Although the DSM-5 diagnostic manual eliminated the differentiation between different types of schizophrenia, this subdivision is still considered very informative by many professionals in that it highlights the main symptoms of each case.
One of the most common types is disorganized schizophrenia, whose classic name is “hebephrenia” . This early-onset disorder is distinguished from other forms of schizophrenia by the prevalence of disorganizing symptoms and psychological deficits over hallucinations and delusions.
Hebephrenia or disorganized schizophrenia
Hebephrenia, also known as “disorganized schizophrenia,” is one of the types of schizophrenia described in the DSM-IV and ICD-10 manuals. It is an extreme manifestation of the so-called “disorganization syndrome” , present to a greater or lesser extent in many cases of schizophrenia.
The German psychiatrist Ewald Hecker in 1871 made the first detailed description of the syndrome that would be called first hebephrenia and later disorganized schizophrenia. Emil Kraepelin included hebephrenia among the subtypes of “early dementia,” the concept he used to refer to schizophrenia.
According to the DSM-IV, hebephrenia is characterized by the predominance of negative symptoms over positive ones. While the positive symptoms of schizophrenia are mainly hallucinations and delusions, among the negative symptoms we find cognitive, behavioral and emotional deficits of different types .
In the case of ICD-10, the basic characteristics of the disorganized subtype of schizophrenia include early onset of symptoms, behavioral unpredictability, the presence of inappropriate emotional expressions, disinterest in social relationships, and motivational deficits.
Characteristic signs and symptoms
As we have said, hebephrenia is mainly characterized by the presence of negative symptoms and disorganization of language and behavior. On the other hand, there are also differences with respect to other types of schizophrenia in the age of onset of the disorder.
1. Early presentation
Disorganized schizophrenia is often detected between the ages of 15 and 25 through the progressive development of negative symptoms. This characteristic was considered the key aspect in hebephrenia for a long time; in fact, the word “hebeos” means “young boy” in Greek.
2. Disorganized behavior
When we talk about schizophrenia, the concept “disorganized behavior” may refer to alterations in motivation to initiate or complete tasks or to eccentric and socially inappropriate behaviors, such as wearing strange clothes or masturbating in public.
3. Disorganized language
In schizophrenia, language disorganization appears as a manifestation of deeper disorders affecting thinking and cognitive processes. Among the typical linguistic signs of hebephrenia we can find sudden blocks in speech or spontaneous changes of subject, which are known as “flight of ideas”.
4. Emotional disturbances
People with hebephrenia show the emotional flattening typical in schizophrenia in general, which is also associated with difficulties in feeling pleasure (anhedonia), among other negative emotional symptoms.
Also noteworthy is the manifestation of emotional and facial expressions inappropriate to the context . For example, a hebephrenic patient may laugh and make smirk-like faces during a conversation about the death of a loved one.
5. Prevalence of negative symptoms
Unlike paranoid schizophrenia, in the case of hebephrenia the negative symptoms are clearly more marked than the positive ones; this means that, in the case of hallucinations and delusions, the lack of interest in social interaction or emotional flattening are less significant than the symptoms of disorganization.
It is important to note that negative symptoms respond less to medication than positive ones; in fact many antipsychotics, especially first generation ones, lead to increased behavioral and emotional deficits. In addition, people with predominantly negative symptoms generally have a poorer quality of life.
Other types of schizophrenia
In the DSM-IV four subtypes of schizophrenia are described in addition to the disorganized one: paranoid, catatonic, undifferentiated and residual. However, in the DSM-5 the distinction between different types of schizophrenia was removed as not very useful. ICD-10, on the other hand, adds post-psychotic depression and simple schizophrenia.
Paranoid schizophrenia is diagnosed when the main symptoms are delusions and/or hallucinations , which are usually auditory. This is the type of schizophrenia with the best prognosis.
In catatonic schizophrenia, behavioural symptoms predominate; in particular, people with this subtype of schizophrenia show either great physical agitation or tend to remain immobile ; in the latter case it is common for a state of stupor to occur and for the phenomenon called “waxy flexibility” to be detected.
The undifferentiated subtype is diagnosed if symptoms of schizophrenia are detected but the characteristics of the paranoid, disorganized or catatonic subtypes are not met.
Residual schizophrenia is defined as the presence of hallucinations and/or delusions of limited clinical significance after a period when symptoms have been more intense.
In people with simple schizophrenia relevant negative symptoms progressively develop without psychotic episodes (or outbreaks) . This subtype is associated with schizoid and schizotypal personality disorders.
6. Post-psychotic depression
Many people with schizophrenia suffer from depression in the period following a psychotic episode. This diagnosis is often used when the emotional disturbances are clinically significant and can be attributed to the negative symptoms characteristic of schizophrenia .