Paranoid, Schizoid, & Schizotypal Personality Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) identifies ten (10) Personality Disorders. These are then divided into clusters. The first cluster involves Paranoid, Schizoid, and Schizotypal Personality Disorders. Patients with Paranoid, Schizoid, and Schizotypal Personality Disorders are often characterized as having odd or peculiar behaviors.

Paranoid Personality Disorder

Individuals with Paranoid Personality Disorder are described as having a pattern of distrustful and suspiciousness regarding other people’s motives.

The patient with Paranoid Personality Disorder assumes that other people will exploit, harm, or even deceive him; he is consumed with unjustified doubts regarding the loyalty and trustworthiness of friends and associates. The patient is reluctant to confide in people or become close to others fearing that information revealed to new people will be used to harm the patient. Patients often misinterpret meaningless remarks; and instead, hear demeaning and threatening messages. Patients with Paranoid Personality Disorder often hold grudges and are unwilling to forgive perceived insults; they are also quick to act with anger to these perceived insults. The patient may also become overly suspicious of his/her partner’s fidelity and become pathologically jealous without adequate justification.

Patients with Paranoid Personality Disorder are very often difficult to get along with and have problems with close relationships. The patient may appear to be objective, rational, and unemotional but in fact, he often displays emotion in hostile, stubborn, and sarcastic expressions. Patients with Paranoid Personality Disorder need to feel that they are in control of their environment and entirely self-sufficient. They often blame others for their problems and are very critical of other people; on the other side of the coin, they have a lot of trouble accepting criticism. 

Schizoid Personality Disorder

Individuals with Schizoid Personality Disorder are described as avoiding social interaction.

The patient with Schizoid Personality Disorder often appears to lack any desire for intimacy or close relationships. The patient prefers to spend time by himself and is often characterized as being a loner; he prefers solitary activities, hobbies and mechanical tasks, such as computer games. The patient usually does not have any close friends or confidants. He seems to have little interest in sexual experiences with other people. The patient also seems to take little, if any, pleasure in sensory or interpersonal activities. The patient often seems indifferent to the approval or criticism of others. He may also be oblivious to the subtleties of social interaction and may not react appropriately to social cues, leading others to think that the patient is socially inept or superficial and self-absorbed. The patient usually reacts with little or no visible emotion and rarely returns gestures such as smiles or nods.

Patients with Schizoid Personality Disorder often seem directionless. Because of the lack of basic social skills and a lack of desire for sexual experiences, patients rarely have close friends, date very infrequently, and often do not marry. Occupational functioning is often impaired when interpersonal activity is required; not surprisingly, the patient does very well with jobs and projects that involve social isolation. 

Schizotypal Personality Disorder

Individuals with Schizotypal Personality Disorder are described as having a pattern of delusions, hallucinations, and eccentric behavior.

The patient with Schizotypal Personality Disorder is often plagued with incorrect assumptions derived from casual incidents; for example, thinking that the guy who cut you off in traffic did because he knew that it was YOU whom he was cutting off. The patient is often superstitious, believes that he has magical powers over others, and may have perceptual experiences; these superstitions, beliefs, and experiences are usually outside the patient’s cultural norms. The speech and thinking of the patient usually seems vague, metaphorical, over elaborate, or even stereotypical. Hand in hand with this is the odd and often eccentric behavior of the patient; many times, the patients appears to interact with others in stiff and inappropriate ways, dress in ways that does not seem to fit in social norms, and inattention to basic social skills and cues that also add to the equation. The patient will have few, if any, close friends or confidants and will often feel anxious in social situations.

Patients with Schizotypal Personality Disorder often seem gregarious and excessive in their behaviors. Many times, when seeking treatment, the patient will define other symptoms such as anxiety, depression, or other associated features.

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