Can Schizophrenia Be on a Spectrum?

Can Schizophrenia Be on a Spectrum?

Yes, schizophrenia can be on a spectrum. In fact, a set of disorders related to schizophrenia make up the spectrum developed by the current medical community from many different disciplines.

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 complex disorders like the 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," (as 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 fractured ability to reason, separating them 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 for each diagnosis.

How Symptoms on the Schizophrenia Spectrum Are Defined

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

Positive Symptoms

Hallucinations

Hallucinations (or seeing and hearing things that no one else can) are defined as "positive," as these sounds, sights, and sensations do not occur without the added symptoms of the spectrum.

Delusions

Delusions (or fixed and false beliefs that resist change) likewise are "positive" symptoms, as they do not ordinarily occur in regular patterns and lines of thinking without the addition of the diagnosis, as well. 

Negative Symptoms

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

Flattened Affect

The full emotions that people feel can become "flattened" or lack natural fullness, leading to less facial expression or a flat tone of voice, (and reaching into the motivational systems in the brain).

The flattened moods can cause many challenging behaviors, including avolition (inability to initiate task or goal oriented action), social withdrawal, and difficulties with self-care.

Alogia and Catatonia

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

Speaking may be highly reserved (alogia), and standing in a fixed posture (or preoccupied in a fixed gaze) may indicate withdrawal of free movement (catatonia).

Cognitive Symptoms

Neurobiological and behavioral traits of the schizophrenia spectrum underlie cognitive symptoms.

When the brain's biology dysregulates cognitive processes, standard cognitive (or thought) processes collide.

As a result of the collision, dysfunction in cognition may occur and affect the observable behavior of people living on the schizophrenia spectrum (and in how they communicate).

A few of the cognitive symptoms people on the schizophrenia spectrum deal with include:

Social Cognition

Discerning social cues, identifying facial expressions, following changes in vocal qualities, and processing how thoughts between people relate are a few symptoms of social cognition difficulties in the schizophrenia spectrum.

Attention and Vigilance

Attention and vigilance in cognition rely largely on how well-rested a person is. But people living on the schizophrenia spectrum often experience sleep deprivation, drowsiness, and sedation from medications.

As a result, day-to-day life can vary in the ability to sustain attention and overcome obstacles that would require greater focus to surpass.

Executive Function

The ability to switch between tasks or ideas, applying strategies to solve problems, and directing actions to achieve goals are among the areas of executive function that schizophrenia spectrum disorder affects.

As a result, people living on the schizophrenia spectrum often face a higher degree of effort to perform in school, advance in employment, or maintain relationships (and how perception and time constraints align with executive function processes).

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.

Hallucinations, delusions, and cognitive symptoms are common without treatment. And disorganized thinking and behavior largely affect cognition or smooth, regular patterns of thought.

People who live with schizophrenia may appear to talk to someone who is not there or be fixed in stillness.

Schizoaffective Disorder

This disorder features the symptoms of schizophrenia in addition to one of two types of mood disorder.

Those living with schizoaffective disorder can experience deep depression (depressive type) or depression with manic episodes (bipolar type).

Differentiating schizoaffective disorder from mood disorders alone (or in addition to schizophrenia) is difficult, as the symptoms of schizophrenia must overlap proportionally to mood symptoms in a characteristic way.

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 schizophrenia spectrum.

Schizotypal Personality Disorder

This disorder features delusions with different distinct themes.

The themes may include a romantic fixation or belief that they are greatly important. For example, someone may think that a celebrity is in love with them or that they're the sole person who can prevent a global disaster through extraordinary means.

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 for each type (more rigidly applied).

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

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

The "undifferentiated subtype" focused on a mix of symptoms that did not fit neatly into any one type.

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

As patients remained in treatment, treatment became more precise, and diagnoses could change as more information was gathered from patients about their symptoms (or the evolution of symptoms related to recovery).

Aging affects the condition, as prolonged adherence or non-adherence to medication and treatment can either improve or worsen outcomes and symptoms over time.

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

Challenges in the Diagnosis of Schizophrenia Spectrum Disorders

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, at times, so people with depression and schizophrenia can lack a feeling of full emotions (or expressions of them).

Ordinary teenage behaviors can look like the symptoms of schizophrenia as a natural part of growing up, such as withdrawing from friends and family at times, occasional insomnia, or feeling a lack of motivation.

It can be difficult to pinpoint anything out of the ordinary until symptoms are observed and diagnostic criteria are met.

Schizophrenia spectrum disorders typically develop from late adolescence to early adulthood, and additional stressors or behaviors that prohibit diagnosis (such as the loss of a loved one) may occur.

Many young people first experiment with drugs in adolescence or early adulthood, so pinpointing a diagnosis becomes difficult here, as well.

The use of drugs must be absent to see if the symptoms of schizophrenia have genuinely surfaced, as they prohibit diagnosis.

Psychiatry has also uncovered a relationship between other disorders that develop around the same age or share certain traits with schizophrenia.

Obsessive-compulsive disorder and schizophrenia spectrum disorders both include a degree of obsessiveness and anxiety.

Major depressive disorder and the schizophrenia spectrum share the traits of lessened emotional expression and content, as noted, but major depressive disorder can cause hallucinations in some cases.

The above is a quick view of how schizophrenia relates to other disorders not in the schizophrenia spectrum. Complications continue to emerge as more is studied and learned about mental disorders.

Advancements in Treatment for People on the Schizophrenia Spectrum

“Precision psychiatry” is a developing concept in mental healthcare. It focuses on the biological and environmental uniqueness of individual patients to apply strategies for prevention and recovery (projected to lead to better outcomes).

The proposed precision uses biological and behavioral data as measurements for appropriate medical practice.

Genetic testing is thought to identify optimal medication, as biological traits can affect a patient's likelihood of metabolizing or responding favorably to the specific drug.

Some practitioners no longer rely solely on patient self-reporting to clearly understand symptoms and prescribe the best care regimen. Instead, biodata helps reduce guesswork and improve the efficiency of delivering medications and therapies earlier.

Research is still in development for a theory-based, biological-data-driven approach to treatment that guarantees better recovery outcomes; however.

Taking a Longer 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 as a model of identifying and understanding the disorder.

Despite some controversy, the schizophrenia spectrum provides clarity on the set of disorders within it. And while competing opinions exist, psychiatry's and medicine's grasp of the spectrum continues to refine ways to identify schizophrenia earlier and the risk factors related to it.

*Disclaimer: This content has not been reviewed by a medical professional. It is intended solely for informational, illustrative, and expressive purposes only. Nothing in any of the content on the site 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.