Disorganized Schizophrenic

Disorganized schizophrenia is one of the subtypes of this complex and chronic psychiatric disorder. It is sometimes referred to as hebephrenic schizophrenia. The primary symptoms include problems with thought processes and speech, behavior, and emotional expression and response.

Characteristics and Symptoms

There are three prominent symptoms which are characteristic of disorganized schizophrenia:

  • Disorganized speech
  • Disorganized behavior
  • Flat or inappropriate affect (emotional expression and response)

Disorganized speech may involve several different things. The person may slip from one topic to the next, even in midsentence. When answering a question, the response may be only vaguely relevant, or it may have nothing to do with the question at all. If the person’s speech is severely disorganized, it may sound like nonsense – gibberish. In clinical terms this is often referred to as “word salad”. S/he may make up words, which are called “neologisms”.

Disorganized speech is a result of abnormal or illogical thought processes. The person has a difficult time organizing his/her thoughts and it shows up in his/her speech. Sometimes people with disorganized schizophrenia exhibit what is referred to as “thought blocking”. When this occurs, the person may suddenly stop right in the middle of a sentence – as if the thought abruptly disappeared midstream.

Disorganized behavior often involves the inability or motivation to initiate a goal-oriented task, or to complete the task once it is started. In more severe cases, the disorganized schizophrenic is unable to do very basic things, like fix a meal, or take a shower. S/he may dress bizarrely, such as wearing multiple layers of clothing on a hot summer day, or engage in inappropriate or bizarre behavior. It is not unusual for someone with this type of schizophrenia to neglect personal hygiene and have a very unkempt appearance.

Flat affect means the person shows or expresses very little or no emotions at all. S/he often has a blank look on his/her face. His/her speech may be a monotone. Inappropriate affect is exhibited when they show emotion which is out of context. They may be talking about something and suddenly laugh or act silly for no apparent reason.

Additional Diagnostic Criteria

In order to meet the diagnosis of schizophrenia, regardless of the type, these other criteria must also be met:

  • A marked decline in functioning, after the onset of symptoms, in at least one of the primary aspects of the person’s life (e.g., work, school, relationships, self-care).
  • Signs of the disorder are present continuously for a period of at least 6 months. For at least one month of that time period (less if they subside due to effective treatment), the active-phase symptoms (e.g. delusions, hallucinations, extremely disorganized behavior, etc.) must be present.
  • Schizoaffective disorder (a disorder similar to schizophrenia but with prominent mood episodes) or other mood disorder have been ruled out.

Other Characteristics

Individuals who present with disorganized schizophrenia may also exhibit other odd or unusual characteristics, such as grimacing, standing or sitting with an odd type of posture, withdrawing socially, and moving about in a clumsy manner. S/he may experience delusions or hallucinations, but they are not prominent. They also often have a difficult time with their school or work performance. Individuals with disorganized schizophrenia are often unable to live independently.

written by Dr. Cheryl Lane, PsyD