If you didn’t know that schizophrenia is classified as a spectrum disorder, you’re not alone. I didn’t know this until a couple of years ago, and I’ve been around people with psychosis illnesses my entire life.
Even after I found out, I wasn’t sure what exactly it meant for a disorder to be classified as being on a spectrum. Even though the reclassification of schizophrenia took place when the DSM-V was released in 2013, there doesn’t seem to be much discussion about this topic, at least through the lens of my own experience in talking to doctors, reading available literature, and attending support groups.
Instead, schizophrenia seemed to be viewed as an ‘all-or-nothing’ disorder– meaning someone either had it or they didn’t. But I’ve learned that the shift to understanding schizophrenia as part of a broader spectrum may benefit our loved ones in several ways.
Schizophrenia: The Old Classification
In the DSM-IV, published in 1994, schizophrenia was categorized into five subtypes: paranoid, disorganized, catatonic, undifferentiated, and residual. Each subtype had specific sets of symptoms and diagnostic criteria.
This classification was straightforward but problematic. It did not account for the wide variety of experiences people with schizophrenia could have. Symptoms often overlapped between subtypes, and the severity of symptoms could vary greatly from person to person. This rigid classification often led to misdiagnosis and ineffective treatment plans.
The Shift: Recognizing the Spectrum
Over time, researchers and clinicians noticed that schizophrenia did not fit neatly into these five boxes. Symptoms varied widely among individuals, the onset and course of the illness differed, and there was significant overlap with other mental health disorders. These observations led to a pivotal realization: schizophrenia might be better understood as a spectrum disorder.
The Change: DSM-5 and Schizophrenia Spectrum Disorder
In 2013, the DSM-5 was published. Here’s what changed:
- Elimination of Subtypes: The five subtypes were removed because they were found to be unreliable and inconsistent over time.
- Spectrum Concept: Schizophrenia was reconceptualized as part of a spectrum that includes a range of psychotic disorders, acknowledging the diversity in symptoms and severity.
- Dimensional Assessments: The DSM-5 emphasizes assessing the severity and frequency of symptoms across several domains, such as delusions, hallucinations, disorganized thinking, abnormal motor behavior, and negative symptoms (like lack of motivation).
What Does “Spectrum Disorder” Mean?
When we say schizophrenia is a spectrum disorder, we mean that it includes a range of symptoms and experiences that can vary in type and severity from person to person. Think of it like a rainbow:
- Wide Range of Symptoms: Just as a rainbow has many colors, schizophrenia has a wide range of symptoms. One person might see or hear things that aren’t there (hallucinations), while another might have trouble organizing their thoughts (disorganized thinking).
- Different Levels of Intensity: Just as colors can be bright or faint, symptoms of schizophrenia can be mild, moderate, or severe.
- Individual Experiences: No two rainbows are exactly the same, and no two people with schizophrenia have exactly the same experience.
Benefits of the Spectrum Approach
Understanding schizophrenia as a spectrum may mean more effective treatment for our loved ones.
- Personalized Treatment: Doctors can tailor treatments to the individual’s specific symptoms and needs, rather than using a one-size-fits-all approach.
- Better Understanding: It helps reduce stigma by acknowledging that schizophrenia is a complex and varied condition, instead of the frightening and stigmatizing label it once was.
- Holistic Care: It encourages a more comprehensive approach to care, considering the person’s overall mental health and related conditions.
Conflicts and Debates
Not everybody was happy about the reclassification. Some clinicians worried that removing the subtypes would muddy the waters and make it harder to communicate about schizophrenia.
To add a personal perspective, in the years and multiple hospitalizations since my daughter’s onset a schizoaffective disorder, doctors rarely communicated much information about her illness. In fact, very little of what I know about schizophrenia has come from talking to doctors.
Without placing blame, and acknowledging the desperate inadequacy of behavioral health resources, I firmly believe this must change. It makes no sense to send someone with schizophrenia home from the hospital, without providing guidance and information to those who will be caring for them.
Other people worried that the reclassification would have a negative impact on studies and treatment protocols. As a lay person who tries to stay updated on recent research, I have observed that there seems to be a new emphasis on peer-focused research and social, functional, and community aspects of schizophrenia in recent years. In my opinion, that’s a good thing. Ideally, we will continue to fund research on all aspects of this perplexing disorder.
What This Means For Your Loved One
These days when a doctor diagnoses schizophrenia, they should consider where a person might fall on a spectrum of experience that includes their unique combination of symptoms and how severe they are, and how these symptoms impact their daily life, work, and relationships. Clinicians should also be considering and identifying any other physical and mental health issues that might be present, including substance used disorders and addiction.
The resulting reatment plan should address the unique, specific challenges and needs of each individual. While this still generally includes medication, there should be a greater emphasis on therapy and support services to teach coping skills and address related issues like anxiety or depression. We are beginning to see other services offered too, like social and job skills training, family education, and peer support programs.
To sum it all up, viewing schizophrenia as a spectrum disorder has paved the way for a more nuanced and personalized approach to care. If universally implemented, this can benefit our loved ones and foster empathy.