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Schizotypal personality disorder

Schizotypal personality disorder. This is similar to schizoid personality with the additional features of strange or eccentric looking, having oddities of perception and communication, odd word usages. Schizotypal personality disorder is the one personality disorder that we know to be genetically linked to schizophrenia. In fact it was created out of the Danish adoption studies found a group of people with this symptom cluster who were much more heavily concentrated in the biological relatives of schizophrenics. These are people who have milder forms of psychotic-like symptoms, derealization, ideas of reference, perceptual illusions. Many of them will feel that they have special powers. Thereís the woman with the crystal ball. In an interview, schizotypal people will be withdrawn like schizoid individuals, but their speech is often quite peculiar. Theyíll use words in odd ways. Theyíll express ideas un-clearly. Again, the major defense of this disorder is a withdrawal into fantasy. The diagnostic criteria emphasizes a pervasive pattern of deficits in interpersonal relatedness and peculiarities of ideation, of appearance and behavior. So they will look funny, they think funny, they act funny and look funny.

In terms of prevalence: there are estimates again from epidemiologic studies of between 2-6% of the population, which is fairly high. Relatively little is known about the long-term course and prognosis of the disorder, although it appears to be chronic.

Differential diagnosis. You want to think about schizoid personality disorder; schizoid individuals donít show the oddities of speech and perception and the quasi-psychotic-like symptoms. The schizotypals are not frankly psychotic in the way that schizophrenic individuals are. Borderline personality disorder surprisingly overlaps the schizotypal personality disorder more than one might think. Because there are many borderline individuals who have oddities of perception and speech and behavior, but borderline individuals are much more likely to have intense, stormy interpersonal relationships, while schizotypal individuals are more likely to have a very restricted range and non-emotional relationships.

Histrionic personality disorder is the grandchild of the diagnosis of hysteria. Hysterical people are typically imaginative, often with well-developed emotional intuition. They tend to look at the world in over impressionistic terms rather than focusing on details, so they tend to be headline readers. They gravitate toward activities that donít necessarily involve concentration for long hours on facts and details, but they are often very creative and colorful. Histrionic personality disorder is really hysteria run amok. Itís hysterical personality traits carried to an extreme that is maladaptive. Histrionic individuals can be quite colorful and outgoing. They are highly excitable. They have difficulty maintaining deep and lasting relationships and they often use displays of emotion to control other people, so that the emotion is not necessarily genuine but used to get attention, to avoid unwanted responsibilities. Histrionic individuals often have temper tantrums, they are often quite fickle in their affections. So someone can be their closest friend one day and then be of no importance the next. They can often be quite seductive. The appearance is that this is for sexual purposes but often this is to seduce lovers into situations where they histrionic individual will then be taken care of.

Diagnostic criteria involve a pattern of excessive emotionality and attention-seeking, with demands for reassurance, inappropriate sexual seductiveness, over-concern with physical attractiveness.

In terms of defense mechanisms, the primary defense mechanisms used by the histrionic are repression. For example, repression of ideational contents so that all that is left over is affect. A histrionic individual will feel flooded by affect but not know why. Histrionic individuals have quite a bit more non-specific somatic complaints, than do people in the general population.

In terms of the etiology, psychodynamic theorists again point to the disturbances in the parent-child relationship that underlie this disorder. But there is also a possible association between histrionic personality disorder and antisocial personality disorder. Perhaps both represent a manifestation of the same temperamental style. Histrionic personality disorder is much more frequently diagnosed in women. Antisocial personality disorder is more frequently diagnosed in men. There is little information on the prevalence of this disorder because many people with this disorder do not come to psychiatric attention.

Course and prognosis. This disorder is thought to improve with advancing age. That continually peopleís defenses become somewhat more adaptive as they begin to see that the dramatic displays lose their effectiveness over time.

In terms of differential diagnosis, the main differential is between histrionic personality disorder and borderline personality disorder. They are quite similar in their overt manifestations, dramatizations, seductiveness, attention-seeking. But the borderline individuals generally feel chronically empty. They have profound identity disturbance. They are more likely to experience brief psychotic episodes and particularly - this is the hallmark - they are more likely to engage in overtly self-destructive acts. Again, there is tremendous overlap. Whether we call someone histrionic or borderline may have a lot to do with just the extent of their history of self-destructiveness. Somatization disorder is another thing to think about in the differential but people with somatization disorder often donít have the emotional interests that people with histrionic personality disorder do.

In terms of treatment, insight-oriented psychotherapy seems to be the treatment of choice for histrionic individuals. Both individual and group therapy have been found to be useful. Essentially the therapist works on helping histrionic individuals clarify what they genuinely feel, clarify ways in which they lose functioning, in which they lose cognitive capacity as a way to seek help and avoid responsibility. And help individuals take more responsibility for the consequences of their actions.

Narcissistic personality disorder. Narcissus was by legend a beautiful Grecian youth who fell madly in love with his own reflection when he happened to see it reflected in a pool one day. Narcissism refers to self-love, and loving self regard is something that is both desirable and necessary in ones inner world. It is only when the absorption of the self impairs oneís ability to form lasting relationships do we call it pathological. And crippling self-doubt and insecurity that is involved in pathological narcissism is a far cry from what we would consider simple self-regard. People with narcissistic personality disorder have severe problems in maintaining a realistic sense of their own worth. And thatís thought to lie at the core of this disorder, and all symptoms seem to build upon that. They generally set goals and make demands of themselves that are unrealistic. They will often then feel inadequate and helpless when they donít meet those standards. They constantly crave love and attention and admiration from other people as a means of bolstering their unstable self-esteem. Their demands for love and praise can be insatiable. They are likely to fly into a rage when these demands are not met. They are exquisitely sensitive to perceived slights from the people.

The narcissistic person struggles with a tenuous balance between the intensity to be admired by other people and the rage that he or she feels when people are disappointing and donít provide the admiration that is needed. The narcissistic individual often starts out by idealizing other people only to come to devalue them when they reveal themselves to have feet of clay. Of course, this is