What Is Disorganized Schizophrenia?

Worldwide, schizophrenia affects 1% of the population, and it is a lifelong disorder that can lead to severe impairments in functioning. Disorganized schizophrenia, also referred to as hebephrenic schizophrenia or hebephrenia (based on the Greek term for adolescence), was a subtype of schizophrenia previously recognized in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

The DSM-IV included five subtypes of schizophrenia, including disorganized, paranoid, catatonic, undifferentiated, and residual. The subtypes were removed from the current version of the DSM (DSM-5, released in 2013), as it was determined that they were not helpful when treating the disorder.

Despite the change, disorganized symptoms remain one criterion for diagnosing schizophrenia. Some individuals may show more of these types of symptoms than other symptoms of the disorder. In the most general sense, disorganized schizophrenia refers to the disorganization of thought processes, behavior, and affect regulation (emotions).

Diagnosis

Diagnosing schizophrenia involves a comprehensive set of medical examinations to rule out other possible causes or contributions to the person's symptoms, including a physical exam, blood count, thyroid assessment, drug and alcohol use assessment, and possibly magnetic resonance imaging (MRI) and CT scans to rule out brain lesions or other abnormalities.

In addition, a psychiatric evaluation will be conducted to determine the thoughts, feelings, behavior patterns, family history, and other history of a patient presenting with symptoms that suggest schizophrenia.

Diagnosis is made according to the DSM-5 criteria. A person must present with two or more of the following (and at least one of them must be from the first three on the list) for a significant portion of the time over a 1-month period:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms

Disorganized Symptoms

What are the disorganized symptoms in schizophrenia? Simply put, they fall into the third and fourth categories of symptoms listed in the DSM-5 for diagnosing the disorder. A person who is experiencing disorganized schizophrenia symptoms may show any of the following:

• Problems with routine tasks like dressing, bathing, and brushing teeth
• Showing emotions that are not appropriate to the situation
• Blunted or flat affect
• Impaired communication ability, including speech
• Problems with the use and ordering of words
• An inability to think clearly and respond appropriately
• Use of nonsense words/making up words (neologism)
• Shifting quickly from one thought to the next without logical connections
• Writing a lot without any meaning
• Forgetting or losing things
• Pacing or walking in circles
• Having problems understanding everyday things
• Responding to questions with unrelated answers
• Repeating the same things over and over again
• Problems with attaining goals or completing tasks
• Lack of impulse control
• Failure to make eye contact
• Childlike behaviors
• Social withdrawal

These disorganized symptoms of schizophrenia cover a range of issues related to thoughts, speech, behavior, and emotion. Unfortunately, these symptoms interfere with the ability to function, both in terms of activities of daily living and communication with others.

Onset of Disorganized Symptoms

The peak age of onset of schizophrenia is in the early to mid-20s for men and late 20s for women. Schizophrenia is most commonly diagnosed from late adolescence to early adulthood.

Because the onset of disorganized symptoms is often gradual and may be attributed to other problems experienced during this time of life, such as trying to adjust to adulthood, the signs of disorganization due to schizophrenia are not always easy to spot. Unfortunately, the prognosis is worse when schizophrenia begins earlier and also when treatment begins later.

Causes and Risk Factors

We don't know precisely what causes schizophrenia. However, it is believed to result from a combination of biological and environmental factors and impacts on brain cells and different neurotransmitter systems. The following risk factors have been implicated in the development of the disorder:

• A family history of schizophrenia
• A viral infection as a fetus during pregnancy (e.g., influenza, herpes, toxoplasmosis, rubella)
• Malnutrition as a fetus during pregnancy
• Experiencing severe stress during early life
• Being born to older parents
• Using recreational drugs during adolescence (though, conversely, substance use can also be a result of having schizophrenia)

Having one or more of these risk factors does not mean that a person will necessarily develop schizophrenia. However, showing symptoms of the disorder along with one or more of these risk factors could be a sign that medical attention is warranted. A doctor can assess the criteria for a diagnosis of schizophrenia.

Treatment for Disorganized Symptoms

Much like other mental health disorders, the primary treatments for schizophrenia are medication and psychotherapy. Earlier diagnosis and treatment mean better outcomes, particularly in the case of disorganized symptoms, because these can have a significant impact on education, finding a job, and living independently.

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Medication

Medications for schizophrenia include antipsychotic drugs. In severe cases, a person diagnosed with schizophrenia may need to be hospitalized for stabilization or safety.

Medications for the disorder will help to reduce disordered thinking and improve functioning. Some people may also be prescribed antidepressants, mood stabilizers, or anti-anxiety medication alongside antipsychotics for symptoms of schizophrenia.

Therapy

Talk therapy, such as cognitive behavioral therapy (CBT) can be used in the treatment of schizophrenia to target specific life problems and help the person to develop coping strategies to deal with those problems. Learning to regulate emotions by examining thought processes is one helpful strategy that can be developed through CBT.

Electro-Convulsive Therapy (ECT)

ECT involves sending an electric current through the brain to provoke a seizure and neurochemical release and may be helpful in those who are also experiencing a risk of suicide, severe depression, or refractory symptoms.

Skills Training

Skills training might be used to help people with disorganized schizophrenia find a job, further their education, or learn how to better communicate with others despite their symptoms.

Family Support

While not a treatment per se, support from family plays a large role in how well those with schizophrenia will fare. Family members need to learn about and understand the disorder, as well as learn how best to support their loved one.

Complications

As with other mental health conditions, there are numerous complications of living with disorganized schizophrenia. These might include:

• Depression
• Family conflict
• Homelessness
• Involvement in crime (as either victim, perpetrator, or both)
• Lower educational attainment
• Malnutrition
• Poor living conditions (e.g., the inability to keep up with housework)
• Poor medication compliance
• Poor personal hygiene
• Poverty
• Risk of suicide
• Substance use to self-medicate
• Unemployment

Unfortunately, many people with this disorder feel that they don't need medications or can stop taking their medication once their symptoms start to resolve.

If you are a person living with schizophrenia, it is important to follow the advice of your doctor regardless of how well you may be feeling. If you are a family member of someone with schizophrenia, be sure to check on them often. Be aware of the signs and symptoms of the disorder that could return if medication is stopped.

A Word From Verywell

Disorganized schizophrenia involves impairment in daily activities and communication with others. If you suspect that you or someone you know may be living with the symptoms of this disorder, it is important to see a doctor for an assessment and diagnosis.

Early detection and treatment mean a better prognosis, particularly when a person is living with disorganized thoughts, behaviors, and emotions. Proper treatment in the form of medication and/or therapy is necessary; without treatment from a professional, it is unlikely that the symptoms will go away on their own.