizophreniform disorder: A person exhibits the defining symptoms of schizophrenia, but the condition lasts less than six months. Can develop into schizophrenia if the symptoms reach the six-month mark.
• Schizoaffective disorder: Has features of schizophrenia and features of a mood disorder (either major depressive disorder or bipolar disorder), including psychosis, depression, and mania. The person must experience psychosis for at least two weeks when they are not having a depressive or manic episode. Depressive or manic episode symptoms are present over half of the duration of the condition.
• Delusional disorder: The person has experienced at least one delusion for at least one month but has never met the criteria for schizophrenia. Functional impairment is due to the delusion only and not experienced outside of it.
• Brief psychotic disorder: An episode of psychotic behavior with a sudden onset lasting less than a month, followed by complete remission. Another psychotic episode in the future is possible.

Associated Conditions

Some conditions commonly occur alongside schizophrenia and/or share symptoms that can make diagnosis more difficult.

These can include:

• Major depressive disorder
• Bipolar disorder with psychotic or catatonic features
• Post-traumatic stress disorder
• Obsessive-compulsive disorder
• Autism spectrum disorder
• Substance use disorder
• Brain tumors
• Cushing's syndrome
• Delirium
• Dementia
• Porphyria
• Lupus
• Thyroid disorder
• Temporal lobe epilepsy
• Vitamin B12 deficiency
• Wilson’s disease

Some studies have demonstrated that individuals with schizophrenia spectrum disorders have higher autistic characteristics than those without schizophrenia spectrum disorders, but lower autistic characteristics than individuals with autism.

DSM-5 Updates

Before the DSM-5 was published in 2013, schizophrenia was officially recognized as having five distinct subtypes.

In practice, the symptoms of these subtypes were not felt to be reliable or consistently valid. The American Psychiatric Association decided that having these distinct subtypes with specific criteria hindered diagnosis.

When the DSM-5 was published, these subtypes were removed as part of the official diagnosis of schizophrenia.

Some mental health professionals still use these subtypes to gain nuanced understanding of how schizophrenia can present, which can help with creating treatment plans that are tailored to the individual.

DSM-IV Subtypes

Before the diagnostic criteria for schizophrenia changed, the DSM-IV recognized the following subtypes:

• Paranoid: Primarily involves positive symptoms, especially delusions and auditory hallucinations. It does not typically involve disorganized speech, disorganized or catatonic behavior, or a flat or inappropriate affect.
• Disorganized: Involves disorganized speech, disorganized behavior, and a flat or inappropriate affect. It does not meet the criteria for the catatonic subtype.
• Catatonic: Meets the criteria for a diagnosis of schizophrenia and also exhibits symptoms of catatonia. Catatonia influences both speech and behavior, including excessive or decreased movement.
• Undifferentiated: Has symptoms that fit with a diagnosis of schizophrenia but does not meet the full criteria for a particular subtype.
• Residual: Does not currently display prominent delusions, hallucinations, disorganized speech, or highly disorganized or catatonic behavior. Exhibits negative symptoms and/or two or more diagnostic symptoms of schizophrenia, but in a milder form.

Managing Schizophrenia Spectrum Disorders

Schizophrenia is typically treated as a team effort among the individual, their friends and family, medical professionals, mental health experts, and community supporters.

In addition to formal treatment involving medication and therapies, there are ways to make living with schizophrenia more manageable.

Lifestyle practices a person with schizophrenia can adopt include:

• Eating a healthy, balanced diet
• Getting regular exercise
• Getting plenty of sleep, with a healthy sleep routine
• Stopping or quitting smoking, drinking alcohol, and other substance use
• Spending time with family and friends
• Doing mindfulness and relaxation exercises and techniques
• Engaging in healthy activities they enjoy that help reduce daily stress

Friends and family can help a loved one with schizophrenia by:

• Helping them to find and start treatment
• Encouraging them to stay in treatment
• Being respectful, supportive, and kind while setting and enforcing boundaries, including not tolerating dangerous or inappropriate behavior
• Looking for local or online support groups that can be helpful for the individual and their loved ones

Schizophrenia Misconceptions

There are many misconceptions about schizophrenia. Some common, long-held ones include:

Schizophrenia means someone has multiple personalities/a split personality.

A "split personality" is an element of a rare condition called dissociative identity disorder, which is a condition entirely separate from schizophrenia.

People with schizophrenia are violent and dangerous.

While some people with schizophrenia can exhibit aggression, it is not always the case, and it is actually rare for a person with schizophrenia to be violent. They are more likely to be the victim of violence than to be dangerous to others.

People with schizophrenia must be hospitalized/can't function independently/can't hold down a job.

Schizophrenia is usually treated on an outpatient basis, unless there is a need for an acute hospital stay.

With treatment, many people with schizophrenia can lead fairly normal lives, including being employed.

In some cases, people with schizophrenia need to use disability services in addition to or instead of working.

A Word From Verywell

The definition and classification of schizophrenia has changed and evolved over the years. Coupled with the existence of many conditions that share similar characteristics as schizophrenia, getting an accurate diagnosis can be difficult.

Taking note of your symptoms, or the symptoms of your loved one, and the factors that influence them can help a healthcare provider understand more clearly what is going on and provide the best treatment possible.

If you or a loved one is experiencing signs of schizophrenia, even if all the criteria for schizophrenia are not met, meet with a healthcare provider to discuss next steps.

Frequently Asked Questions

Is schizophrenia diagnosed on a spectrum?

Schizophrenia is just one of several conditions that fall under the spectrum of psychotic disorders.

While there is one set of criteria for the diagnosis of schizophrenia, the severity of symptoms can vary both by individual and over time in the same individual. Sometimes symptoms can be mild. 

Someone who has some symptoms of schizophrenia but doesn't meet the criteria for a diagnosis may be experiencing a different psychotic disorder that is similar to schizophrenia.

Can someone with schizophrenia have multiple mental illnesses?

It is common for people with one mental illness to have other mental illnesses at the same time. This is also true of schizophrenia. A person with schizophrenia may also have a depressive disorder such as major depression, an anxiety disorder, PTSD, or other comorbid (coexisting) conditions.

What can I do to help someone with schizophrenia?

Some ways to help someone with schizophrenia include:

• Helping them to find resources for treatment and support
• Encouraging them to stay in treatment
• Being supportive, but enforcing healthy boundaries