Cluster A Personality Disorders

Question 1

Schizoid Personality Disorder

Answer 1

Patients with a pervasive pattern of indifference to social relationships, restricted range of emotional experience and expression.

They have difficulty in expressing hostility and are self-absorbed, detached daydreamers. As a rule, they are indifferent to intimate personal contact.

They are often functional at work as long as it does not require significant social interaction/interpersonal contact. They do not have many or any close friends and do not engage in family or social situations.

Question 2

Alloplastic defenses

Answer 2

Defenses used by patients who react to stress by attempting to change the external environment, for example, by threatening or manipulating others

Question 3

Autoplastic defenses

Answer 3

Defenses used by patients who react to stress by changing their internal psychological processes.

Question 4

Ego-dystonic vs -syntonic

Answer 4

Describes how a character trait is perceived by the patient

Ego-dystonic is objectionable, distressing, inconsistent to the self.

Ego-syntonic is acceptable, nobjectionable, consistent to the self.

Question 5

Intellectualization

Answer 5

Defense mechanism an individual uses to deal with stressors

Rehashing events over and over. Making use of abstract thinking or making generalization in order to minimize disturbing feelings.

Question 6

Features of a personality disorder

Answer 6

Enduring patterns of perceiving, relating to, and thinking about the environment and/or onseself that are inflexible, maladaptive, or cause significant impairment socially or occupationally.

Question 7

Personality disorder clusters

Answer 7

A: Odd and eccentric (Schizoid, Schizotypal, Paranoid)

B: Dramatic and erratic (Histrionic, Narcissistic, Antisocial, Borderline)

C: Anxious and timid (OBPD, Avoidant PD, Dependent PD)

Question 8

Projection

Answer 8

Defense mechanism by which individuals deal with conflict by falsely attributing to another their own unacceptable feelings, impulses, or thoughts.

Question 9

Schizoid Fantasy

Answer 9

A defense mechanism whereby fantasy is used as an escape and means of gratification so that other people are not required for emotional fulfillment.

The retreat into fantasy itself acts as a means of distancing others.

Question 10

SIR SAFE mnemonic for Schizoid personality

Answer 10

• Solitary
• Indifferent to praise or criticism
• Relationships (not interested)
• Sexual experiences (not interested)
• Activities (not enjoyed)
• Friends (lacking)
• Emotionally distant

Question 11

Although schizoid persoanlity patients may have robust fantasy lives and appear as odd, they do not. . .

Answer 11

. . . have evidence of frank psychosis

Question 12

Schizotypal vs Schizoid personalities

Answer 12

Schizotypal: Often engage in quasi-delusional or magical thinking. Eccentric.

Schizoid: May live odd fantasy lives, but are not delusional and have completely intact reality testing. Socially disinterested.

Question 13

OCPD and Avoidant vs Schizoid personalities

Answer 13

All of them can appear just as emotionally constricted, but schizoid patients expreience loneliness as ego-syntonic while OCPD and Avoidant see it as ego-dystonic

Question 14

Treatment for schizoid personality disorder

Answer 14

Psychotherapy is first-line, although most patients will prefer no therapy

Group therapy is also an option.

Question 15

Sublimation

Answer 15

Defense mechanism where an individual transforms an unacceptable impulse into a socially acceptable behavior (aggression into sports, etc)

Question 16

Undoing

Answer 16

Defense mechanism in which something is done to symbolically cancel or reverse a perviously unacceptable act or thought.

Question 17

Avoidant personality vs Schizoid personality

Answer 17

A schizoid individual simply has no interest in social interaction and is perfectly content without it.

An avoidant individual wishes to engage in social interaction, but finds it distressing and confusing in practice.

Question 18

Personality disorders and family history of schizophrenia

Answer 18

Schizotypal patients often have a family history of schizophrenia.

Schizoid patients do not.

This makes sense, since schizotypal patients do tend to engage in magical, borderline delusional thinking, while schizoid patients do not.

Question 19

Patients with schizotypal personality tend to exhibit flamboyantly odd behavior, such as engagement with. . .

Answer 19

. . . the occult, witchcraft, the paranormal

Question 20

Patients with mild autism vs Schizoid patients

Answer 20

PAtients with mld autism may resemble schizoid patients, but have more severely impaired social interactions and the presence of stereotyped behaviors.

Question 21

Psychosis in patients with schizotypal personality disorder

Answer 21

Patients with SPD are not psychotic at baseline, they are just magical thinkers without frank hallucinations or fixed delusions

However, their reality testing can be somewhat tenuous, and this is best thought of as a nonpsychotic thought disorder with partial loss of reality testing.

However, under periods of extreme stress is not atypical for them to display transient psychosis.

Question 22

Denial vs psychotic denial

Answer 22

Denial: obvious definition

Psychotic denial: When there is gross impairment of reality testing associated with this denial.

Question 23

Derealization

Answer 23

A feeling that the world, or reality, has changed. The environment feels strange of unreal.

Question 24

Family history and Schizotypal PD

Answer 24

Family history of schizophrenia is associated with schizotypal personality disorder, and vice versa

SPD can be thought of as a milder form of schizophrenia with magical thinking rather than frank psychosis at baseline

Question 25

“Two heritable forms” of SPD

Answer 25

One related to bizarre/magical thinking

One related to social isolation and lack of comfort with people

Question 26

Predisposing genetic syndrome for schizotypal personality disorder

Answer 26

Females with fragile X syndrome

Question 27

Treatment of schizotypal personality disorder

Answer 27

• It is important that clinicians not ridicule or be judgemental about the patient’s magical beliefs
• Once rapport and trust have been established, a low-dose antipsychotic (often second generation) can be used to reduce magical thinking and odd beliefs
• Group therapy is also helpful in allieviating social anxiety and awkwardness common among these patients
• Supportive psychotherapy is also beneficial

Question 28

What % of the general population has a personality disorder of some sort?

What % of the outpatient psychiatric population?

Answer 28

General population: 9-16%

Outpatient psychiatric population: 30-50%

Question 29

What distinguishes paranoid personality disorder from paranoid schizophrenia?

Answer 29

Two things:

1. Paranoid personality is persistent and pervasive, while paranoid schizophrenia may be episodic
2. Paranoid personality does not have psychotic features (no true delusions or hallucinations), just pervasive suspicion

Question 30

Ideas of reference

Answer 30

A person’s false belief that people are talking about him or her

Question 31

Paranoid ideation

Answer 31

Suspiciousness that is abnormal, but less than delusional in nature

Question 32

Patients with paranoid personality are prone to. . .

Answer 32

. . . angry outbursts

This can make them look a lot like borderline personality! This is why understanding the motives for the angry outburst is very diagnostically important.

Question 33

Treatment of Paranoid personality disorder

Answer 33

Supportive psychotherapy with an emphasis on establishing a therapeutic relationship and intermittent reality testing is the best approach. Be low-key, but don’t be too friendly, because that will make them suspicious.

True paranoid delusions suggest another diagnosis, but if present should be treated with antipsychotics. Sometimes patients with paranoid personality can have brief psychosis, but psychosis should not be a pervasive, persistent feature.