Can Schizophrenia Be on a Spectrum?

Yes, schizophrenia can be on a spectrum. As a matter of fact, a set of disorders related to schizophrenia make up the spectrum developed by the current medical community.

The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) is the manual healthcare professionals use as a reference when diagnosing schizophrenia and many other disorders. But while organizing a complex disorder like schizophrenia is challenging, the spectrum model is the clearest way to view schizophrenia to date.

How the Schizophrenia Spectrum Was Understood in the Past

In the past, schizophrenia was thought of as a type of dementia and diagnosed as "dementia praecox," or "precocious dementia," because it primarily affected young people.

Later, a German psychiatrist (named Eugen Bleuler) developed the modern term "schizophrenia," which means "split brain."

Bleuler had observed people with schizophrenia experiencing hallucinations and delusions, separated from their understanding of reality or "split" from it.

Even though the terms and ways to understand schizophrenia have changed, the schizophrenia spectrum is still recognized as a set of distinct conditions with unique symptoms.

How Symptoms on the Schizophrenia Spectrum Are Defined

Symptoms on the schizophrenia spectrum have individual definitions that fit into two categories: positive or negative.

Hallucinations (or seeing and hearing things that are not real) are defined as "positive," as they are added experiences that do not ordinarily occur.

Delusions (or fixed and false beliefs that resist change) likewise are "positive" symptoms, as they do not ordinarily occur without the addition of a disorder. 

Negative symptoms on the schizophrenia spectrum subtract things from ordinary experiences and include symptoms related to mood, speech, or movement.

The full emotions that people feel can become "flat" or lack natural fullness, leading to a lack of facial expression or a flat tone of voice.

People on the schizophrenia spectrum may avoid speaking or moving freely, which most people naturally do, but it may be uncomfortable for those on this spectrum.

What Are Some Disorders on the Schizophrenia Spectrum?

The schizophrenia spectrum includes several disorders, namely:

Schizophrenia

Schizophrenia is the primary disorder on which the spectrum is based. It includes the most common symptoms of the schizophrenia spectrum and many similarities between the related disorders.

Disorganized thinking and behavior are common symptoms of schizophrenia, and people with it may remain motionless for long periods or appear to talk to someone who is not there.

Schizoaffective Disorder

This disorder features the symptoms of schizophrenia in addition to mood disorders. People with schizoaffective disorder can experience deep depression or depression with manic episodes.

Due to these different mood symptoms, schizoaffective disorder is broken into a depressive type or a bipolar type.

Delusional Disorder

People with delusional disorder often have false beliefs that are based outside of reality, and even though evidence shows that the belief is false, those with the disorder are usually unable to accept the evidence, still following their beliefs.

Delusional disorder does not always include hallucinations, but when it does, they are usually fewer and farther between than other disorders on the psychosis spectrum.

Schizotypal Personality Disorder

This disorder features delusions with different distinct themes. The themes may include a romantic fixation on someone or believing they are greatly important (for example, someone who thinks they're the sole person who can prevent a global disaster or someone with extraordinary spiritual power or knowledge).

With this disorder, people generally remain functional in daily life and only infrequently (if ever) experience hallucinations.

While they tend to be withdrawn and isolated, their behavior is usually within the norms of their communities, and they do not typically have mood disorders associated with their condition.

How Has the Schizophrenia Spectrum Changed?

The change to a spectrum model in the DSM-5 happened because the previous ways of diagnosing schizophrenia were not always reliable or precise, based on what medical workers saw.

In the old DSM-4 system, schizophrenia was sorted into "types" that had strict qualities and definitions for each.

For example, the "paranoid type" included symptoms that mainly focused on delusions related to paranoia rather than disorganized behavior.

The "catatonic type" focused mainly on the physical symptoms of schizophrenia, such as restlessness, muscle rigidity, or completely silent patients.

The "undifferentiated type" focused on a mix of symptoms that did not fit neatly into the other types.

Despite efforts and research to develop the "type" system in the DSM-4, healthcare providers frequently found the types did not fit their patients with great reliability over time.

As patients remained in treatment, treatment became more precise, and diagnosis could change due to more information gathered from patients about their symptoms.

Aging also affects the condition, as prolonged adherence to medication and treatment can either improve or worsen outcomes and show changes in the shape and form of symptoms over time.

Due to these challenges, the DSM-4's "type" system was replaced by the spectrum model that is used today.

Current Challenges in the Diagnosis of Schizophrenia

A more current challenge to diagnosis on the schizophrenia spectrum is how symptoms overlap with other unrelated disorders.

Depression can resemble the flattened emotional state of schizophrenia, so people with depression can lack a feeling of full emotions.

The experiences teenagers have can look like the symptoms of schizophrenia as a natural part of growing up before the disorder emerges fully, making it difficult to pinpoint anything out of the ordinary. People in this age range may withdraw from friends, have occasional insomnia, or lack motivation.

As schizophrenia typically develops when many first experiment with drugs in the late teens to early twenties, pinpointing a diagnosis becomes difficult again. The use of drugs must be absent to see if the symptoms of schizophrenia have genuinely surfaced.

Psychiatry has also uncovered a relationship between obsessive-compulsive disorder and schizophrenia, as the two share certain aspects of anxiety and obsessiveness.

Some researchers have even speculated that schizophrenia may be the original mental disorder which all others came from, although it has not been proven.

All of the above makes diagnosing people with schizophrenia challenging, as diagnosis takes time to determine who has the condition accurately.

Advancements in Treatment for People on the Schizophrenia Spectrum

A broader discussion and movement to psychiatry and medicine that are more precise creates the potential for better treatments in the future.

Medication and therapy have become more specific depending on the disorder identified on the schizophrenia spectrum, which enables healthcare providers to tailor treatments to individuals.

Even now, progress in genetic tests shows with some accuracy which medications may or may not have the greatest effect.

The larger healthcare industry has also received more training on the mental wellness of their patients to check in daily practice. And previous biases are reduced with the education and supportive services routinely offered to patients.

The Long View of the Schizophrenia Spectrum

A debate about the usefulness of the spectrum model for schizophrenia persists currently. Some say it over-simplifies the condition, while others say it's sufficient.

Despite some controversy, the schizophrenia spectrum model provides clarity on the set of disorders in it. While advancements are slow, psychiatry's and medicine's grasp of the spectrum helps refine ways to identify schizophrenia earlier and the risk factors related to it.

The efforts to improve care for people on the schizophrenia spectrum so far are hopeful.

*Disclaimer: This blog has not been reviewed by a medical professional. Its content is intended solely for informational and entertainment purposes only. Nothing in this blog should replace, substitute, or inform the advice of healthcare providers or any medical caretaker. Please consult a qualified medical professional to verify the information provided here.