Understanding the DSM-5 Criteria for Schizophrenia

Schizophrenia is a distressing mental health condition that causes the affected individual to lose touch with reality during active phases. This means at times, those with the disease struggle to differentiate between what is real and what is not. As a result, they cannot recognize their symptoms because their false beliefs appear true to them.

Symptoms of schizophrenia affect a person’s thoughts and senses, perceptions of reality, emotions, and behavior. For example, a person with schizophrenia might believe their family wants to kill them, which could lead to a state of shock and adrenaline. This is incredibly disturbing for both the affected and their loved ones^[1][2].

Fortunately, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) provides a clear set of criteria for diagnosing mental health disorders, including schizophrenia. This helps professionals agree on one diagnosis despite overlapping symptoms that could also be found in other similar conditions. After diagnosis, a treatment plan can be developed.

What is Schizophrenia?

Schizophrenia is a lifelong brain disorder found in approximately 0.3 to 0.7 percent of the American population. The disease is typically diagnosed between the mid-teens and age 30 after psychotic symptoms emerge for the first time. A psychotic episode is when a person completely loses touch with reality and experiences delusions, hallucinations, or both^[1][2].

Usually, affected people assigned male at birth have their first psychotic break between the late teens and mid-20s, while those assigned female at birth could be affected slightly later. As many as 15 to 20 percent of schizophrenia cases develop after the age of 44 years, which is thought of as a late onset. Unfortunately, co-occurring health conditions often lead to people who have schizophrenia dying young^[1][3][4].

There are both active and residual phases of schizophrenia. During an active phase, delusions, hallucinations, or disorganized speech are usually present, significantly affecting a person’s ability to function. In contrast, the residual (inactive) phase occurs when these symptoms reduce in severity, though some milder issues, like reduced motivation or emotional flatness, may persist.

Schizophrenia and Society

Although the term schizophrenia means “split mind,” it does not describe a split personality. Instead, it illustrates how the condition hijacks the brain and interferes with thoughts, senses, memory, and behaviors. While this can cause some with schizophrenia to be violent (perhaps out of perceived self-defense), most people who have schizophrenia are no more dangerous than the general population.^[1]

People with schizophrenia are incredibly vulnerable to becoming victims of crime, especially if their delusions lead them to trust strangers more than their own family. While there are many misconceptions about those with schizophrenia being homeless or institutionalized, many live alone, in group homes, or with their family^[1].

DSM-5 Diagnostic Criteria for Schizophrenia

Schizophrenia can be tricky to diagnose, as there is no specific diagnostic test to use. As a result, healthcare professionals rely on the DSM-5 list of criteria to make accurate diagnoses. Like any medical condition, the severity, frequency, and duration of symptoms can differ from person to person^[1].

To be diagnosed as having schizophrenia, the DSM-5 states an individual must be experiencing hallucinations, delusions, or disordered speech, as well as either disorganized behavior or negative symptoms. Of course, they could be experiencing more than 2 symptoms, but that is the minimum criteria for diagnosis^[5].

These are the 5 key symptoms of schizophrenia that must be causing significant impairment in one or more major areas of functioning, such as work, interpersonal relations, or self-care. To make the diagnosis, symptoms must be present in both active and inactive phases for 6 months, with 1 month of an active phase^[5].

The Five Key Symptoms of Schizophrenia

The DSM-5 criteria for a schizophrenic diagnosis is that a person must have at least 2 of the 5 key symptoms. There needs to be a minimum of 1 active phase symptom for a month and 1 residual phase symptom for 6 months^[5].

Substance use, stress, or medication non-adherence can exacerbate symptoms of schizophrenia. Bear in mind that many people who have schizophrenia will display a combination of these key symptoms, varying from person to person^[5].

Active Phase Symptoms

To be diagnosed as having schizophrenia, an individual must exhibit 1 of the following symptoms for 1 month:

1. Hallucinations

Hearing, seeing, feeling, smelling, or tasting things vividly when they do not exist. Auditory hallucinations (hearing things that aren’t there) are the most common form of hallucinations for people with schizophrenia^[1].

2. Delusions

Delusions are false beliefs that are not based in reality and have no evidence. The most common delusions for people with schizophrenia are persecutory delusions, where it is believed that a person or group wants to harm or harass them^[1].

3. Disordered Speech

Disordered speech can include rambling, where thoughts or speech shift rapidly and lack a clear goal, including repetitive statements. It can also involve made-up or rhyming words with no clear meaning, unrelated answers, incoherent speech, and difficulty following conversations.

Residual Phase Symptoms

In addition to 1 active symptom, there must be 1 residual symptom for 6 months for a diagnosis of schizophrenia. Below are the residual phase symptoms:

4. Disorganized Behavior

Actions that seem random or out of place, like acting unusual, agitated, or repeating movements with no clear purpose. In severe cases, it can make everyday tasks difficult and may include catatonia, where a person seems dazed and unresponsive^[1].

5. Negative Symptoms

People with schizophrenia sometimes lose the ability to express themselves as usual. For instance, a person might stop showing facial expressions, speak in a flat voice, or feel unmotivated, avoiding socializing or activities they usually enjoy.

Functional Impairment

In addition to meeting the criteria for the 5 key symptoms above, to be diagnosed with schizophrenia, a person’s day-to-day life must be significantly impaired. In other words, the disease must affect relationships, work performance, and self-care^[5][6].

Untreated schizophrenia can cause the sufferer to neglect personal hygiene and engage in risky behaviors. The level of daily functioning is measured by comparing current behaviors to how the person behaved before their first psychotic break^[5][6].

Exclusion Criteria

It is essential to seek out a professional diagnosis of the disease to differentiate between the overlapping symptoms in the DSM-5 chapter, Schizophrenia Spectrum and Other Psychotic Disorders Class^[1].

Before diagnosing schizophrenia, a psychiatrist must rule out other possible causes, like substance use, medical conditions, or similar mental health disorders with overlapping symptoms^[1].

Conditions such as schizoaffective disorder, delusional disorder, bipolar disorder with psychotic features and brief psychotic disorder are carefully evaluated to rule out and ensure a correct diagnosis^[1][5].

Changes from DSM-IV to DSM-5

The DSM-5 updated its diagnostic criteria for schizophrenia and other mental health conditions (such as anxiety and OCD) in May 2013. The changes aim to improve diagnosis, treatment, and research to better manage schizophrenic disorders. The previous edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) needed to be updated to remove schizophrenia subtypes^[7].

These subtypes were used to diagnose people by grouping them into different types of schizophrenia according to specific symptoms. The DSM-5 eliminated the subtypes because they didn’t consistently help in diagnosis or treatment, as symptom patterns often changed over time. The DSM-IV included several subtypes, such as^[8]:

• Paranoid Schizophrenia: Characterized mainly by delusions and hallucinations, often with fewer disorganized behaviors.
• Disorganized Schizophrenia: Marked by disorganized speech and behavior, and flat or inappropriate emotions.
• Catatonic Schizophrenia: Involved significant movement issues, including not being able to move and excessive movement.
• Undifferentiated Schizophrenia: Where the symptoms don’t clearly fit into the other subtypes.
• Residual Schizophrenia: When active symptoms have lessened, but some features remain.

The removal of subtypes in the DSM-5 reflects a promising shift in understanding and more accurately diagnosing schizophrenia. By eliminating these subtypes, the DSM-5 focuses on a more personalized approach to diagnosis. Instead of fitting patients into fixed categories, professionals now assess symptoms on a spectrum^[7].

Causes of Schizophrenia

Experts are unsure of what causes the onset of schizophrenia, but certain risk factors are thought to play a role. According to the World Health Organization (WHO), genetics (particularly if a person has an immediate relative with the disorder) increases the chances of schizophrenia^[1][9].

The WHO also states that environmental factors are believed to contribute to a person getting schizophrenia. These include stress experienced by a pregnant mother, birth complications, substance use (especially cannabis, amphetamines, or acid), living in areas with higher social stress, childhood trauma or abuse, social isolation, or a dysfunctional family home^[9].

Another theory for developing schizophrenia is that psychosocial factors affect the onset of the disease. Psychosocial factors can be stressful life events (like losing a loved one or major life changes), high levels of family conflict, experiencing poverty or discrimination or having a lack of social support^[9].

Treatment for Schizophrenia

Although there is currently no cure for schizophrenia, many symptoms of the disease can improve significantly with treatment. Additionally, the risk of an acute phase surfacing again can be greatly reduced. Antipsychotic medications have been shown to reduce psychotic symptoms that occur during an active phase^[1].

Other treatments include psychotherapy, such as cognitive behavioral therapy (CBT), which may help with day-to-day life and minimize symptoms. This includes learning how to extend a recovery period, identify the early signs of a relapse, deal with stress, and engage with others socially^[1].

Rehabilitation has been found to help with career training or studies and building life skills. Supportive job programs help people with schizophrenia become more independent. While results vary, one study found that “treatment can help many people with schizophrenia lead highly productive and rewarding lives^[1].”

Substance abuse can make diagnosing and treating schizophrenia significantly more complicated. People with the condition are generally more likely to have issues with drugs or alcohol than others. If an individual shows signs of addictive-like behavior, they should be treated for both addiction and schizophrenia at the same time^[1].

How to Support Someone with Schizophrenia

Evidence suggests that family support plays a major role in a person with schizophrenia’s well-being. Learning about the disease is essential in helping a loved one with the condition. Another practical way to help is by encouraging them to get treatment and join a support group^[1].

Living with schizophrenia, as well as supporting someone who suffers from the illness, can be emotionally challenging. The Schizophrenia and Psychosis Action Alliance offers both a peer support group for those with schizophrenia and a caregiver support group for people helping a loved one with the condition.

These support groups allow individuals with schizophrenia and their caregivers to share experiences and knowledge, helping each other on the path to recovery. This can reduce feelings of hopelessness, address behavioral challenges, and empower people with the condition to stick with their treatment plan.

Key Takeaways

Schizophrenia is a debilitating mental health condition characterized by a person losing touch with reality for periods of time. There are 5 key symptoms critical to the DSM-5 diagnosis of schizophrenia, with 3 active phase symptoms and 2 residual (inactive) phase symptoms.

The criteria specifies a minimum of 1 active phase symptom for a month and 1 residual phase symptom for 6 months. Active phase symptoms include hallucinations, delusions, or disordered speech, while residual phase symptoms include disorganized behavior or negative symptoms.

While there is no cure for the disease, treatments (such as antipsychotic medications and therapy) can reduce the risk of active phases, as well as improve self-sufficiency. People with schizophrenia can also benefit from peer support groups.