Schizotypal personality disorder
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Schizotypal personality disorder is characterized by an ongoing pattern in which the affected person distances him- or herself from social and interpersonal relationships. Affected people typically have an acute discomfort when put in circumstances where they must relate to others. These individuals are also prone to cognitive and perceptual distortions and a display a variety of eccentric behaviors that others often find confusing.
People with schizotypal personality disorder are more comfortable turning inward, away from others, than learning to have meaningful interpersonal relationships. This preferred isolation contributes to distorted perceptions about how interpersonal relationships are supposed to happen. These individuals remain on the periphery of life and often drift from one aimless activity to another with few, if any, meaningful relationships.
A person with schizotypal personality disorder has odd behaviors and thoughts that would typically be viewed by others as eccentric, erratic, and bizarre. They are known on occasion to have brief periods of psychotic episodes. Their speech, while coherent, is marked by a focus on trivial detail. Thought processes of schizotypals include magical thinking, suspiciousness, and illusions. These thought patterns are believed to be the schizotypal's unconscious way of coping with social anxiety. To some extent, these behaviors stem from being socially isolated and having a distorted view of appropriate interpersonal relations.
Causes and symptoms
Schizotypal personality disorder is believed to stem from the affected person's original family, or family of origin. Usually the parents of the affected person were emotionally distant, formal, and displayed confusing parental communication. This modeling of remote, unaffectionate relationships is then reenacted in the social relationships encountered in the developing years. The social development of people with schizotypal personality disorder shows that many were also regularly humiliated by their parents, siblings, and peers resulting in significant relational mistrust. Many display low self-esteem, self-criticism and self-deprecating behavior. This further contributes to a sense that they are socially incapable of having meaningful interpersonal relationships.
The Diagnostic and Statistical Manual of Mental Disorders , a professional manual, specifies nine diagnostic criteria for schizotypal personality disorder:
- Incorrect interpretations of events. Individuals with schizotypal personality disorder often have difficulty seeing the correct cause and effect of situations and how they affect others. For instance, the schizotypal may misread a simple non-verbal communication cue, such as a frown, as someone being displeased with them, when in reality it may have nothing to do with them. Their perceptions are often distortions of what is really happening externally, but they tend to believe their perceptions more than what others might say or do.
- Odd beliefs or magical thinking. These individuals may be superstitious or preoccupied with the paranormal. They often engage in these behaviors as a desperate means to find some emotional connection with the world they live in. This behavior is seen as a coping mechanism to add meaning in a world devoid of much meaning because of the social isolation these individuals experience.
- Unusual perceptual experiences. These might include having illusions, or attributing a particular event to some mysterious force or person who is not present. Affected people may also feel they have special powers to influence events or predict an event before it happens.
- Odd thinking and speech. People with schizotypal personality disorder may have speech patterns that appear strange in their structure and phrasing. Their ideas are often loosely associated, prone to tangents, or vague in description. Some may verbalize responses by being overly concrete or abstract and insert words that serve to confuse rather than clarify a particular situation, yet make sense to them. They are typically unable to have ongoing conversation and tend to talk only about matters that need immediate attention.
- Suspicious or paranoid thoughts. Individuals with schizotypal personality disorder are often suspicious of others and display paranoid tendencies.
- Emotionally inexpressive. Their general social demeanor is to appear aloof and isolated, behaving in a way that communicates they derive little joy from life. Most have an intense fear of being humiliated or rejected, yet repress most of these feelings for protective reasons.
- Eccentric behavior. People with schizotypal personality disorder are often viewed as odd or eccentric due to their unusual mannerisms or unconventional clothing choices. Their personal appearance may look unkempt—clothing choices that do not "fit together," clothes may be too small or large, or clothes may be noticeably unclean.
- Lack of close friends. Because they lack the skills and confidence to develop meaningful interpersonal relationships, they prefer privacy and isolation. As they withdraw from relationships, they increasingly turn inward to avoid possible social rejection or ridicule. If they do have any ongoing social contact, it is usually restricted to immediate family members.
- Socially anxious. Schizotypals are noticeably anxious in social situations, especially with those they are not familiar with. They can interact with people when necessary, but prefer to avoid as much interaction as possible because their self-perception is that they do not "fit in." Even when exposed to the same group of people over time, their social anxiety does not seem to lessen. In fact, it may progress into distorted perceptions of paranoia involving the people with whom they are in social contact.
Schizotypal personality disorder appears to occur more frequently in individuals who have an immediate family member with schizophrenia . The prevalence of schizotypal personality disorder is approximately 3% of the general population and is believed to occur slightly more often in males.
Symptoms that characterize a typical diagnosis of schizotypal personality disorder should be evaluated in the context of the individual's cultural situation, particularly those regarding superstitious or religious beliefs and practices. (Some behaviors that Western cultures may view as psychotic are viewed within the range of normal behavior in other cultures.)
The symptoms of schizotypal personality disorder may begin in childhood or adolescence showing as a tendency toward solitary pursuit of activities, poor peer relationships, pronounced social anxiety, and underachievement in school. Other symptoms that may be present during the developmental years are hypersensitivity to criticism or correction, unusual use of language, odd thoughts, or bizarre fantasies. Children with these tendencies appear socially out-of-step with peers and often become the object of malicious teasing by their peers, which increases the feelings of isolation and social ineptness they feel. For a diagnosis of schizotypal personality disorder to be accurately made, there must also be the presence of at least four of the above-mentioned symptoms.
The symptoms of schizotypal personality disorder can sometimes be confused with the symptoms seen in schizophrenia. The bizarre thinking associated with schizotypal personality disorder can be perceived as a psychotic episode and misdiagnosed. While brief psychotic episodes can occur in the patient with schizotypal personality disorder, the psychosis is not as pronounced, frequent, or as intense as in schizophrenia. For an accurate diagnosis of schizotypal personality disorder, the symptoms for schizotypal cannot occur exclusively during the course of schizophrenia or other mood disorder that has psychotic features.
Another common difficulty in diagnosing schizotypal personality disorder is distinguishing it from other the schizoid, avoidant, and paranoid personality disorders . Some researchers believe that schizotypal personality disorder is essentially the same disorder as schizoid, but many feel there are distinguishing characteristics. Schizoids are deficient in their ability to experience emotion, while schizotypals are more pronounced in their inability to understand human motivation and communication. While avoidant personality disorder has many of the same symptoms as schizotypal personality disorder, the distinguishing symptom in schizotypal is the presence of behavior that is noticeably eccentric. The schizotypal differs from the paranoid by tangential thinking and eccentric behavior.
The diagnosis of schizotypal personality disorder is based on a clinical interview to assess symptomatic behavior. Other assessment tools helpful in confirming the diagnosis of schizotypal personality disorder include:
- Minnesota Multiphasic Personality Inventory (MMPI-2)
- Millon Clinical Multiaxial Inventory (MCMI-II)
- Rorschach Psychodiagnostic Test
- Thematic Apperception Test (TAT)
The patient with schizotypal personality disorder finds it difficult to engage and remain in treatment. For those higher-functioning individuals who seek treatment, the goal will be to help them function more effectively in relationships rather than restructuring their personality.
Psychodynamically oriented therapies
A psychodynamic approach would typically seek to build a therapeutically trusting relationship that attempts to counter the mistrust most people with this disorder intrinsically hold. The hope is that some degree of attachment in a therapeutic relationship could be generalized to other relationships. Offering interpretations about the patient's behavior will not typically be helpful. More highly functioning schizotypals who have some capacity for empathy and emotional warmth tend to have better outcomes in psychodynamic approaches to treatment.
Cognitive approaches will most likely focus on attempting to identify and alter the content of the schizotypal's thoughts. Distortions that occur in both perception and thought processes would be addressed. An important foundation for this work would be the establishment of a trusting therapeutic relationship. This would relax some of the social anxiety felt in most interpersonal relationships and allow for some exploration of the thought processes. Constructive ways of accomplishing this might include communication skills training, the use of videotape feedback to help the affected person perceive his or her behavior and appearance objectively, and practical suggestions about personal hygiene, employment, among others.
Treatment using an interpersonal approach would allow the individual with schizotypal personality disorder to remain relationally distant while he or she "warms up" to the therapist. Gradually the therapist would hope to engage the patient after becoming "safe" through lack of coercion. The goal would be to develop trust in order to help the patient gain insight into the distorted and magical thinking that dominates. New self-talk can be introduced to help orient the individual to reality-based experience. The therapist can mirror this objectivity to the patient.
Group therapy may provide the patient with a socializing experience that exposes them to feedback from others in a safe, controlled environment. It is typically recommended only for schizotypals who do not display severe eccentric or paranoid behavior. Most group members would be uncomfortable with these behavioral displays and it would likely prove destructive to the group dynamic.
Family and marital therapy
It is unlikely that a person with schizoid personality disorder will seek family or marital therapy. Many schizoid types do not marry and end up living with and being dependent upon first-degree family members. If they do marry they often have problems centered on insensitivity to their partner's feelings or behavior. Marital therapy ( couples therapy ) may focus on helping the couple to become more involved in each other's lives or improve communication patterns.
There is considerable research on the use of medications for the treatment of schizotypal personality disorder due to its close symptomatic relationship with schizophrenia. Among the most helpful medications are the antipsychotics that have been shown to control symptoms such as illusions and phobic anxiety, among others. Amoxapine (trade name Asendin), is a tricyclic antidepressant with antipsychotic properties, and has been effective in improving schizophrenic-like and depressive symptoms in schizotypal patients. Other antidepressants such as fluoxetine (Prozac) have also been used successfully to reduce symptoms of anxiety, paranoid thinking, and depression.
The prognosis for the individual with schizotypal personality disorder is poor due to the ingrained nature of the coping mechanisms already in place. Schizotypals who depend heavily on family members or others are likely to regress into a state of apathy and further isolation. While some measurable gains can be made with mildly affected individuals, most are not able to alter their ingrained ways of perceiving or interpreting reality. When combined with poor social support structure, most will not enter any type of treatment.
Since schizotypal personality disorder originates in the patient's family of origin, the only known preventative measure is a nurturing, emotionally stimulating and expressive caretaking environment.
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International Society for the Study of Personality Disorders. Journal of Personality Disorders. Guilford Publications, 72 Spring St., New York, NY 10012. <http://www.guilford.com> . (800) 365-7006.
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Also read article about Schizotypal personality disorder from Wikipedia
Schizophreniform disorder Seasonal affective disorder
Personal boundaries are guidelines, rules or limits that a person creates to identify reasonable, safe and permissible ways for other people to behave towards them and how they will respond when someone passes those limits. They are built out of a mix of conclusions, beliefs, opinions, attitudes, past experiences and social learning. This concept or life skill has been widely referenced in self-help books and used in the counseling profession since the mid-1980s.
According to some counselors, personal boundaries help to define an individual by outlining likes and dislikes, and setting the distances one allows others to approach. They include physical, mental, psychological and spiritual boundaries, involving beliefs, emotions, intuitions and self-esteem.Jacques Lacan considered such boundaries to be layered in a hierarchy, reflecting "all the successive envelopes of the biological and social status of the person". Personal boundaries operate in two directions, affecting both the incoming and outgoing interactions between people. These are sometimes referred to as the "protection" and "containment" functions.
The three most commonly mentioned categories of values and boundaries are:
Some authors have expanded this list with additional or specialized categories such as "spirituality", "truth", and "time/punctuality".
Nina Brown proposed four boundary types:
- Soft – A person with soft boundaries merges with other people's boundaries. Someone with a soft boundary is easily a victim of psychological manipulation.
- Spongy – A person with spongy boundaries is like a combination of having soft and rigid boundaries. They permit less emotional contagion than soft boundaries but more than those with rigid. People with spongy boundaries are unsure of what to let in and what to keep out.
- Rigid – A person with rigid boundaries is closed or walled off so nobody can get close either physically or emotionally. This is often the case if someone has been the victim of physical, emotional, psychological, or sexual abuse. Rigid boundaries can be selective which depend on time, place or circumstances and are usually based on a bad previous experience in a similar situation.
- Flexible – Similar to spongy rigid boundaries but the person exercises more control. The person decides what to let in and what to keep out, is resistant to emotional contagion and psychological manipulation, and is difficult to exploit.
The personal boundaries concept is particularly pertinent in environments with controlling people or people not taking responsibility for their own life.
Co-Dependents Anonymous recommends setting limits on what members will do to and for people and on what members will allow people to do to and for them, as part of their efforts to establish autonomy from being controlled by other people’s thoughts, feelings and problems.
The National Alliance on Mental Illness tells its members that establishing and maintaining values and boundaries will improve the sense of security, stability, predictability and order, in a family even when some members of the family resist. NAMI contends that boundaries encourage a more relaxed, nonjudgmental atmosphere and that the presence of boundaries need not conflict with the need for maintaining an understanding atmosphere.
Risks of reestablishing
In Families and How to Survive Them, Robin Skynner MD explains methods for how family therapists can effectively help family members to develop clearer values and boundaries by when treating them, drawing lines, and treating different generations in different compartments – something especially pertinent in families where unhealthy enmeshment overrides normal personal values. However, the establishment of personal values and boundaries in such instances may produce a negative fall-out, if the pathological state of enmeshment had been a central attraction or element of the relationship. This is especially true if the establishment of healthy boundaries results in unilateral limit setting which did not occur previously. It is important to distinguish between unilateral limits and collaborative solutions in these settings.
Anger is a normal emotion that involves a strong uncomfortable and emotional response to a perceived provocation. Often, it indicates when one's personal boundaries are violated. Anger may be utilized effectively by setting boundaries or escaping from dangerous situations.
Addicts often believe that being in control of others is how to achieve success and happiness in life. People who follow this rule use it as a survival skill, having usually learned it in childhood. As long as they make the rules, no one can back them into a corner with their feelings.
People with certain mental conditions are predisposed to controlling behavior including those with obsessive compulsive disorder, paranoid personality disorder,borderline personality disorder, and narcissistic personality disorder,attention deficit disorder, and the manic state of bipolar disorder.
- Borderline personality disorder (BPD): There is a tendency for loved ones of people with BPD to slip into caretaker roles, giving priority and focus to problems in the life of the person with BPD rather than to issues in their own lives. Too often in these relationships, the codependent will gain a sense of worth by being "the sane one" or "the responsible one".
- Narcissistic personality disorder (NPD): For those involved with a person with NPD, values and boundaries are often challenged as narcissists have a poor sense of self and often do not recognize that others are fully separate and not extensions of themselves. Those who meet their needs and those who provide gratification may be treated as if they are part of the narcissist and expected to live up to their expectations.
Codependency often involves placing a lower priority on one's own needs, while being excessively preoccupied with the needs of others. Codependency can occur in any type of relationship, including family, work, friendship, and also romantic, peer or community relationships.
While a healthy relationship depends on the emotional space provided by personal boundaries, co-dependent personalities have difficulties in setting such limits, so that defining and protecting boundaries efficiently may be for them a vital part of regaining mental health.
In a codependent relationship, the codependent's sense of purpose is based on making extreme sacrifices to satisfy their partner's needs. Codependent relationships signify a degree of unhealthy clinginess, where one person doesn't have self-sufficiency or autonomy. One or both parties depend on the other for fulfillment. There is usually an unconscious reason for continuing to put another person's life first, often for the mistaken notion that self-worth comes from other people.
- Demanding parent: In the dysfunctional family the child learns to become attuned to the parent's needs and feelings instead of the other way around.
- Demanding child: Parenting is a role that requires a certain amount of self-sacrifice and giving a child's needs a high priority. A parent can, nevertheless, be codependent towards a child if the caretaking or parental sacrifice reaches unhealthy or destructive levels.
Freud described the loss of conscious boundaries that may occur when an individual is in a unified, fast-moving crowd.
Almost a century later, Steven Pinker took up the theme of the loss of personal boundaries in a communal experience, noting that such occurrences could be triggered by intense shared ordeals like hunger, fear or pain, and that such methods were traditionally used to create liminal conditions in initiation rites.Jung had described this as the absorption of identity into the collective unconscious.
Rave culture has also been said to involve a dissolution of personal boundaries, and a merger into a binding sense of communality.
Unequal power relations
Also unequal relations of political and social power influence the possibilities for marking cultural boundaries and more generally the quality of life of individuals. Unequal power in personal relationships, including abusive relationships, can make it difficult for individuals to mark boundaries.
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