Schizophrenia DSM-5 Criteria

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What are the DSM-5 Criteria for Schizophrenia?

The DSM-5 criteria for schizophrenia include:[1],[2]

  • Presence of delusions, which are false beliefs that persist despite evidence to the contrary
  • Hallucinations, involving sensory perceptions like hearing voices or seeing things that others do not
  • Disorganized thinking, evident in speech patterns that are disjointed or difficult to follow
  • Grossly disorganized or abnormal motor behavior, including unpredictable movements or unusual postures
  • Negative symptoms, such as reduced emotional expression or withdrawal from social interactions

In order to be diagnosed with schizophrenia, your symptoms must last for at least six months, with active symptoms present for at least one. You must also have at least two listed symptoms, including delusions, hallucinations, or disordered speech, with one symptom being one of the listed symptoms during a significant portion of a one-month period. These symptoms must cause significant distress and impairment, affecting daily activities like work, relationships, and self-care.

In this article, we discuss changes to the former DSM-4 category called Schizophrenia and Other Psychotic Disorders. The DSM-5 has added the word, “spectrum” to the title. The same basic diagnoses are still available in the DSM-5. Some symptom criteria were changed to make the diagnosis more accurate and precise. Additionally, catatonia has been reconceptualized as a separate diagnostic feature that cuts across several broad categories of disorders. The distinction between bizarre and non-bizarre delusions is no longer diagnostically significant.

What is the DSM-5?


The DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is a standardized classification system used by mental health professionals to diagnose and classify mental disorders, including schizophrenia.[1]

It provides criteria for identifying specific symptoms and patterns of behavior associated with schizophrenia, helping clinicians make accurate diagnoses and develop appropriate treatment plans. 

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The DSM-5 outlines specific criteria, including the presence of positive symptoms like hallucinations and delusions, negative symptoms such as social withdrawal and lack of emotional expression, and impairments in daily functioning, all of which are essential for diagnosing schizophrenia.[1]

Why the DSM-5 is Useful 

The DSM-5 criteria for schizophrenia serve as a valuable tool for various stakeholders involved in mental healthcare. For clinicians, the criteria provide a standardized framework for identifying and diagnosing schizophrenia based on observable symptoms and behaviors, guiding treatment planning and interventions. 

Patients and their families benefit from a clearer understanding of the disorder and its symptoms, helping to reduce confusion and stigma surrounding mental illness. 

Researchers utilize the DSM-5 criteria to ensure consistency in studying schizophrenia across different populations and settings, enhancing the reliability and validity of research findings. 

Overall, the DSM-5 criteria play a crucial role in facilitating communication, treatment, and research efforts related to schizophrenia, ultimately improving outcomes and support for individuals affected by the disorder.

Many changes were made from the DSM-4 to DSM-5, including:[1]

  • Elimination of subtypes: The DSM-5 removed the subtypes of schizophrenia, such as paranoid, disorganized, catatonic, etc., as they were found to be inconsistently applied and lacked predictive validity.
  • Introduction of spectrum concept: The DSM-5 introduced a spectrum concept for schizophrenia spectrum disorders, acknowledging the diverse range of symptoms and severity levels across individuals with the disorder.
  • Incorporation of dimensional assessments: The DSM-5 emphasizes dimensional assessments of symptoms and severity, allowing for a more nuanced understanding of the presentation and progression of schizophrenia.
  • The criterion for schizoaffective disorder: The DSM-5 clarified the criteria for schizoaffective disorder, ensuring better differentiation from schizophrenia and mood disorders with psychotic features.
  • Emphasis on cross-cultural factors: The DSM-5 underscores the importance of considering cultural factors in the diagnosis and treatment of schizophrenia, recognizing variations in symptom expression and help-seeking behaviors across different cultural contexts.

Schizophrenia subtypes have been eliminated:

Perhaps the most substantial change to this category of disorders is the elimination of subtypes (paranoid, disorganized, catatonic, undifferentiated, and residual). The rationale for doing away with these subtypes is they are not stable conditions, and have not afforded significant clinical utility nor scientific validity and reliability.

Catatonic specifiers and new Catatonic Disorders:

As mentioned above, the catatonic subtype has been eliminated. However, a catatonic specifier has been added and may be used with depressive, bipolar, and psychotic disorders. This change recognizes that catatonia occurs across several categories of disorders, without necessarily indicating psychosis. In addition, there are two new catatonic disorders: Catatonic Disorder due to Another Medical Condition and Other Specified Catatonic Disorder. Similar to the rationale for the catatonic specifier, the Catatonic Disorder due to Another Medical Condition recognizes that catatonia occurs in the context of several medical conditions. The Other Specified Catatonic Disorder may be used when the clinician is not yet certain of the underlying condition associated with catatonia. In other words, the clinician is uncertain whether the catatonia is related to depression, bipolar, psychotic, or medical conditions. DSM-5 requires 3 of 12 catatonic symptoms for all four conditions (depression, bipolar, psychotic, and medical). In DSM-IV, psychotic and mood disorders required 2 of 5 symptom sets, while medical conditions only required 1 of 5 symptom sets.

Full DSM-5 Criteria for Schizophrenia

Below are the five main symptoms of schizophrenia outlined in the DSM-5:


Delusions are false beliefs that persist despite evidence to the contrary. They’re often implausible and not based in reality.

Examples include:[1],[2]

  • Believing you are being followed
  • Believing your thoughts are controlled by external forces like the government
  • Believing you possess special powers not possessed by others


Hallucinations involve sensory perceptions that occur without any external stimuli. They can affect any of the five senses.

Examples include:[1],[2]

  • Hearing voices when no one is around
  • Seeing things that others cannot see
  • Feeling sensations on the skin without any physical cause

Disorganized Thinking

Disorganized thinking refers to difficulties in organizing thoughts or making logical connections between ideas.

Examples include:[1],[2]

  • Speaking incoherently
  • Jumping from one topic to another unrelated topic
  • Having difficulty expressing yourself in a clear manner

Grossly Disorganized or Abnormal Motor Behavior

This symptom involves unusual or unpredictable movements or behaviors that are not culturally or socially appropriate.

Examples may include:[1],[2]

  • Agitation
  • Odd facial expressions
  • Repetitive movements
  • Unusual postures
  • Unpredictable actions that seem out of context

Negative Symptoms

Negative symptoms refer to the absence or reduction of normal behaviors or functions that are typically seen in healthy individuals. Some examples of negative symptoms include:[1],[2]

  • Reduced emotional expression
  • Lack of motivation
  • Social withdrawal
  • Diminished speech
  • Inability to experience pleasure (anhedonia)

Symptom criteria changes:

Schizophrenia: Criterion A lists the five key symptoms of psychotic disorders: 1) delusions, 2) hallucinations, 3) disorganized speech, 4) disorganized or catatonic behavior, and 5) negative symptoms. In DSM-IV 2 of these 5 symptoms were required. However, only 1 of the 5 symptoms was required if delusions were bizarre or if hallucinations included a running commentary on a person's thoughts/behavior, and/or two or more voices conversing. This exception has been removed for lack of specificity and poor reliability. This change makes intuitive sense. The notion of what constitutes “bizarre” is rather vague, and its removal reduces cultural bias. In DSM-5, two of these five symptoms are required AND at least one symptom must be one of the first three (delusions, hallucinations, disorganized speech).

Schizoaffective: Schizoaffective disorder forms a link between psychosis and mood. Previously, DSM-IV required that the mood episode be present for a substantial duration of the illness. DSM-5 requires the mood episode be present for the majority of the illness. It probably seems like splitting hairs but the change was made to improve the reliability, validity, and stability of the disorder. After all, how long is “substantial” anyway?

Delusional Disorder: The requirement that delusions be non-bizarre has been removed. A ‘delusion bizarre type' specifier is available. Shared delusional disorder is no longer a distinct, separate disorder. It would simply be Delusional Disorder.

Differential diagnosis: Delusional Disorder and OCD delusional belief specifier:

A change that will be discussed in more detail in another article is the formation of a new category of disorders called Obsessive-Compulsive and Related Disorders. This new category of disorders includes Obsessive-Compulsive Disorder, Body Dysmorphic Disorder, and Hoarding Disorder (among others). These three disorders have a new specifier related to insight. The DSM-IV ‘with poor insight' specifier has been expanded to include good, fair, poor and absent/delusional insight. Therefore, Delusional Disorder has an exclusion criterion that specifies the symptoms cannot be better explained by OCD or similar disorder with absent/delusional insight. In other words, delusional beliefs no longer automatically suggest a psychotic disorder. They must be carefully evaluated to determine if another disorder can better account for the delusional beliefs.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  2. American Psychiatric Association. (2020). What is Schizophrenia?

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