Schizoid PD

Mnemonic “Sir Safe”

Solitary Indifferent to praise and criticism Relationships of little interest Sexual experiences not of interest Activities preferred are solitary Friendships are few Emotionally cold and detached

DSM IV – Essential Features

detachment from social relationships

restricted range of emotions

DSM-V

Very low base rates No stats in DSM on prevalence Prevalence rates vary (.5 to 7%)

Not well-studied

Eliminated from DSM-V?

ICD-10 Criteria detachment, aloofness, coldness,

solitude little interest in sexual relationships fondness for fantasy and introspection

indifference to others lack of close friends insensitivity to social norms

Schizoid Style

Retiring (Millon, 1994)

Solitary (Oldham and Morris, 1995)

History Hoch (1910) - “shut-in” personality

Kraepelin (1920s) – comparison to autism

Bleuler (1924) - coined – “schizoidie”

schizophrenia was characterized by 1) autistic thinking, 2) loose associations, 3) disturbed affect, 4) ambivalence

if one of these characteristics - schizoid

History

Kretschmer (1925) – two types

overly sensitive (hyperaesthetic - AVD)

insensitive (anesthetic - SZD)

History

SZD past was an amalgam of the schizoid, avoidant and schizotypal PDs

DSM-III – 3 parts avoidant (Millon) schizoid (Bleuler) schizotypal (Rado)

Clinical Observations

Compulsive masturbation Autistic thinking Fragmented self-identity Depersonalization/Derealization

Primitive Defenses - splitting

Associated Features do not desire emotional intimacy rarely marry (particularly men) activities involve intellectual abstraction bland, lack social graces still can function in society take jobs with little person contact

Associated Features difficulty expressing anger lives seem directionless and a drift deficient motivation

poor peer relations underachievement at school lacks interest in hobbies humorless

might be creative

Etiology debatable link to schizophrenia introversion is a highly inheritable trait

lack the emotional equipment to display emotions?

cold distant caregivers? overinvolved and overinvested parents?

Hoek et al. (1996) found an association between 1st trimester famine and SZD

5 “schizo” disorders

(1) schizophrenia (2) schizophreniform (3) schizoaffective (4) schizotypal (5) schizoid

Comorbidity and Differential Diagnosis

co-occurs with SZT, PAR, AVD

Millon proposes 4 subtypes affectless (SZD with COM) depersonalized (SZD with SZT) languid (SZD with DPR) remote (SZD, AVD, SZT)

Media Examples

The Net – Sandra Bullock Batman Mad Max – Mel Gibson Clint Eastwood westerns Zero Effect – Darrel Zero

Interview Themes boring do not feel uncomfortable in the

interview interviewer can’t feel the connection radiate little emotional warmth

tend to give yes or no short responses to questions

responses tend to lack detail tone of their voice rarely changes

Interview Themes

Withdrawn and reclusive Works below potential Observer, not a participant Robotic Aloof, distant, constricted

emotions

Assessment

0

30

60

90

120

150

180

210

240

270

300

330

0 11 SDFPAR

AVD

HIS

DEPSZD

ANT

NAR

Assured-Dominance

Unassured-Submissive

Warm-Agreeable

Cold-Hearted

Gregarious-Extraverted

Unassuming-Ingenuous

Aloof-Introverted

Arrogant-Calculating

N E O A CSZD L

AVD H L

DEP H

HST H

NAR H h

ANT L L

COM h

SZT H L l

BDL H l l

PAR h L

See commentary below slide to understand letters and numbers

Treatment

1) major clinical syndrome (i.e., depression)

2) some major life change and the parents or spouse of the individual recommend therapy

Treatment Few studies

Beck and Freeman (1990) Increase social contact Learn how to identify emotions Group therapy

Roles of drug therapy is an open question

Schizotypal PD

Mnemonic Unusual perceptions, Friendless Odd beliefs, thinking and speech,

superstitiousness interest in paranormal, astrology, UFOs,

abductions

Affect is inappropriate or constricted Ideas of Reference Doubts others - suspicious. paranoid Eccentric appearance and behavior avoid eye contact, unkempt clothes (ill-fitted,

stained) - hair style, amulets, charms Reluctant in social situations

History Kraepelin (1920s) relatives of Schizophrenic patients had traits

Bleuler (1924) described latent and simple schizophrenia parallels with SZT

Rado (year ?) - coined SZT

History

DSM-III (1980) - first listed as disorder

discomfort in close relationships cognitive or perceptual distortions eccentricities of behavior

Media Examples

Travis Bickle in film Taxi Driver

Interview Themes

seek treatment because of:

a) an acute stressor b) psychosis - minutes to hours c) other Axis I condition

mood or anxiety depression, dysthymia, social phobia,

GAD

Themes

ideas of reference emotional reasoning,

suspiciousness premonitions alternative/fringe interests magical thinking erratic progress in life

Epidemiology

3% of general population

slightly more common among males

an individual's culture needs to be considered speaking in tongues

Differential Diagnosis Schizophrenia

1) delusions

2) hallucinations

3) disorganized speech loose associations, non understandable

4) grossly disorganized or catatonic behavior

5) negative symptoms

Schizotypal

acute discomfort in close relationships

cognitive or perceptual distortions

eccentricities of behavior

Schizophrenia

Delusional DisorderSchizoaffective

schizophreniform

Shared Psychotic Brief Psychosis

Boundaries of Schizophrenia

Differential Diagnosis

Schizophrenia Spectrum

Normal Introversion

schizoid schizotypal schizophrenia

Schizotypal

PAR

SZD

BDL

AVD

Boundaries of Schizotypal

Assessment

N E O A CSZD L

AVD H L

DEP H

HST H

NAR H h

ANT L L

COM h

SZT H L l

BDL H l l

PAR h L

See commentary below slide to understand letters and numbers

MMPI – Three Point Codes

2-7-8 profile