Hebephrenia (disorganized schizophrenia): symptoms and causes

Although the diagnostic manual of disorders DSM-5 eliminated the differentiation between the different types of schizophrenia, a large number of Professionals continue to find this subsection 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 distinguished from other forms of schizophrenia by the predominance of symptoms of disorganization and psychological deficits over and above hallucinations and delusions.

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Hebephrenia or disorganized schizophrenia

Hebephrenia, also known as "disorganized schizophrenia," is one of the types of schizophrenia which are described in the DSM-IV and ICD-10 manuals. Is about aextreme 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 "dementia praecox," 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 the hallucinations and the delusions, among the negative symptoms we find cognitive, behavioral and emotional deficits of different types.

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

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Characteristic symptoms and 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 the ages of 15 and 25 through the progressive development of negative symptoms. This characteristic was considered the key aspect in hebephrenia for a long time; in fact, the word “hebeos” means “young boy” in Greek.

2. disorganized conduct

When we talk about schizophrenia, the concept "disorganized behavior" can refer to alterations in motivation to starting or completing tasks or 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 cognitive processes. Among the typical linguistic signs of hebephrenia we can find sudden blocks when speaking or spontaneous changes of subject, which are known as "flight of ideas".

4. emotional disturbances

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

It is also noteworthy the manifestation of emotional and facial expressions inappropriate to the context. For example, a hebephrenic patient may laugh and make grimaces similar to 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 event that hallucinations and delusions are present, they are less significant than the symptoms of disorganization, lack of interest in social interaction or emotional flattening.

It is important to bear in mind that negative symptoms respond to medication to a lesser extent than positive ones; in fact, many antipsychotics, especially the first-generation ones, cause 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

The DSM-IV describes four subtypes of schizophrenia in addition to disorganized: paranoid, catatonic, undifferentiated, and residual. However, in the DSM-5 the distinction between different types of schizophrenia was eliminated because it was not considered very useful. The ICD-10, for its part, adds postpsychotic 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 catatonic schizophrenia, behavioral symptoms predominate; Specifically, people with this subtype of schizophrenia show great physical agitation or tend to remain still; in the latter case, it is common for a state of stupor to occur and the phenomenon called “waxy flexibility” can be detected.

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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 more intense.

5. Simple

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

6. postpsychotic depression

Many people with schizophrenia experience depression in the period following a psychotic episode. This diagnosis is usually used when the emotional disturbances are clinically significant and can be attributed to the negative symptoms of schizophrenia.