Schizotypal Personality Disorder Traits

Schizotypal Personality Disorder TraitsTo those who determine themselves in turn over with schizotypal individuals they a lot range searchming eccentric and aberrant to outright anomalous in their actions. Their demeanor is clearly erratic. School and employment histories of these individuals show label deficits and irregularities. Not tho be they frequent dropouts, simply they drift from angiotensin converting enzyme generator of employment to another. If married, they argon a great deal separated or divorced.At times, their behavior appears eccentric, that is, they prefer loving closing off and whitethorn engage in activities that other find curious. In more monstrous cocktail dresss, their behavior may seem clearly bizarre. The presence of odd vernacular patterns is an example. Schizotypal individuals may verbally digress or be enumerate metaphorical in their chations. According to the DSM-III, Often, speech shows marked mirthfulities concepts may be express ed unclearly or oddly or words used deviantly, but never to the point of loosening of associations or incoherence (Ameri put up Psychiatric Association, 1980, p. 312)Interpersonal ConductInterpersonally, schizotypals bring forth a animation of isolation, with minimal personal attachment and obligations. As their lives happen it is not fantastic to find these individuals drifting into increasingly superficial and peripheral sociable and vocational roles. These individuals have virtually no close friends or confidants. They have immense difficulty with face-to-face fundamental interaction. They comm notwithstanding experience intense societal disturbance at relatively minimal accessible challenge. For these reasons, we recall the social deal out of schizotypals may be categorized as ranging from being interpersonal detacted and secretive to in entranceible.Cognitive StyleThe cognitive style of schizotypal individuals may be reflective and autistic in slight severe varia tions to blatantly deranged in more severe wee-wees of the ail. The cognitive slippage and interference that characterize the thought processes of this trouble in its milder forms are simply amplified here. Schizotypals are frequently unable to sharpen their thoughts logically. They black market to become lost in a plethora of irrelevancies. Their idea appears scattered and autistic as the distemper manifests itself in its more severe variations.According to the DSM-III, these individuals may report magical mentation (i.e., clairvoyance, telepathy, a 6th star, or just extreme superstitious behavior). Similarly schizotypals may experience recurrent illusions where they report the presence of a person or twinge not actually there. Psychotic thought, when it does occur, is transient and not indicative of a diagnosis of schizophrenia.Affective ExpressionThe deficient or disharmonious imprint of umpteen of these patients deprives them of the capacity to relate to plurality, places, or things as anything but now and invigorationless phenomena. Their affective expression ranges from being apathetic to insentient and deadened. On the other return, some schizotypal individuals seem in a constant soil of agitation. Their affective expression ranges from being apprehensive, perhaps plane frantic in their affective expression. We will present more on these clinical variations later.Self-PerceptionSchizotypal individuals ofttimes view themselves as forlorn and lacking meaning in life or, in more severe cases, on introspection, they may see themselves as vacant. They may experience recurrent feelings of emptiness or of estrangement. Experiences of depersonalization and dissociation may in like manner be present in these patients. In sum, schizotypals appear virtually self-less as they look inward towards self-appraisal.Primary Defense machineThe schizotypal personality bother is characterized by extreme social and affective isolation as well as autist ic and bizarre cognitive functioning. The defence reaction mechanism comm unless used by individuals who possess this disorder is undoing. untying is a self-purification mechanism in which individuals attempt to repent for some hateful behavior or evil motive. In effect, undoing even ups a form of atonement. In severly pathological forms, undoing may take the form of labyrinthine and bizarre rituals, or magical acts. These rituals, such as compulsive hand washing, are designed to cleanse or purify the individual. These compulsions not only cause these individuals rawness, but they may also consciously recognize them as absurd. Nevertheless, individuals employing such a mechanism appear to have lost the king to control these acts as well as the ability to see their authoritative meaning.Differential Personality DiagnosisThe schizotypal personality disorder is likely to be confused with another severe personality disorder, the boundary line disorder. Both the schizotypal and the marginal patterns represent severe personality disorder. Furthermore, according to the present biosocial learning theory, they both emerge when the less severe personality variants decompensate. Yet, there are marked differences in these two disorders.The schizotypal disorder features schizophrenic-like symptoms. These symptoms reflect disturbances in cognitive processes. Thus, the schizotypal is characterized by perceptual pathology as well as social withdrawal and isolation.The well-nigh obvious feature of the borderline disorder, on the other hand, is instability of mood. The symptoms of the borderline reflect disturbances in affect rather than cognitive. Finally, the borderline individual is interpersonally dependent, inappropriate the socially isolated schizotypal.A final note should be make regarding the schizotypal disorder in contrast to the Axiz I schizophrenic disorders. Axis I disorders are characteristically more severe and of relatively shorter duration. The Axi s II schizotypal disorder represents the operation of internal, ingrained, and more enduring defects in the patients personality. Although schizophrenic episodes often reflect a psychosocial stressor, the schizotypal disorder represents an cardinal and persistent characterological pattern.CLINICAL VARIATIONSThe exposition of the schizotypal personality disorder presented in the previous section portrays the generic aspects of this disorder. It is more common, however, to see the schizotypal pattern manifest itself in one of two major(ip) variations. The two major clinical variations of the schizotypal disorder are (1) the schizotypal- schizophrenic pattern and (2) the schizotypal-avoidant pattern.Schizotypal-Schizoid divisionSchizotypal-schizoid individuals are characteristically drab, sluggish, and inexpressive. They dis dissemble a marked deficit in their affective expression and appear bland, untroubled, indifferent, and unmotivated by the outside world. Their cognitive proces ses seem obscure and unknown. Such individuals seem unable to experience the astute emotional aspects of social exchange. Interpersonal conferences are often vague and confused. The speech pattern of these individuals tend to be monotonous, listless, or at times, inaudible. close people consider these individuals as strange, curious, aloof, and lethargic. In effect, they become background people satisfied to live their lives in an isolated, secluded manner. Case 11.1 portrays such an individual.Schizotypal-Avoidant mutantSchizotypal-avoidant individuals are restrained and isolated. Similarly, they are apprehensive, guarded, and interpersonally withdrawing. As a protective device, they attempt to eliminate their own desires and feeling for interpersonal affiliation, for they expect only rejection and torture from interacting with others. Thus, apathy, indifference, and impoverished thought, which we saw in the cognitive and affective insensitivity, is presented here as a resul t of an attempt to dampen an intrinsic oversensitivity. The case of Harold T. is a study of a schizotypal-avoidant individual.SELF-PERPETUATION OF THE SCHIZOTYPAL PERSONALITY DISORDERThe prognosis for the schizotypal personality disorder is perhaps the least promising of all the personality disorder discussed in this text. Let us examine why.The self-perpetuating handbuild of deterioration that occurs in the schizotypal disorder is fostered by three major factors (1) social isolation, (2) dependency training, and (3) self-insulation.Social isolationIndividuals who possess the schizotypal disorder are often segregated from social contact. They are kept at home or hospitalized with minimal encouragement to progress on a social basic. Social isolation such as this serves not to perpetuate the difficulties these individuals have with cognitive organization and social skills, but also serves to worsen the status of both. In many instances, the social isolation seems to stimulate a regr ession on the interrupt of these individuals. They will tend to lose what cognitive and social abilities they may have had before the isolation. Jane W. was clearly capable of returning to society if she had been provided adequate social support. Without such support, the only option was to keep her institutionalized.Dependency TrainingOften found in conjunction with social isolation is the tendency on the part of those near schizotypal individuals to be also protective. They will tend to patronize or bilk them. Such overprotection tends to reinforce dependent behavior on the part of the schizotypal. According to Millon (1981), Prolonged guidance and shielding of this kind may lead-in to a progressive impoverishment of competencies and self-motivation, and result in a fare helplessness. Under such ostensibly good regimens, schizotypals will be reinforce to learn dependency and apathy (p. 427).Self-InsulationFinally, not only done misdirection and neglect will the schizotypa l disorder be perpetuated, but also through the tendency of these individuals to insulate themselves from outside stimulation. As we described earlier, to protect themselves from pestiferous humiliation, rejection, or excessive demands, schizotypals have learned to withdraw from universe and retire themselves from social life. nevertheless though exposed to active social opportunities, nearly of these individuals will participate only reluctantly. They prefer to keep to themselves-to withdraw. Without active social kinds, these individuals will simply recede further into social isolation, apathy, and dependency. Thus, the disorder is perpetuated.The case of Harold T. demonstrates a condition in which his ability to insulate himself has served as an hard-hitting barrier to rehabilitation. His apathy, lack of verbal communication, and habit of drawing strange and religiouslike pictures has in effect insulated him from other and has removed any hope of improvement for almost 10 years.So, in summary, we see that through social isolation, dependency training, and self-insulation, the schizotypal disorder is perpetuated. Although the motives for socially isolating and overprotecting these individuals are usually good, that is, with best interests of the patient in mind, the tactical maneuver are actually counterproductive for they deprive the patients of the opportunity to develop social skills while reinforcing dependency. The schizotypals own tendency to insulate himself/herself from social contact serves to change the disorder even further. Such self-insulation serves to foster and further perpetuate the spiral of cognitive and social deterioration that typifies the schizotypal disorder.Schizotypal Personality Disorder DSM-IV CriteriaA distributive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and accentricities of behavior, be ginning by early due date and present in a variety of contexts, as indicated by five (or more) of the followingIdeas of reference (excluding delusions of reference)Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or sixth aesthesis in children and adolescents, bizarre fantasies or preoccupations)Unusual perceptual experiences, including bodily illusionsOdd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)Suspiciousness or insane ideationInappropriate or constricted affectBehavior or appearance that is odd, eccentric, or peculiarLack of close friends or confidants other than first-degree relativesExcessive social fretfulness that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments virtually selfReproduced with permission from the Diagnostic and Statistical Manual of Mental Disorders, fourthly Edition. Copyright 1994 American Psychiatric Association.TherapyThe schizotypal is perhaps one of the easiest personality disorders to divulge but one of the most difficult to treat with psychotherapy. The thought disorder and accompanying paranoid ideation work to distort communication between healer and client and inhibit the formation of a trusting cure alliance. Moreover, because schizotypals are inherently isolative and nonrelational, the therapist may sometimes be experienced as an intrusive presence. Because the alliance is the very foundation of therapy, medication is often call for before lasting progress can be made, curiously with champaigns who express the disorder severely.THERAPEUTIC TRAPSThe expectations of the therapist and their influence on therapy are oddly all important(p) and may require careful monitoring. Most schizotypals initially see the therapist as attacking or humiliating ( asa dulcis, 1996). As anxiety increases, t hey may retreat further behind a curtain of upset communication as a means of shielding themselves and confusing the intruder. passing(a) retreats are universal. Therapists who become vexed when greeted with silence and emotional distancing only require an atmosphere that justifies such a reaction.Instead, the need for distance must be respected, without conveying feelings of disapproval or inducing guilt, to which many subjects are especially sensitive. Not pushing too hard or too sporting can stay severe anxiety and paranoid reactions. Extraordinary diligence may be required because schizotypals repeatedly misperceive aspects of the therapeutic relationship and and so act on these misperceptions. Subjects who believe they have privileged access to information beyond the five senses sometimes apply their extrasensory powers to therapy and the therapist, accept that they can read the therapists mind or arrive at conclusions just more or less what the therapist secretly desi res on the basic of tangential or irrelevant cues.Accordingly, communication should be simple, straightforward, shorn of psychological jargon, and require a minimm of inference. Schizotypals find it difficult enough to bring order to their own thoughts, much less penetrate ambiguities and double messages carelessly introduced by others. The concrete is to be prefer over the poetic because the latter is naturally rich in connotations, which play havoc with schizotypal cognition. Special attention to the countertransference is in order, for unconscious feelings emitted by the therapist bring an unknown complexity to communication and are especially likely to be misconstrued by subjects.STRATEGIES AND TECHNIQUESWhat can be done in therapy often depends on the extent to which the thought disorder intrinsic to the syndrome can be controlled. Otherwise, every aspect of therapy becomes more complicated. Further, the appropriate goals and strategies for any particular subject depend on whe ther his or her symptoms most resemble an exaggerated schizoid pattern, an exaggerated avoidant pattern, or a mixture of the two. Strategies and techniques appropriate for the dominant underlying personality disorder can be used to supplement the first-string goals of treating the schizotypal pattern (refer to the appropriate chapter).Establishing a more normal pattern of interpersonal relationships is a primary goal of therapy. Social isolation intensifies cognitive deficits and allows social skills to atrophy. Contatc with a therapist can prevent further deterioration. Because patterns of disordered family communication typify the early developmental environment of these subjects, therapy offers the chance for a novel, disciplinal interpersonal relationship through steady support and euthenticity.Accordingly, as accent by Benjamin (1996), the basic skills of humanistic therapy, including accurate empathy, mirroring, and unconditional authoritative regard, become particularly i mportant. Benjamin states that the therapeutic alliance may represent a chance to experience a nonexploitive protectiveness, one that eventually permits the schizotypal to touch up management of the universe by magical means (p. 360). later an alliance has been established, subject can be encouraged to voice distortions of reality as they occur, and these can be discussed in the context of the therapeutic relationship.Benjamin (1996) further stresses that many schizotypals are likely to belive that harm may come to the therapist through their association. As such ideas are voiced, they can be tested realistically and tactfully refuted. In general, interpersonal therapy should enhance subjects sense of self-worth and encourage the realization of positive attributes, an important step in defeating detachment, build motivation, and providing confidence necessary to take the first steps toward constructive social encounters outside therapy. Because schizotypals have difficulty sortin g the relevant and irrelevant in interpersonal relationships, therapists may find that much of their time is spent dowery the schizotypal test interpersonal reality and gain perspective on which behaviors aptitude be appropriate in whatever situations are current in the subjects life. Repeated discussions of essentially similar situations may be necessary, as many schizotypals fail to realize that these are but variations on a theme. staple fibre social skills training are often helpful. Modeling behaviors provides an example that even concrete subjects can imitate. The ability to appraise interpersonal realities appropriately is an important step in decreasing social anxiety and accompanying paranoid symptoms while creating a capacity for appropriate affect and a sense of reward.From a cognitive perspective, psychotherapy must adapt to the schizotypals limited attentional resources and tendency to intrude tangential factors. Because many schizotypals are either overly concrete o r overly abstract, learning may be infer to other settings and situations only with great difficulty. Simplicity and structure help prevent the lessons of therapy from being obscured by the discombobulating effects of thought disorder. Furthermore, cognitive techniques allow the discipline of thought to be identified and eventually modified. This suggests that the combination of medication and cognitive therapy should be particularly effective.Writing in Beck et al. (1990), Ottaviani indicates that the first step is to individualism characteristic automatic thoughts, such as, I am a nonbeing, as well as patterns of emotional reasoning and personalization, reviewed previously. Moreover, she suggests that assumptions underlying social interaction present an especially profitable avenue for change, as schizotypals usually believe that other dislike them. Subjects must be taught to act as nave scientists and test their thoughts against the evidence. Feelings do not make facts instead , each cognition is a hypothesis and should be disregarded if found inconsistent with the mark evidence. as yet bizarre thoughts can be dealt with in this way. The thought, I am loss my body, for example, can be countered with prepared countercognitions There I go again. Even though Im thinking this thought, it doesnt mean that its true (p. 141)Because an effective grasp of objective reality is the Catch-22 of the cognitive approach, Ottaviani further suggests that schizotypals also be taught methods for gathering foreign evidence. Subjects can list evidence inconsistent with their predictions, for example. Going beyond content, cognitive style interventions can also be made. Rambling can be countered by requests for summary statements, and global statements can be countered by asking for elaboration. Finally, where subjects are not too paranoid or bizarre, group settings can be used to practice social functioning and provide feedback about distorted cognitions.Because classica l psychodynamic therapy is inherently unstructured, its use is probably not advised. As noted by Stone (1985), the purpose of psychodynamic therapy should be to internalize the therapeutic alliance. Because the early home environment of most schizotypals is likely to feature break up and chaotic communications, the ego boundaries of the schizotypal subject are only poorly developed. The description of conflict not only disregards their desire for distance but also plays into their fear of engulfment. Accordingly, silence should be accepted as a accepted part of the personality (Gabbard, 1994). Once this acceptance is felt, the subject may then begin to reveal hidden aspects of the self that can be adaptively integrated. uninflected procedures such as free association, the neutral attitude of the therapist, and the focus on dreams may foster an increase in autistic reveries and social withdrawal. belike the most useful analytic suggestion comes from Rado (1959), who suggests that identifying and capitalizing on some source of pleasure, however small, is a superordinate therapeutic goal. Motivation develops from the capacity for pleasure, and ultimately, only this can balance the painful emotions, attach the schizotypal to the real world, and prevent the separation of the self and cognitive disintegration that results from autistic withdrawal.