In 2013, the American Psychiatric Association (APA) released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which included significant changes to the way schizophrenia is diagnosed.
One of the first changes is that the DSM-5 now requires patients to experience two or more symptoms of psychosis, at least one of which must be delusions, hallucinations, or disorganized speech, for at least one month in order to be diagnosed with schizophrenia. This change was made in recognition of the fact that the onset of schizophrenia is often gradual, and patients usually do not experience all of the symptoms of the disorder at the same time. In fact, in some cases, more severe symptoms may not present themselves at all.
In addition, the DSM-5 also recognizes that there is a high rate of comorbidity between schizophrenia and other mental disorders, such as anxiety and depression. As a result, the new diagnostic criteria allow for patients to be diagnosed with schizophrenia even if they do not meet the full criteria for the disorder if they have a history of another mental disorder and have presented symptoms of schizophrenia.
Eliminating Schizophrenia Subtypes
One of the most significant changes was the removal of the subtypes of schizophrenia, including residual schizophrenia. The rationale for this change was that the subtypes of schizophrenia did not have clear and distinct boundaries between them, and they often could not be reliably diagnosed. Furthermore, the subtypes did not have a consistent relationship to treatment response or outcome.
The removal of the subtypes of schizophrenia from the DSM-5 has been somewhat controversial, and there is still some debate about whether or not this was the right decision. However, the DSM-5 Task Force has defended the change, arguing that it is based on the best available evidence.
There is no doubt that the former diagnosis of residual schizophrenia and the other schizophrenia subtypes still represent a serious mental disorder that can have a profound impact on a person’s life. However, the removal of the diagnoses from the DSM-5 does not mean that people with these disorders are no longer receiving treatment or that they are no longer considered to be ill.
It is important to remember that the DSM-5 is not the final word on mental disorders and that it is constantly evolving. The removal of the subtypes of schizophrenia from the DSM-5 does not mean that they will never be recognized again, but simply that the current evidence does not support their inclusion.
What Were the Schizophrenia Subtypes?
Before the DSM-5, schizophrenia diagnoses were broken down into categorical subtypes which were based on the patient’s predominant symptomatology. The subtypes were:
Paranoid type:
The paranoid type was characterized by delusions and auditory hallucinations, with relatively normal thinking and affect.
Disorganized type
The disorganized type was characterized by disorganized speech and thinking, flat or inappropriate affect, and sometimes catatonia.
Catatonic type
The catatonic type was characterized by motor abnormalities such as mutism, negativism, posturing, and stupor.
- Undifferentiated type: The undifferentiated type was characterized by symptoms that did not meet the criteria for the other subtypes.
- Residual type: The residual type was characterized by the presence of positive symptoms, but at a lower level than in the other subtypes.
How the DSM-5 is Different
The elimination of the subtypes was based on the finding that they did not have good diagnostic validity, meaning that they did not accurately predict treatment response or course of illness. The subtypes were also found to have poor inter-rater reliability, meaning that different clinicians would often diagnose the same patient differently.
The DSM-5 instead uses a single diagnosis of schizophrenia, with specifiers for the presence of prominent positive or negative symptoms, prominent catatonia, and prominent delusional or disorganized thinking. The specifiers are intended to provide more information about the patient’s individual presentation and to help better guide treatment.
The changes in the DSM-5 have been questioned by some, and there is still much debate about the best way to diagnose and treat schizophrenia. However, the elimination of the subtypes is generally considered to be a positive change, as it leads to a more accurate and consistent diagnosis.
While the changes to the DSM-5 diagnostic criteria for schizophrenia are significant, they provide a more accurate and nuanced picture of the disorder. It is important to note, however, that these changes do not mean that any schizophrenia diagnosis is any less serious or any less debilitating. Schizophrenia is a complex mental disorder that has a profound impact on every aspect of a person’s life, and the severity of symptoms often changes over time. Those living with the condition should always be treated with the utmost care and respect.
If you want to learn more about schizophrenia and its impact, contact Life Adjustment Team today.
