Disorganized schizophrenia was an obsolete subtype of schizophrenia. It is no longer diagnosed as a separate condition in DSM-5 and ICD-11, two diagnostic manuals published in 2013 and 2022, respectively.
Disorganized schizophrenia was classified up to DSM-IV and ICD-10 as a mental and behavioural disorder, because the classification was thought to be an extreme expression of the disorganization syndrome that has been hypothesized to be one aspect of a three-factor model of symptoms in schizophrenia, the other factors being reality distortion (involving delusions and hallucinations) and psychomotor poverty (lack of speech, lack of spontaneous movement and various aspects of blunting of emotion). It is considered to have relatively poor prognosis.
History German psychiatrist Ewald Hecker first proposed the condition in the 1870s under the term hebephrenia,Hecker, E. (2009). Hebephrenia: A Contribution to Clinical Psychiatry. (Translated and introduced by A. Kraam.) History of Psychiatry 20: 87–106. from Greek ἥβη (hḗbē) for adolescence, and -phrenia for mental disorder. The name referred to the ostensibly more prominent appearance of the disorder in teenagers and young adults."The very great majority of cases [of dementia præcox] begin in the second or third decade; 57 per cent, of the cases made use of in the clinical description began before the twenty-fifth year. This great predisposition of youth led Hecker to the name hebephrenia, "insanity of youth," for the group delimited by him; Clouston also, who spoke of an " adolescent insanity," had evidently before everything dementia praecox in view. ... Hecker was even inclined to regard the issue of his hebephrenia just as an arrest of the whole psychic life on the developmental stage of the years of puberty. In fact, we find in silly dementia at least many features which are well known to us from the years of healthy development. Among these there is the tendency to unsuitable reading, the naive occupation of the mind with the "highest problems," the crude "readiness" of judgment, the pleasure in catch words and sounding phrases, also sudden changes of mood, depression and unrestrained merriment, occasional irritability and impulsiveness of action. Further the desultoriness of the train of thought, the half-swaggering, boastful, half-embarrassed, shy behaviour, the foolish laughing, the unsuitable jokes, the affected speech, the sought-out coarseness and the violent witticisms are phenomena which in healthy individuals, as in the patients, indicate that slight inward excitement which usually accompanies the changes of sexual development." From Kraepelin, Emil Dementia praecox and paraphrenia, Chapter IX "Frequency and Causes", Chicago Medical Book. Co., (Text), 1919
Symptoms In DSM-IV, the subtype was characterised by disorganized speech, behaviour, and flat or inappropriate affect, and diagnosed based on symptoms only. Disorganized speech, e.g., word salads, reflects an individual's underlying thought disorder; where an individual with disorganized behaviour may struggle to carry out normal daily activities. Inappropriate affect display is the outward presentation of one's emotions that, given the circumstances under which it is performed, is perceived by social norms to be awkward, offensive or otherwise unacceptable.
The subtype was considered to be one in which these features were more prominent than in other types of schizophrenia, and affected individuals may carry more stigmatization.
See also Catatonia Communication deviance Paranoid schizophrenia
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