usually auditory and/or visual. When the hallucinations are moderate, the sounds and
images are often unformed (e.g ., shadows, trails, halos, mu rmurs, rumbling), and they are
experienced as unusual or puzzling. When the hallucinations are severe, these experiences
become more vivid and frequent (i.e., recurring illusions or hallucinations that capture at-
tention and affect thinking and concentratio n). These perceptual abnormalities may dis-
rupt behavior, but skepticism about their reality can still be induced. 
Disorganized communica tion (Criterion A3) may manifest as odd speech (vague, meta-
phorical, overelaborate, stereoty ped), unfocused speech (confuse d, muddled, too fast or too
slow, wrong words, irrelevant context, off trac k), or meandering speech (circumstantial, tan-
gential). When the disorganization is moderately  severe, the individual frequently gets into
irrelevant topics but re sponds easily to clarifying questi ons. Speech may be odd but under-
standable. At the moderately severe level, speech becomes meandering and circumstantial,
and when the disorganization is severe, the in dividual fails to get to the point without
external guidance (tangential). At the severe level, some thought blocking and/or loose as-
sociations may occur infrequently, especially wh en the individual is under pressure, but re-
orienting questions quickly re turn structure and organiza tion to the conversation. 
The individual realizes that changes in mental state and/or in relationships are taking
place. He or she maintains reasonable insigh t into the psychotic-like experiences and gen-
erally appreciates that altered perceptions are not real and magical ideation is not compel-
ling. The individual must experience distress and/or impaired performance in social or role