Cluster A Personality Disorders Flashcards
Schizoid Personality Disorder
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.
Alloplastic defenses
Defenses used by patients who react to stress by attempting to change the external environment, for example, by threatening or manipulating others
Autoplastic defenses
Defenses used by patients who react to stress by changing their internal psychological processes.
Ego-dystonic vs -syntonic
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.
Intellectualization
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.
Features of a personality disorder
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.
Personality disorder clusters
A: Odd and eccentric (Schizoid, Schizotypal, Paranoid)
B: Dramatic and erratic (Histrionic, Narcissistic, Antisocial, Borderline)
C: Anxious and timid (OBPD, Avoidant PD, Dependent PD)
Projection
Defense mechanism by which individuals deal with conflict by falsely attributing to another their own unacceptable feelings, impulses, or thoughts.
Schizoid Fantasy
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.
SIR SAFE mnemonic for Schizoid personality
- Solitary
- Indifferent to praise or criticism
- Relationships (not interested)
- Sexual experiences (not interested)
- Activities (not enjoyed)
- Friends (lacking)
- Emotionally distant
Although schizoid persoanlity patients may have robust fantasy lives and appear as odd, they do not. . .
. . . have evidence of frank psychosis
Schizotypal vs Schizoid personalities
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.
OCPD and Avoidant vs Schizoid personalities
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
Treatment for schizoid personality disorder
Psychotherapy is first-line, although most patients will prefer no therapy
Group therapy is also an option.
Sublimation
Defense mechanism where an individual transforms an unacceptable impulse into a socially acceptable behavior (aggression into sports, etc)
Undoing
Defense mechanism in which something is done to symbolically cancel or reverse a perviously unacceptable act or thought.
Avoidant personality vs Schizoid personality
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.
Personality disorders and family history of schizophrenia
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.
Patients with schizotypal personality tend to exhibit flamboyantly odd behavior, such as engagement with. . .
. . . the occult, witchcraft, the paranormal
Patients with mild autism vs Schizoid patients
PAtients with mld autism may resemble schizoid patients, but have more severely impaired social interactions and the presence of stereotyped behaviors.
Psychosis in patients with schizotypal personality disorder
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.
Denial vs psychotic denial
Denial: obvious definition
Psychotic denial: When there is gross impairment of reality testing associated with this denial.
Derealization
A feeling that the world, or reality, has changed. The environment feels strange of unreal.
Family history and Schizotypal PD
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
“Two heritable forms” of SPD
One related to bizarre/magical thinking
One related to social isolation and lack of comfort with people
Predisposing genetic syndrome for schizotypal personality disorder
Females with fragile X syndrome
Treatment of schizotypal personality disorder
- 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
What % of the general population has a personality disorder of some sort?
What % of the outpatient psychiatric population?
General population: 9-16%
Outpatient psychiatric population: 30-50%
What distinguishes paranoid personality disorder from paranoid schizophrenia?
Two things:
- Paranoid personality is persistent and pervasive, while paranoid schizophrenia may be episodic
- Paranoid personality does not have psychotic features (no true delusions or hallucinations), just pervasive suspicion
Ideas of reference
A person’s false belief that people are talking about him or her
Paranoid ideation
Suspiciousness that is abnormal, but less than delusional in nature
Patients with paranoid personality are prone to. . .
. . . 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.
Treatment of Paranoid personality disorder
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.
