Abnormal Psychology

Schizophrenia and Other Psychotic Disorders 521

These symptoms are distinguished by their extreme quality. From time to time, we all

have hallucinations, such as thinking we hear the doorbell ring when it didn’t. But the

hallucinations experienced by people with schizophrenia are intrusive—they may be

voices that talk constantly or scream at the patient. Similarly, a delusion of someone

with schizophrenia isn’t an isolated, one-time false belief (e.g., “My roommate took my

sweater and that’s why it’s missing”). With schizophrenia and other psychotic disorders,

the delusions are extensive, although they often focus on one topic (e.g., “My roommate

is out to get me, and the fact that she has taken my sweater is just one more example”).

The positive symptoms of disorganized speech and disorganized behavior are

apparent from watching or talking to an individual who has them—it’s diffi cult,

if not impossible, to understand what’s being said, and the individual’s behavior

is clearly odd (wearing a coat during a heat wave, for example). Let’s examine the

four positive symptoms in more detail.

Hallucinations

As discussed in Chapter 1, hallucinationsare sensations so vivid that the perceived

objects or events seem real eventhough they are not. Any of the fi ve senses can be

involved in a hallucination,although auditory hallucinations—specifically, hear-

ing voices—are the most common type experienced by people with schizophrenia.

Pamela Spiro Wagner describes one of her experiences with auditory hallucinations:

[The voices] have returned with a vengeance, bringing hell to my nights and days.

With scathing criticism and a constant scornful commentary on everything I do, they

sometimes order me to do things I shouldn’t. So far, I’ve stopped myself, but I might

not always be able to....

(Wagner & Spiro, 2005, p. 2)

Research that investigates possible underlying causes of auditory hallucinations

fi nds that people with schizophrenia, and to a lesser extent their unaffected siblings,

have diffi culty distinguishing between verbal information that is internally generated

Table 12.1 • DSM-IV-TR Diagnostic Criteria for Schizophrenia

A. Characteristic symptoms: Two (or more) of the following, each present for a signifi cant portion

of time during a 1-month period (or less if successfully treated):

(1) delusions

(2) hallucinations

(3) disorganized speech

(4) grossly disorganized or catatonic behavior

(5) negative symptoms, i.e., affective fl attening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a

voice keeping up a running commentary on the person’s behavior or thoughts or two or more voices

conversing with each other.

B. Social/occupational dysfunction: For a signifi cant portion of the time since the onset of the

disturbance, one or more major areas of functioning, such as work, interpersonal relations,

or self-care, are markedly below the level achieved prior to the onset (or when the onset is

in childhood or adolescence, failure to achieve expected level of interpersonal, academic,

or occupational achievement).

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month

period must include at least 1 month of symptoms (or less if successfully treated) that meet Crite-

rion 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 two or more symptoms listed in Criterion A present in an attenuated

form (e.g., odd beliefs, unusual perceptual experiences).

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision,

Fourth Edition, (Copyright 2000) American Psychiatric Association.

Although DSM-IV-TR divides symptoms of schizophrenia into two categories (positive and negative),

current research suggests that the symptoms fall into three clusters, or dimensions: positive, in green

(A1 and A2), disorganized, in orange (A3 and A4), and negative, in blue (A5).

Hallucinations

Sensations that are so vivid that the

perceived objects or events seem real, even

though they are not.

delusions

hallucinations

disorganized speech

grossly disorganized or catatonic behavior

negative symptoms, i.e., affective fl attening, alogia, or avolition