DSM-V-TR and Diagnosis of Schizophrenia Spectrum and Psychosis

Posted on June 25, 2026 by Mark Moran

When one considers the classical image of mental illness, psychosis, hallucinations and delusions are the first to come to mind. This can create frightening images or archetypes, or remind individuals of the old asylums of the late 19th and early 20th centuries. While some of the symptoms of psychosis and schizophrenia can be odd and frightening to some, the reality is most are individuals who are suffering and trying to survive. 1 in 100 individuals suffer from schizophrenia and if exists within family history , the chances of inheriting the gene that activates it rises (McRay, et al., 2016). With that in mind, more individuals than one would think suffer at some level within the spectrum of Schizophrenia and psychosis related disorders. This blog will review the DSM-V-TR and its diagnosis of Schizophrenia as well as related disorders.

Psychosis and Schizophrenia causes hallucinations, delusions, negative symptoms and disorganized thought. Please also review AIHCP’s Healthcare Certifications

Please also review AIHCP’s Healthcare Certifications for behavioral health professionals, as well as nurses and other healthcare professionals.

Etiology Behind Psychosis and Schizophrenia

Psychosis itself can occur within any hallucinating drug, substance or meditation. Those with the genetic predisposition can activate it in life by use of drugs, or enduring various stressors (McRay, et al., 2016). The disorders have no gender bias and usually occur late in adolescence or early adulthood (Barlow, et al., 2023). The first phase consists premorbid conditions of cognitive and social impairments, followed by the prodromal phase which exhibits minor psychotic like behaviors for 1 to 2 years. It can take up to 10 years for one to fully manifest positive and negative symptoms with the deterioration continuing without treatment (Barlow, et al., 2023).

Since Schizophrenia is highly connected to family history, various neurological defects are apparent, including larger ventricles, as well as higher levels of the neurotransmitter dopamine (Barlow, et al., 2023). For some, the use of drugs, as well as stressors can play a role in activating it. Finally, fetal exposition to viral infection and different pregnancy complications can play a role (Barlow, et al., 2023).

Schizophrenia Spectrum

There is not merely one type of psychosis, but a full spectrum that illustrates Schizophrenia and psychosis and how it manifests differently at various degrees and durations. The DSM-V-TR lists the spectrum as consisting of Delusional Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder, and Psychotic Disorder due to Substance or Medication induced. Schizotypal Disorder is briefly listed but categorized within personality disorders (DSM-V-TR, 2022).

Within all of these disorders to some extent or level certain symptoms manifest in extremity, duration or presence that are key in differentiating one disorder from another, but within that group of symptoms are clear signs that point to some type of psychosis. Within the nature of psychosis delusions, hallucinations, negative symptoms and disordered speech and thought are key divisions of psychosis.

Delusions

Delusions are a disorder of thought content (Barlow, et al., 2023). The DSM-V-TR adds that delusions are unable to change or be altered even if conflicting evidence against them is supplied to the person (2023). Persecutory delusions are beliefs that an individual is being persecuted, or that one is going be harmed or harassed by a group. Individuals who feel the CIA or FBI is hunting them is a prime example of this type of delusion. Referential delusions are when the individual believes that certain benign cues, gestures, or comments are directed at them. Grandiose delusions refer to delusions that entail the person thinking he or she is someone famous or has individual powers not possessed. Erotomanic delusions entail belief that someone is in love with them, even someone famous. Nihilistic delusions are strong convictions that a catastrophe will occur and finally Somatic delusions are fears regarding health and organ functioing (DSM-V-TR, 2023). Furthermore delusions are considered bizarre if the delusion falls out of the category of even possible, such as aliens inserting a chip in someone’s head (DSM-V-TR, 2023). It is important to differentiate strongly held beliefs or convictions from delusions as well as culturally based ideals that may seem odd to others.

Hallucinations

Hallucinations are perception like experiences that occur without external stimulus (DSM-V-TR, 2023). They can be auditory or visual and must occur within the range of normal experiences. The most common hallucination in Schizophrenia is auditory. Interesting to note, that when individuals experience auditory hallucinations, it the area of the brain associated with speech or Broca’s area that has been shown in experiments to activate instead of the hearing area known as Wernicke’s area. This is because the voices are actually coming from own’s speech area and not from a true external auditory source (Barlow, et. al. 2023).

Those from other cultures or religious traditions, especially within mysticism, are not always considered to be hallucinating. The DSM-V-TR clearly specifies that these cases need to be evaluated differently than a pure disorder (2023). Apparitions and voices of a deity should be evaluated to rule out any mental defect but in some cases no defect exists. Sometimes, a religious experience can possess qualities of a hallucination but the information or message is foreign from the person. Other times, religious experiences can affect the five senses themselves and are not hallucinations. It is important for any spiritual message to sometimes undergo rigid investigation to understand if it is from within a person or if filtered into the person through a spiritual source. Ultimately, how one views these experiences will pend on if one is an atheist or a believer in the spiritual realm. Regardless, they deserve special differential treatment in diagnosis than pure hallucinations before denying it or labeling one with a disorder.

Disorganized Thinking, Speech and Abnormal Motor Control

It is common with psychosis and schizophrenia for many odd cognitive thoughts, reactions, and word salads to emerge within the individual. This is part of the disorder and inability to process thoughts and reality. The DSM-V-TR lists a variety of disorganized thinking and speech symptoms, including derailment or loose association where the person switches without logic from topic to topic, or tangentialtions that illustrate completely unrelated answers to questions. In addition, incoherence can reach such a state where a word salad manifests where the train of thought is impossible to follow (2023). In other cases, inappropriate affect can emerge in which the person’s emotional responses do not match the question or situation (Barlow, et. al., 2022).

In regards to motor control, some individuals display catotonia or decreased ability to react to stimuli. It can also manifest in incomplete or no verbal responses such as stupor or mutism. It is important to note that catatonia symptoms while related to schizophrenia exist, they can also exist in other disorders as well (DSM-V-TR, 2023).

Negative Symptoms

Positive symptoms such as hallucinations and delusions are directly manifested in psychosis and schizophrenia, but there are also passive or negative symptoms. Among them are avolition, alogia, anhedonia, asociality, and affective flattening (Barlow, et al., 2022). Avolition deals with inability or interest to partake in daily tasks. Alogia refers to the absence of speech. Anhedonia refers to the indifference to pleasure or activities that are a source of pleasure. Asociality refers to withdraw and lack of interest of social interaction. Finally, affective flattening is a lack of emotional response or a flat affect to questions or a situation (Barlow, et al., 2022).

Diagnosis Criteria of Schizophrenia Spectrum

Delusional Disorder

This disorder requires the presence of at least one type of delusion for the persistence of one month and the delusions must cause social impairments but do not appear as bizarre or as odd of those exhibiting schizophrenia. These delusions are not due to drugs, substance or other medications and finally, Hallucinations, negative symptoms and disorganization is rare and any form of catatonia rules out this diagnosis (DSM-V-TR, 2022).

Brief Psychotic Disorder

Brief Psychotic Episode lasts 1 day to 1 month

A brief psychotic disorder exhibits the positive symptoms and is not described by other mental health issues such as major depression or bi-polar. It lasts a minimum of 1 day to 1 full month and then a full return to premorbid level of functioning (DSM-V-TR, 2022).

Schizophreniform

This disorder possesses all the positive and negative symptoms of schizophrenia but its duration is its key attribute. It manifests from 1 month to 6 months (DSM-V-TR, 2022). It is also not attributed to any other mood disorders or drugs, substances or medications.

Schizophrenia

Schizophrenia requires 2 of the following during a period exceeding 1 month.

1.delusions

2. hallucinations

3. disorganized speech

4. grossly disorganized behavior

5. negative symptoms.

Of the above conditions, one must be from delusions, hallucinations or disorganized speech.

In addition to these core psychosis symptoms, there must be significant impairment and functioning with work, social interaction and self care. These signs must persist beyond 6 months. In addition, major depressive disorder and bi-polar disorder must be ruled out. Finally, the disorder must not be due to any drug, substance or medicine. (DSM-V-TR, 2022).

Schizoaffective Disorder

This disorder exhibits psychotic symptoms for a 6 month period while also enduring bi-polar or major depressive disorder must be present through the majority of the schizoaffective disorder. It can be specified as bipolar, depressive or catatonia (DSM-V-TR, 2022).

Treatment of Psychosis and Schizophrenia Spectrum

Treatment remains very difficult for many because of the numerous side effects, lack of family and social support, and the damaging effects of the illness for self care but it can help alleviate symptoms and help some individuals live normal lives.

Identifying psychosis disorders is important to finding healing and preventing long term harm to self

Medically, since the 1950s, anti-psychotics have proven to be a powerful tool in helping individuals with psychosis and schizophrenia. Also, referred to as neuroleptics, these drugs are dopamine antagonists that reduce the production of dopamine (Barlow, et al., 2022). While helping many individuals who suffer from schizophrenia, the medications can also cause numerous side effects from weight gain to fatigue. Uniquely to schizophrenia, the lowering of dopamine can cause tremor like symptoms similar to Parkinson disease. Ironically, individuals who take medications to increase dopamine for Parkinson disease can experience schizophrenic like hallucinations (Barlow, et. al., 2022).

In addition to anti-psychotics, interventions are key in helping individuals face their delusions and social struggles. Psychotherapy can help individuals understand their way of thinking, as well as provide tools and skills to achieve goals in life while facing the struggles associated with the disorder. In addition, symptom management is essential in identifying warning signs of potential flare ups and when to seek assistance. Social and family assistance is key to helping individuals find their way. Those facing these issues must also always refrain from drugs and alcohol due to their condition of possible psychosis but also due to the nature of the medications they are prescribed (Barlow, et al., 2022). Essentially, it involves not only accepting and discovering that one has this mental disorder but adjusting to a new way of life to manage the symptoms and promote health. Barlow points out that treatment plans should be integrative and include collaborative psychopharmacology, community treatment access, family psychoeducation, supportive employment and illness management skills (2023).

Conclusion

Psychosis while odd and sometimes scary affects many people. Hallucinations, delusions, disorganized speech and negative symptoms are the key groupings of symptoms that manifiest with psychosis. Understanding why it happens and identifying the signs is important in controlling it. It is essential to diagnose and treat before it derails a person’s social, academic, family and professional life. Unfortunately, due to social support, life style change, medicine side effects, and extreme of impairment, many never receive the full help they need. This leads to many be left to fend for themselves as they become more disconnected from reality. Many find themselves homeless, unemployed and in and out of the prison system without proper care.

Please also review AIHCP’s Behavioral Health Certifications for healthcare professionals.

Additional Blogs

Stress and Trauma Disorders: Access here

Anxiety Disorders: Access here

Mood Disorders: Access here

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.

Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th ed.). Cengage Learning

McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic

Additional Resources

Gregory, S. (2026). “Understanding care and treatments for schizophrenia”. Mayo Clinic. Access here

Schizophrenia (2025). Cleveland Clinic. Access here

Carey, E. (2024). Psychosis. Healthline. Access here

Psychosis: Causes, Symptoms, and Treatment. WebMed. Access here

Schizophrenia Video

Posted on November 15, 2023December 18, 2024 by Dominick Flarey

Schizophrenia is obviously a disorder treated by highly trained licensed counselors, psychologists and psychiatrists with specialty training in the disorder. Mere certified counselors may come across it and hence should have a basic understanding of it and when to call for help. The disorder itself distorts reality for many. Individuals have grandiose goals and ideals that are not connected to reality. They also are in and out of acute state of psychosis where they may feel they are in danger or being followed. Some behaviors are outwardly unacceptable due to action, while other behaviors are unacceptable due to inaction. Some may be deeper trapped within their own mind and unable to articulate thought completely.

If ever dealing with one, one never should confront a delusion, but merely ignore it, and not escalate the situation. No type of therapy can be conducted during acute psychosis.

Please also review AIHCP’s Christian Counseling Program, as well as many of its other mental health certifications. AIHCP does not offer any type of education in schizophrenia itself, but again reiterates the importance of only licensed professionals with appropriate background in the disorder to deal with these types of individuals who sometimes can become quite dangerous if not medicated.

What is Schizophrenia?

Posted on August 16, 2023 by Dominick Flarey

Many mental maladies deal with personality. Anti-Social Personalities deal with individuals whose consciences and sense of right or wrong are completely muddied and confused. Other personality disorders deal with emotional states and an inability to control anxiety or sadness. Perhaps the most crippling form of mental illness is Schizophrenia. In the case of Schizophrenia, individuals experience psychosis and an inability to decipher true reality and their own delusions. This type of disorder is classified as psychotic due to its irrational and distorted perceptions from reality (Myers and Dewall. 2019, p. 522).

Schizophrenia is a psychotic disorder that creates delusions within the brain confusing one from reality and fantasy

Schizophrenia can be chronic and long term or acute. Acute is far easier to recover from while chronic is a life long struggle. Most chronic cases are usually genetic and tied to abnormal brain structure and development within the frontal lobes which aid individuals with reason, planning and problem solving skills (Myers and Dewall, 2019, p. 524). Brain waves and activity also are irregular within Schizophrenic individuals. When attempting to filter incoming sensory information, the Thalamus becomes ultra active, as well the Amygdala during emotional distress. In addition, experts have noticed thinning in the Cerebral Cortex as a sign of Schizophrenia (Myers and Dewall, 2019, p. 525). Hence irregular brain waves, less developed portions of the brain and fewer neural connections can all correspond with Schizophrenia. In addition, studies show Dopamine, a neurotransmitter, is overactive in Schizophrenic individuals (Myers and Dewall, 2019, p. 524). This neurotransmitter can intensify brain signals that can lead to hallucinations and paranoia.

Those stricken with Schizophrenia display symptoms that are either positive or negative. In positive instances, inappropriate behaviors are present, while in negative instances, appropriate behaviors are lacking. Examples of inappropriate behaviors include disorganized speech, abrupt laughter, sadness or rage, while negative symptoms include absence of emotion and lack of expression (Myers and Dewall, 2019, p. 523).

One of the primary symptoms is delusion or the “false belief of persecution or grandeur” (Myers and Dewall, 2019, p. 523). Many individuals with Schizophrenia are paranoid and fearful. They believe they are being followed or threatened. Some may also hear voices or weird commands. There is also an overall disorganized thinking where selective attention that usually is filtered out by the brain is amplified. Tiny unrelated stimuli can distract one with Schizophrenia such as a tiny crack in the ground or something far down the road (Myers and Dewall, 2019, p. 523). Stemming from this can emerge disorganized speech. Disorganized speech can include multiple ideas smashed together into an odd word salad that makes no sense. The Schizophrenic will jump from idea to idea with no logical connection or coherence.

The distress of Schizophrenia also impairs emotional expressions. Some with Schizophrenia will exhibit motionless behavior, while others may exhibit continual movement or rubbing or rocking of the body. In addition, some may display no emotion, while others may laugh or become angry. Due to impaired theory of mind, they also have extreme difficulty reading facial expressions (Myers and Dewall, 2019, p. 523). With these immense issues, those with Schizophrenia are very unpredictable and from an untrained person, may become very scary. In fact, in the medieval ages, many were thought to be possessed.

Schizophrenics require anti-psychotics and cognitive therapies to help them better cope with their false sense of reality

Fortunately, only 1 in 100 are afflicted with Schizophrenia which totals roughly 21 millions people (Myers and Dewall, 2019, p. 524). Many are medicated, counseled or closely monitored. Most are not a threat to others but there can be cases when they can become a threat to society when violent voices tell them to do harmful things or when their own delusions lead them into unsafe situations.

Another type of psychotic disorder is Dissociative Identity Disorder. Formerly known as Multiple Personality Disorder. This disorder is also psychotic in nature and stems from the creation of a new identity. Most cases stem from a traumatic event that pushes the individual to forget the trauma by creating a new identity. There is still much research to be done in this field but it is separate and different than Schizophrenia.

Those who suffer from Schizophrenia cannot exist without medical and professional help. They are a threat primarily to their own safety without proper treatment and medication. For most, it is a life long cross of trying to distinguish reality from delusion. Obviously, only licensed therapists can treat and care for Schizophrenics and it falls far out of the levels of competence of mere pastoral counselors. If a pastoral counselor and one suspects Schizophrenia, it is important to help the person find the professional counseling and assistance the person’s needs.

As Pastoral Counselors, one can see the suffering such delusions can bring to a person. As Christian Counselors, one can see the steep price of sin and how disease both physical and mental are a result of that sin. These individuals while odd and offbeat nevertheless are children of God and deserve compassion and respect in treatment and care. They deserve patience and love. If a loved one is suffering from this, it can be very painful to witness. One needs to not argue with the delusions but patiently walk one through it. Staying connected with the person and not becoming agitated is key to keeping the person calm. If on the other side, one is experiencing these symptoms it is crucial to find the help that is needed and to avoid drugs and drinking that will only make the delusions worse.

While there is no cure, some treatments can alleviate the issue. Most treatment involves anti-psychotic medications and also Behavioral Cognitive Therapies. Some therapies also include Electroconvulsive Therapy which includes while sedated, electric impulse shocks to improve brain activity.

Please also review AIHCP’s Christian Counseling Certification and see if it meets your academic and professional goals.

If you would like to learn more about counseling and helping others from a pastoral and Christian perspective, then please review AIHCP’s Christian Counseling Certification. The program is designed for qualified professionals to help others from a Christian perspective. The program is also online and independent study and can be completed at one’s own timing and speed.

References

“Exploring Psychology” 11th Edition. Myers, D & Dewall, N. (2019). Worth Publishers: Macmillan Learning, New York.

Additional Resources

“Schizophrenia” Mayo Clinic Staff. (2020). Mayo Clinic. Access here

“Schizophrenia”. Cleveland Clinic. (2023). Cleveland Clinic. Access here

“Schizophrenia: An Overview”. WebMed Editors. (2022). WebMed. Access here

“What is Schizophrenia?”. APA. (2020). Access here