Three personality disorder- paranoid, schizoid, and schizotypal share common features that resemble some of the psychotic symptoms seen in schizophrenia. These odd or eccentric personality disorders are described next.
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Paranoid Personality Disorder.
Although it is probably adaptive to be a little wary of other people and their motives, being too distrustful can interfere with making friends, working with others, and, in general, getting through daily interactions in a functional way. People with paranoid personality disorder are excessively mistrustful and suspicious of others, without any justification. They assume other people are out to harm or trick them; therefore, they tend not to confide in others.
The defining characteristic of people with paranoid personality disorder is a pervasive unjustified distrust. People with paranoid personality disorder are suspicious in situations in which most other people would agree their suspicions are unfounded.
Suspiciousness and mistrust can show themselves in a number of ways. People with paranoid personality disorder may be argumentative, may complain, or may be quiet. This style of interaction is communicated, sometimes nonverbally, to others, often resulting in discomfort among those who come in contact with them because of this volatility. Having this disorder increases the risk of suicide attempts and violent behavior, and these people tend to have a poor overall quality of life.
Diagnostic Criteria for Paranoid Personality Disorder.
A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights.
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.
Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “paranoid personality disorder (premorbid).”
Causes.
Evidence for biological contributions to paranoid personality disorder is limited. Some research suggests the disorder may be slightly more common among the relatives of people who have schizophrenia, although the association does not seem to be strong. In general, there appears to be a strong role for genetics in paranoid personality disorder.
Psychological contributions to this disorder are even less certain, although some interesting speculations have been made. Retrospective research, asking people with this disorder to recall events from their childhood. It suggests that early mistreatment or traumatic childhood experiences may play a role in the development of paranoid personality disorder.
Cultural factors have also been implicated in paranoid personality disorder. Certain groups of people, such as prisoners, refugees, people with hearing impairments, and older adults, are thought to be particularly susceptible because of their unique experiences.
Treatment.
Because people with paranoid personality disorder are mistrustful of everyone, they are unlikely to seek professional help when they need it and they have difficulty developing the trusting relationships necessary for successful therapy. Because they are suspicious and untrusting, patients with this disorder are not likely to seek therapy on their own. A particularly disturbing development or life crisis may prompt them to get help. More often, however, the legal system or the patient’s relatives order or encourage him or her to seek professional treatment.
Psychotherapy: The primary approach to treatment for such personality disorders is psychotherapy . The problem is that patients with paranoid personality disorders do not readily offer therapists the trust that is needed for successful treatment. As a result, it has been difficult to gather data that would indicate what kind of psychotherapy would work best. Therapists face the challenge of developing rapport with someone who is, by the nature of his personality disorder, distrustful and suspicious.
Medications: With individual supportive psychotherapy is the treatment of choice for this disorder, medications are sometimes used on a limited basis to treat the symptoms In addition, during periods of extreme agitation and high stress that produce delusional states, the patient may be given low doses of antipsychotic medications.
Schizoid Personality Disorder:
Schizoid personality disorder is one of a group of conditions called eccentric personality disorders. People with these disorders often appear odd or peculiar. People with schizoid personality disorder also tend to be distant, detached, and indifferent to social relationships. They generally are loners who prefer solitary activities and rarely express strong emotion. Although the names sound alike and they might have some similar symptoms, schizoid personality disorder is not the same thing as schizophrenia. Many people with schizoid personality disorder can function fairly well. They tend to choose jobs that allow them to work alone, such as night security officers and library or laboratory workers.
Diagnostic Criteria for Schizoid Personality Disorder.
A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions
in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little, if any, interest in having sexual experiences with another person.
4. Takes pleasure in few, if any, activities.
5. Lacks close friends or confidants other than first-degree relatives.
6. Appears indifferent to the praise or criticism of others.
7. Shows emotional coldness, detachment, or flattened affectivity.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition.
Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizoid personality disorder (premorbid).”
Symptoms
- Detachment from other people.
- Little or no desire to form close relationships with others.
- Rarely participates in activities for fun or pleasure.
- A sense of indifference to praise and affirmation, as well as to criticism or
rejection. - Often described as cold, uninterested, withdrawn, and aloof
- Difficulty in relating with others
- Don’t desire any close relationship even with family members
- Aloof from any emotion
- Suffering from daydream and create vivid fantasies of complex inner lives.
Causes
The schizoid personality disorder has its roots in the family of the affected person. These families are typically emotionally reserved, have a high degree of formality, and have a communication style that is aloof and impersonal. Parents usually express inadequate amounts of affection to the child and provide insufficient amounts of emotional stimulus. This lack of stimulus during the first year of life is thought to be largely responsible for the person’s disinterest in forming close, meaningful relationships later in life.
People with schizoid personality disorder have learned to imitate the style of interpersonal relationships modeled in their families. In this environment, affected people fail to learn basic communication skills that would enable them to develop relationships and interact effectively with others. Their communication is often vague and fragmented, which others find confusing.
Treatments.
Psychodynamically oriented therapies: A psychodynamic approach would typically not be the first choice of treatment due to the patient’s poor ability to explore his or her thoughts, emotions, and behavior. When this treatment is used, it usually centers around building a therapeutic relationship with the patient that can act as a model for use in other relationships.
Cognitive behavioral therapy: Attempting to cognitively restructure the patient’s thoughts can enhance self insight. Constructive ways of accomplishing this would include concrete assignments such as keeping daily records of problematic behaviors or thoughts.
Group therapy: Group therapy may provide the patient with a socializing experience that exposes them to feedback from others in a safe, controlled environment. It can also provide a means of learning and practicing social skills in which they are deficient.
Family and marital therapy: It is unlikely that a person with schizoid personality disorder will seek this therapy. Many people with this disorder do not marry and end up living with and are dependent upon first-degree family members.
Medications: Some patients with this disorder show signs of anxiety and depression which may prompt the use of medication to counteract these symptoms. In general, there is to date no definitive medication that is used to treat schizoid symptoms.
Reference,
David H. Barlow, V. Mark Durand. Abnormal Psychology, An Integrative Approach. (7th ed).