By Dr. Nicole Siegfried, PhD, CEDS — Chief Clinical Officer, Lightfully Behavioral Health

Dr. Nicole Siegfried is a licensed clinical psychologist with over 20 years of experience in behavioral health. She specializes in complex mental health conditions, including psychotic and mood disorders.

When you or a loved one receives a diagnosis of schizophrenia, it’s natural to have many questions. You may have heard terms like “paranoid” or “catatonic” and wondered how they apply to your specific situation. Schizophrenia is a complex, long-term mental health condition that affects how a person thinks, feels and behaves. It’s often characterized by what clinicians call “psychosis,” which is a break from reality that can include seeing or hearing things that others do not.

In the past, schizophrenia was divided into several distinct types. However, as our understanding of the brain has grown, the way we diagnose this condition has changed. Instead of focusing on strict categories, clinicians look at patterns of symptoms and how they show up over time.

This guide will help explain how schizophrenia is understood today, along with the older subtypes you may still see referenced.

What is schizophrenia?

Dr. Siegfried — Schizophrenia is a serious mental health condition that affects how a person thinks, feels and experiences reality. It is considered a psychotic disorder. Psychosis is a medical term that describes experiences where a person has difficulty distinguishing what is real from what is not.

Some people may experience:

• Hallucinations (seeing or hearing things others do not)
• Delusions (strong beliefs that may not match reality)
• Disorganized thinking or speech
• Reduced emotional expression or motivation

Schizophrenia is a diagnosable mental health condition and affects about 1% of the population worldwide. Occasional stress, unusual thoughts or mood changes alone don’t mean someone has schizophrenia. A full clinical evaluation is required for diagnosis. 

What are the different types of schizophrenia?

Dr. Siegfried — In previous versions of the Diagnostic and Statistical Manual of Mental Disorders (the DSM), schizophrenia was categorized into five subtypes. Today, these subtypes are no longer used as official diagnoses. However, you may still see the older subtype terms used in educational resources, so it can be helpful to understand them.

The historical subtypes included:

• Paranoid schizophrenia

This type was associated with:

• Strong delusions, often involving fear or suspicion
• Auditory hallucinations (hearing voices)
• People with these symptoms may have relatively organized thinking in other areas.

• Disorganized schizophrenia

This type was associated with:

• Disorganized speech or behavior
• Difficulty organizing thoughts
• Reduced emotional expression
• Daily functioning may be more affected in this presentation.

• Catatonic schizophrenia

Catatonia refers to changes in movement and responsiveness.

Symptoms may include:

• Limited movement or lack of response
• Unusual or repetitive movements
• Difficulty speaking

Although less common, these symptoms are still recognized today as part of schizophrenia or other conditions.

• Undifferentiated schizophrenia

This category was used when symptoms did not clearly fit into one subtype but still met criteria for schizophrenia.

• Residual schizophrenia

This referred to a phase where major symptoms were less intense, but some ongoing symptoms remained, such as:

• Low motivation
• Reduced emotional expression

Today, clinicians focus on symptom patterns and severity instead of fixed categories.

Why are subtypes no longer used?

Dr. Siegfried — Mental health professionals moved away from strict subtypes because:

• Symptoms often overlap between categories
• People’s experiences can change over time
• Subtypes did not always help guide treatment decisions

Instead, clinicians now use a more flexible, individualized approach that focuses on symptom patterns.

How is schizophrenia described today?

Dr. Siegfried — Today, clinicians view schizophrenia as a single diagnosis that exists on a spectrum. Instead of picking a subtype, clinicians now describe schizophrenia based on:

• Symptom types
• Severity
• Functional impact
• Co-occurring conditions

This approach allows for more personalized and flexible treatment planning.

What symptoms are used to understand schizophrenia today?

Dr. Siegfried — Today, schizophrenia is often understood in terms of symptom groups. Clinicians often categorize symptoms as either positive or negative. These terms don’t mean good or bad. Instead, they refer to whether a behavior is an addition to a person’s experience or a loss of normal functioning.

• Positive symptoms

These are symptoms that add experiences beyond typical functioning.

Examples include:

• Hallucinations — Perceiving things others don’t, such as hearing voices when no one is speaking. 
• Delusions — Firmly held beliefs that are not changed by evidence, such as believing one has special powers or is being watched.
• Disorganized thinking or speech — Thoughts or speech that may be hard for others to follow.

• Negative symptoms

These involve a reduction in typical behaviors or emotional expression.

Examples include:

• Avolition — A significant decrease in the motivation to initiate or complete tasks.
• Anhedonia — A reduced ability to feel pleasure in daily life.
• Social withdrawal — Difficulty interacting with others or a desire to be alone.

• Cognitive symptoms

These affect thinking and memory.

Examples include:

• Difficulty concentrating — Finding it hard to maintain focus on a single task or follow a conversation.
• Trouble organizing thoughts — Challenges with logical thinking or connecting ideas in a way that makes sense to others.
• Challenges with decision-making — A struggle to process information to make choices or plan for the future.

Not everyone experiences all symptoms. Understanding these symptom groups helps clinicians create more personalized treatment plans. For example, certain medications may be more effective for positive symptoms, while specialized therapies often focus on managing negative and cognitive challenges.

What causes schizophrenia?

Dr. Siegfried — There is no single known cause. Schizophrenia is associated with a combination of factors, including:

• Genetic vulnerability
• Brain chemistry and structure differences
• Early life stress or trauma
• Environmental stressors

Having risk factors does not mean someone will develop schizophrenia.

How is schizophrenia treated?

Dr. Siegfried — Schizophrenia is a treatable condition, and many people benefit from a combination of approaches.

Treatment may include:

• Medication to reduce psychotic symptoms
• Psychotherapy to build coping skills
• Social and life skills support
• Family education and support
• Structured levels of care when needed

Treatment plans are personalized and may change over time.

When should someone seek help?

Dr. Siegfried — If someone experiences hallucinations, delusions or major changes in thinking or behavior, professional support may be helpful. Early support is often associated with improved long-term outcomes.

If safety concerns arise, immediate support is important. You can call or text the 988 Suicide & Crisis Lifeline at any time in the United States. These services are free, confidential and available 24/7.

Find personalized support at Lightfully Behavioral Health

At Lightfully, we understand that living with schizophrenia or a related condition requires a unique and compassionate approach. We utilize a whole-person-centered care model, which means we look at you as a complete individual, considering your physical health, your social connections and your personal goals alongside your clinical symptoms.

We provide personalized treatment that is evidence-aligned and focused on your specific needs. Our variety of levels of care allows us to offer the right amount of support as your needs change. Our mission is empowering people to live more stable, connected lives through expert clinical guidance and a kind, supportive community.

Change is possible. When you’re ready to take the first step, contact us. We’ll take the next steps together, toward the fullest, brightest version of you.

Frequently Asked Questions

Are there still five types of schizophrenia?

While the five subtypes (paranoid, disorganized, catatonic, undifferentiated and residual) were used in the past, they are no longer used as official diagnostic categories in the current DSM-5.

What is the most common symptom of schizophrenia?

Many people experience hallucinations, particularly auditory ones (hearing voices), though the specific combination of symptoms varies significantly from person to person.

Is catatonia always a part of schizophrenia?

No. Catatonia, which involves unusual movements or a lack of movement, can be a symptom of schizophrenia, but it is also associated with other medical and mental health conditions.

Can schizophrenia be cured?

Currently, there is no known cure for schizophrenia, as it is a chronic condition. However, symptoms can often be managed effectively with long-term clinical care.

Does schizophrenia involve a split personality?

No. This is a common myth. Schizophrenia involves a split from reality (psychosis), whereas split personality refers to a completely different condition called dissociative identity disorder.

What causes schizophrenia?

The exact cause is not fully understood, but it is believed to be a combination of genetic factors, brain chemistry and environmental triggers.

At what age does schizophrenia usually start?

Symptoms often first appear in the late teens to early 20s for men and the late 20s to early 30s for women.

Is medication always required for schizophrenia?

Medication is a foundational part of treatment for most people with schizophrenia to help manage psychosis symptoms, though it is usually most effective when combined with therapy.

What should I do if a loved one refuses treatment?

This is a difficult situation. It may be helpful to consult with a mental health professional about assisted outpatient treatment or how to use empathetic communication to encourage care.

Can stress trigger a relapse of symptoms?

Yes, high levels of stress are often associated with an increase in symptoms. Learning distress tolerance and stress-management skills is a core part of long-term wellness.