Disorganized Schizophrenia (Hebephrenic Schizophrenia)

Another one of the types of schizophrenia that manifests itself among those suffering with the illness is disorganized schizophrenia, which is also known as hebephrenic schizophrenia.  The difference in the naming convention derives itself from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which uses “disorganized,” versus the International Statistical Classification of Diseases and Related Health Problems (ICD-10), which uses “hebephrenia.”

As previously covered, there are three main types of schizophrenia that are related to a certain cluster of symptoms each.  Paranoid schizophrenia has symptoms related to the distortion of reality, perceptions, and thinking.  Catatonic schizophrenia deals more with psychomotor poverty and excitement.  Disorganized schizophrenia, however, is concerned with behavioral, emotional, and psychological disorganization.

Disorganized Schizophrenia Symptoms

Although the symptoms are many and there are hardly ever any pure diagnoses, the symptoms that gain prominence in this form of schizophrenia are related to thought disorders.  These symptoms often begin showing themselves around the age of puberty.  Due to this age of onset, disorganized schizophrenia has also become known as hebephrenic schizophrenia in reference to the goddess of youth, Hebe, in the Greek mythos.

Because thought disorders are characterized by a disruption in thought, it is not uncommon for hallucinations and delusions to be present in hebephrenia, however they are not the main features of the illness.  The disruption in thought manifests itself more through a difficulty in communication due to schizophasia, or word salad.  This is due to the person’s mind moving from one thread of thought to the next in rapidity with loose associations the outside observer cannot follow logically.  The confusion of emotions and facial affect also arises at inappropriate times, causing others to view the person as deranged, sadistic, depressed, etc.  Due to the often flattened affect and interest in activity, it’s important to rule out catatonic schizophrenia before making the diagnosis of disorganized schizophrenia.

The behavioral disorganization mentioned earlier can cause secondary symptoms to arise such as poor personal hygiene, inappropriate clothing choices, malnutrition, behavioral issues in public, problems in vocation or education, and more.  These are due to anhedonia and avolition, the disinterest in pleasure and a lack of motivation in seeking enjoyment.

Disorganized Schizophrenia Treatment

Unfortuantely, due to the rapidity of symptom development and the early onset of the illness, disorganized schizophrenia and hebephrenic schizophrenia have very poor prognoses.  This is largely due to the negative symptoms that remove a desire and create an inability to engage in psychological therapy.  The lack of social interaction makes it difficult to maintain a social support network as well.  Electroconvulsive therapy has been tested to alleviate the symptoms, but this form of treatment has not proven a consistent effectiveness.  Incoherence, blunted and inappropriate emotions, and a blank or goofy affect interferes with the patient’s ability to report progress or preferences.

The presence of disorganized schizophrenia can require hospitalization, residential treatment, or constant outpatient treatment.  If a family member is available to help, this can greatly reduce the cost of the treatment, however, nobody can be available at all hours by themselves.  Medications are available to help reduce symptomatic expression, however, dosages and consistency in administration must be evaluated several times daily.  Due to the poor prognosis, this is likely to be a lifelong pursuit and will usually result in permanent hospitalization.

Conclusion

Among the several types of schizophrenia, the disorganized type has the poorest prognosis and chance for recovery.  The disorganization in thought and behavior causes the individual to become socially isolated and unable to communicate their needs and desires.  Constant help is required for many disorganized schizophrenics.  You will also find reference in the literature using the name hebephrenic schizophrenia or hebephrenia.