Unifying Concepts

DSM-5 Diagnostic Criteria for Schizophrenia

Schizophrenia is a psychiatric syndrome characterized by psychotic symptoms of hallucinations, delusions, and disorganized speech, by negative symptoms such as decreased motivation and diminished expressiveness, and by cognitive deficits involving impaired executive functions, memory, and speed of mental processing.The specific DSM-5 criteria for schizophrenia are as follows:

  • The presence of at least two of the following five items, each present for a clinically significant portion of time during a 1-month period (or less if successfully treated), with at least one of them being items 1), 2), or 3): 1) delusions, 2) hallucinations, 3) disorganized speech, 4) grossly disorganized or catatonic behavior, and 5) negative symptoms (e.g., decreased motivation and diminished expressiveness).
  • For a clinically significant portion of the time since the onset of the disturbance, the level of functioning in one or more major areas (e.g., work, interpersonal relations, or self-care) is markedly below the level achieved before onset; when the onset is in childhood or adolescence, the expected level of interpersonal, academic, or occupational functioning is not achieved.
  • Continuous signs of the disturbance persist for a period of at least 6 months, which must include at least 1 month of symptoms (or less if successfully treated); prodromal symptoms often precede the active phase, and residual symptoms may follow it, characterized by mild or subthreshold forms of hallucinations or delusions.
  • Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms or any mood episodes that have occurred during active-phase symptoms have been present for a minority of the total duration of the active and residual periods of the illness.
  • The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse or a medication) or another medical condition. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms or schizophrenia, are also present for at least 1 month (or less if successfully treated).
  • In addition to the symptom domain areas identified in the first diagnostic criterion, assessment of cognition, depression, and mania symptom domains is vital for distinguishing between schizophrenia and other psychotic disorders.



  1. Marder SR, Cannon TD. Schizophrenia. N Engl J Med. 2019;381(18):1753-1761. [Medline]
  2. Agarwal V, Maheshwari S, Agarwal V, Kalra ID. Simple Schizophrenia Remains a Complicated Diagnosis: Case Report and Literature Review. J Nerv Ment Dis. 2016;204(1):57-60. [Medline]


Created Dec 09, 2019.

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