Understanding The Schizophrenia DSM-5 Criteria

Schizophrenia is a complex psychiatric disorder characterized by a wide range of often-disruptive symptoms. The official criteria for diagnosing schizophrenia are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This article covers the DSM-5 criteria for diagnosing schizophrenia and explores its usefulness in understanding the disorder. 

Schizophrenia symptoms can be challenging

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What do the schizophrenia DSM-5 criteria mean?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the official handbook healthcare professionals use to define and diagnose mental health disorders. While the DSM was established in the United States, it is referenced worldwide. Along with detailed descriptions of mental health disorders, symptoms, and other diagnostic criteria, the DSM provides a common language for ease of communication between patients and providers.

Additionally, the DSM-5 establishes consistent diagnoses that can be used in research on mental disorders. This consistency aids in the development of medications and other methods of treatment. As mental health disorders are being continuously researched, the DSM is continuously updated. Since the DSM-5 was published in 2013, the DSM-5-TR is a text revision that includes fully revised text, new references, clarifications to diagnostic criteria, and updates to medical codes. 

Along with schizophrenia, the DSM-5 includes outlines and information on conditions and symptoms like depressive disorders, bipolar disorder, schizoaffective disorder, and psychotic disorders. To learn more about the DSM-5, the American Psychiatric Association offers resources for clients and clinicians on its official website. 

Understanding schizophrenia as a psychiatric disorder

Schizophrenia is a psychiatric disorder that significantly impacts physical and mental health. This disorder disturbs the standard functioning of the brain, affecting cognition, memory, sensory perceptions, and behaviors. Schizophrenia can severely disrupt an individual's ability to function in everyday life and can lead to risky behavior, as well as challenges in organizing thoughts.

Individuals with schizophrenia may not recognize their symptoms, but those around them might. The five primary symptoms of schizophrenia are as follows:

1. Delusions: False beliefs persist despite evidence to the contrary. For instance, you may believe that someone is controlling your thoughts, words, or actions.
2. Hallucinations: Hallucinations cause sensory perceptions of seeing, hearing, smelling, touching, or tasting stimuli that do not exist, such as auditory hallucinations like hearing voices.
3. Disorganized or incoherent speech: Disorganized speech involves difficulty organizing thoughts while speaking, resulting in trouble staying on topic or expressing ideas clearly.
4. Disorganized or unusual movements: Behaviors that deviate from expected norms, such as frequent random movements or a lack of movement altogether, may characterize disorganized movements. 
5. Negative symptoms: These symptoms involve a decrease or loss of expected behaviors, including reduced facial expressions, disorganized or catatonic behavior, flat or emotionless speech, and diminished motivation, particularly in socializing or engaging in enjoyable activities.

Negative symptoms of schizophrenia

As a result of these symptoms, individuals with schizophrenia may:

• Experience suspicion, paranoia, or fear
• Neglect personal hygiene and appearance
• Experience symptoms of depression and anxiety
• Experience suicidal thoughts
• Turn to substances like alcohol, nicotine, prescription medications, or recreational drugs in attempts to alleviate symptoms

Schizophrenia has two main phases: active and residual periods. During the active phase, symptoms like hearing voices, having unusual thoughts, or seeing what is not present can be intense and challenging.

The residual phase comes after the active phase. The symptoms might not be as severe in this phase but can still linger. People in this phase may continue to experience some effects of schizophrenia, like difficulty thinking clearly or being less motivated than usual.

What are the official criteria for schizophrenia? 

The schizophrenia DSM-5 criteria are as follows.

Primary symptoms under the schizophrenia DSM-5 criteria 

Two (or more) of the following symptoms must be present for a significant portion of time during a one-month period (or less if successfully treated). At least one of these must be delusions, hallucinations, or disorganized speech:

• Delusions
• Hallucinations
• Disorganized speech (e.g., frequent derailment or incoherence)
• Grossly disorganized or catatonic behavior
• Negative symptoms (i.e., diminished emotional expression or avolition)

Functional impairments 

For a significant portion of the time since the onset of the disturbance, one’s level of functioning in one or more significant areas, such as work, interpersonal relations, or self-care, must have been markedly below the level achieved before the onset. When the onset is in childhood or adolescence, one must experience difficulty achieving the expected level of interpersonal, academic, or occupational functioning.

Persistence 

Continuous signs of the disturbance must persist for at least six months. This six-month period must include at least one month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Lack of other mental illness or psychotic disorders like schizoaffective disorder

Schizoaffective disorder and depressive or bipolar disorder with psychotic features must be ruled out because either no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or, if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

The disturbance is not attributable to the physiological effects of a substance (e.g., a misused drug, a medication) or another medical condition. (Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.)

If there is a history of autism spectrum disorder (ASD) or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least one month (or less if successfully treated).

Specifications 

The diagnostic professional must specify if the following course specifiers are only to be used after a one-year duration of the disorder and are not in contradiction to the diagnostic course criteria:

• First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a period in which the symptom criteria are fulfilled.
• First episode, currently in partial remission: Partial remission is a period during which improvement after a previous episode is maintained and in which the disorder's defining criteria are only partially fulfilled.
• First episode, currently in full remission: Full remission is a period after a previous episode during which no disorder-specific symptoms are present.
• Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (i.e., after a first episode, a remission, and a minimum of one relapse).
• Multiple episodes, currently in partial remission: Symptoms are in partial remission after multiple episodes. 
• Multiple episodes, currently in full remission: Symptoms are in complete remission after multiple episodes. 
• Continuous: Symptoms fulfilling the disorder's diagnostic symptom criteria remain for most of the illness course, with subthreshold symptom periods being very brief relative to the overall course.

Catatonia 

A diagnostic professional may also specify if the condition is present with catatonia. They can refer to the criteria for catatonia associated with another mental disorder, pp. 119–120, for definition. As a coding note, providers must use additional code 293.89 (F06.1) for catatonia associated with schizophrenia to indicate the presence of comorbid catatonia.

Severity of positive and negative symptoms 

Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last seven days) on a five-point scale ranging from zero (not present) to four (present and severe). See Clinician-Rated Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.” Diagnosis of schizophrenia can be made without using this severity specifier.

See a mental health professional

Schizophrenia is a complex disorder. While the DSM-5 provides detailed information on the condition, these criteria should be explored with the help of a qualified medical or mental health professional.

Benefits of therapy

There are several treatment options available for schizophrenia that aim to manage symptoms and improve quality of life. Medications, such as antipsychotics, are often prescribed to manage psychotic symptoms like hallucinations, delusions, and other symptoms. 

Therapy, including cognitive-behavioral therapy (CBT), can help individuals understand and cope with their symptoms and address underlying issues. Supportive therapies like family or group therapy can provide valuable information and support networks. 

Schizophrenia symptoms can be challenging

Get help from a licensed professional

In recent years, online therapy through platforms like BetterHelp has emerged as a convenient and flexible resource for individuals facing mental health challenges. While the effectiveness of online therapy for treating schizophrenia requires more research, virtual therapy offers the opportunity to reach support remotely, which can be especially helpful for those who may have difficulty attending in-person appointments. In addition, clients can choose between phone, video, or live chat sessions, giving them control over how they receive support.

Some initial studies have found that internet-based therapy may be beneficial for those experiencing first-episode psychosis. A recent study found that online therapy reduced symptoms in those experiencing first-episode psychosis, with results similar to studies on face-to-face treatment.