Disorganized schizophrenia
Disorganized schizophrenia, or hebephrenia, is an obsolete term for a subtype of schizophrenia. It is no longer recognized as a separate condition, following the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition in 2013, which dropped the concept of subtypes of schizophrenia, and global adoption of the eleventh revision of the International Classification of Diseases in 2022. It was originally proposed by the German psychiatrist Ewald Hecker in the 1870s.
Disorganized schizophrenia was classified up to 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 and psychomotor poverty. It is considered to have relatively poor prognosis.
Presentation
The subtype was named by Hecker as "hebephrenia" after the Greek term for "adolescence" – ἥβη – and possibly the ancient-Greek goddess of youth, Hebe, daughter of Hera. The name referred to the ostensibly more prominent appearance of the disorder in persons between the ages of 15 and 25 years.The prominent characteristics of the subtype were considered to be disorganized behavior and speech, which may include loosened associations and schizophasia, flat or socially inappropriate affect, mannerism, and behaviour. Inappropriateness refers to the quality of an action that, when considering the circumstances under which it is performed, is perceived by social norms to be awkward, offensive or otherwise unacceptable. Examples in disorganized schizophrenia may include grimacing, joking, singing, utterance of profanity, and echolalia; exposing one's body in public spaces, inappropriate body contact, and urination outside socially acceptable areas.
Delusions and hallucinations, seen in paranoid schizophrenia, were not, although fleeting and fragmentary delusions and hallucinations are present. Behavioral disorganization, which may impair a sufferer's ability to carry out daily activities such as showering or eating, was also included.
The emotional responses of sufferers diagnosed with the subtype could seem strange or inappropriate, including inappropriate facial expression or laughter, or contrastingly a complete lack of emotion, including anhedonia, and avolition. The subtype was considered to be one in which these features were more prominent than in other types of schizophrenia.