Hebephrenia (disorganized schizophrenia): symptoms and causes

Although the diagnostic manual of DSM-5 disorders eliminated the differentiation between the different types of schizophrenia, a large number of professionals still consider that this subdivision is very informative in that it highlights the main symptoms of each case.

One of the most common types is Disorganized schizophrenia, whose classic name is "hebephrenia" . This early-onset disorder is differentiated from other forms of schizophrenia by the predominance of symptoms of disorganization and psychological deficits over hallucinations and delusions.

• You may be interested: "Paraphrenia: types, symptoms and treatment of this disorder"

Hebephrenia or disorganized schizophrenia

Hebephrenia, also known as "disorganized schizophrenia," is one of the types of schizophrenia described in the DSM-IV and ICD-10 manuals. Is about a extreme manifestation of the so-called "disorganization syndrome" , present to a greater or lesser extent in many cases of schizophrenia.

The German psychiatrist Ewald Hecker made in 1871 the first detailed description of the syndrome that would be called first hebephrenia and later disorganized schizophrenia. Emil Kraepelin included hebephrenia among the subtypes of "early dementia," the concept he used to refer to schizophrenia.

According to the DSM-IV hebephrenia is characterized by the predominance of negative symptoms over positive ones. While the positive symptoms of schizophrenia are mainly hallucinations and delusions, among the negative symptoms we find cognitive, behavioral and emotional deficits of different types .

In the case of ICD-10, the basic characteristics of the disorganized subtype of schizophrenia include early onset of symptoms, behavioral unpredictability, the presence of inappropriate emotional expressions, disinterest in social relationships and motivational deficits.

• Related article: "The 5 differences between psychosis and schizophrenia"

Symptoms and characteristic signs

As we have said, hebephrenia is characterized mainly by the presence of negative symptoms and disorganization of language and behavior. On the other hand, there are also differences with respect to other types of schizophrenia in the age of onset of the disorder.

1. Early presentation

Disorganized schizophrenia it is frequently detected between 15 and 25 years through the progressive development of negative symptoms. This feature was considered the key aspect in hebephrenia for a long time; In fact, the word "hebeos" means "young boy" in Greek.

2. Disorganized behavior

When we speak of schizophrenia, the concept of "disorganized behavior" may refer to alterations in the motivation to initiate or complete tasks or to eccentric and socially inappropriate behaviors, such as wearing strange clothes or masturbating in public.

3. Disorganized language

In schizophrenia, the disorganization of language appears as a manifestation of deeper disorders that affect thinking and to cognitive processes. Among the typical linguistic signs of hebephrenia we can find sudden blockages when speaking or spontaneous subject changes, which are known as "flight of ideas".

4. Emotional alterations

People with hebephrenia show the typical affective flattening in schizophrenia in general, which is also associated with difficulties in feeling pleasure (anhedonia), among other negative emotional symptoms.

It is also remarkable the manifestation of emotional and facial expressions inappropriate to the context . For example, a hebephrenic patient can laugh and grin like smiles during a conversation about the death of a loved one.

5. Predominance of negative symptoms

Unlike paranoid schizophrenia, in the case of hebephrenia the negative symptoms are clearly more marked than the positive ones; this means that, in the case of hallucinations and delusions, they are less significant than the symptoms of disorganization, lack of interest in social interaction or emotional flattening .

It is important to keep in mind that negative symptoms respond to medication to a lesser extent than positive ones; in fact, many antipsychotics, especially those of the first generation, provoke an increase in behavioral and emotional deficits. In addition, people with a predominance of negative symptoms generally have a poorer quality of life.

Other types of schizophrenia

In the DSM-IV four subtypes of schizophrenia are described in addition to the disorganized: paranoid, catatonic, undifferentiated and residual. But nevertheless, in the DSM-5 the distinction between different types of schizophrenia was eliminated because it was considered not very useful. ICD-10, on the other hand, adds post-psychotic depression and simple schizophrenia.

1. Paranoid

Paranoid schizophrenia is diagnosed when the main symptoms are delusions and / or hallucinations , which are usually auditory. It is the type of schizophrenia with the best prognosis.

2. Catatonic

In the catatonic schizophrenia behavioral symptoms predominate; specifically, people with this subtype of schizophrenia show a large physical agitation or they tend to remain motionless ; in the latter case, it is usual for a state of stupor to occur and for the phenomenon known as "waxy flexibility" to be detected.

• Related article: "Catatonia: causes, symptoms and treatment of this syndrome"

3. Undifferentiated

The undifferentiated subtype is diagnosed if symptoms of schizophrenia are detected but the characteristics of the paranoid, disorganized or catatonic subtypes are not met.

4. Residual

Residual schizophrenia is defined as the presence of hallucinations and / or delusions of limited clinical significance after a period in which the symptoms have been most intense.

5. Simple

In people with simple schizophrenia, relevant negative symptoms progressively develop without psychotic episodes (or outbreaks) appear . This subtype is associated with schizoid and schizotypal personality disorders.

6. Postpsychotic depression

Many people with schizophrenia suffer from depression in the period following a psychotic episode. This diagnosis is usually used when emotional disturbances are clinically significant and can be attributed to the Negative symptomatology typical of schizophrenia .