Unit 4
Unit 4
PERSONALITY DISORDER
Structure
4.0 Introduction
4.1 Objectives
4.2 Schizoid Personality Disorder
4.2.1 Diagnostic Criteria
4.2.2 Causes
4.2.3 Treatment
4.2.4 Prognosis
4.0 INTRODUCTION
In our social interaction we sometimes come across to such persons who are alone,
reserved, socially withdrawn, and seclusive. They choose a solitary walk over an
invitation to a party. Such people rarely express their feelings directly. Since they
show an inability to form social relationship, they typically do not have good friends.
The persons having these characteristics are labeled as suffering from schizoid
personality disorder. On the other hand we sometimes come across to such persons
who are very mistrustful and suspicious of others. Being too distrustful they can
interfere with making friends, working with other. The persons having these
characteristics are labeled as suffering from paranoid personality disorder. In the
present unit we will discuss the meaning, diagnostic criteria of schizoid and paranoid
personality disorders. We will also try to understand the causes and treatment of
schizoid personality disorder and paranoid personality disorder.
4.1 OBJECTIVES
After reading this unit, you will be able to:
Explain the meaning of schizoid personality disorder;
Discuss the diagnostic criteria of schizoid personality disorder;
Distinguish schizoid personality disorder from other mental disorders;
Understand the causes of schizoid personality disorder;
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Explain the treatment of schizoid personality disorder;
Define paranoid personality disorder and explain its symptoms; Schizoid and Paranoid
Personality Disorder
Understand the diagnostic criteria of paranoid personality disorder;
Explain the differential diagnosis of paranoid personality disorder;
Explain the causes of paranoid personality disorder; and
Understand the treatment of paranoid personality disorder.
4.2.2 Cause
The exact causes of schizoid personality disorder are unknown, although a combination
of genetic and environmental factors, particularly in early childhood, are thought to
contribute to development of all personality disorders. 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. Many individuals with schizoid personality disorder feel
misunderstood by others.
A person with schizoid personality disorder may have had a parent who was cold
or unresponsive to emotional needs, or might have grown up in a foster home where
there was no love. Or, because people with schizoid personality disorder are often
described as being hypersensitive or thin-skinned in early adolescence, a person with
schizoid personality disorder may have had needs that others treated with exasperation
or scorn. A family history such as having a parent who has any of the disorders on
the schizophrenic spectrum also increases the chances of developing the disorder.
Some other theorists subscribe to a bio-psychosocial model of causation- that is,
the causes of are likely due to biological and genetic factors, social factors (such as
how a person interacts in their early development with their family and friends and
other children), and psychological factors (the individual’s personality and temperament,
shaped by their environment and learned coping skills to deal with stress). This
suggests that no single factor is responsible — rather, it is the complex and likely
intertwined nature of all three factors that are important. If a person has this personality
disorder, research suggests that there is a slightly increased risk for this disorder to
be “passed down” to their children
4.2.3 Treatment
As with all personality disorders, the treatment of choice for schizoid personality
disorder is psychotherapy. However, people with this disorder are unlikely to seek
treatment unless they are under increased stress or pressure in their life. Treatment
will usually be short-term in nature to help the individual solve the immediate crisis 53
Personality Disorders or problem. The patient will then likely terminate therapy. Goals of treatment most
often are solution-focused using brief therapy approaches. Long-term psychotherapy
should be avoided because of its poor treatment outcomes and the financial hardships
inherent in length therapy. Instead, psychotherapy should focus on simple treatment
goals to alleviate current pressing concerns or stressors within the individual’s life.
Cognitive behavioural therapy, group therapy, family therapy and marital therapy
have been widely used for treating people with schizoid personality disorder.
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 behaviours or thoughts. Another helpful method
can be teaching social skills through role-playing. This might enable individuals to
become more conscious of communication cues given by others and sensitise them
to others’ needs. Group therapy may provide the patient with a socialising 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.
Since the patient usually avoids social contact, timing of group therapy is of particular
importance. It is best to develop first a therapeutic relationship between therapist and
patient before starting a group therapy treatment. It is unlikely that a person with
schizoid personality disorder will seek family therapy or marital therapy. If pursued,
it is usually on the initiative of the spouse or other family member. Many people with
this disorder do not marry and end up living with and are dependent upon first-
degree family members. In this case, therapy may be recommended for family members
to educate them on aspects of change or ways to facilitate communication. Marital
therapy may focus on helping the couple to become more involved in each other’s
lives or improve communication patterns.
4.2.4 Prognosis
Since a person with schizoid personality disorder seeks to be isolated from others,
which includes those who might provide treatment, there is only a slight chance that
most patients will seek help on their own initiative. Those who do may stop treatment
prematurely because of their difficulty maintaining a relationship with the professional
or their lack of motivation for change. If the degree of social impairment is mild,
treatment might succeed if its focus is on maintenance of relationships related to the
patient’s employment. The patient’s need to support him- or herself financially can
act as a higher incentive for pursuit of treatment outcomes.
Self Assessment Questions
1) Discuss the meaning of schizoid personality disorder.
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2) Explain the diagnostic criteria of dependent personality disorder.
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Schizoid and Paranoid
3) How does dependent personality disorder differ from other mental disorders? Personality Disorder
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4) Explain the causes of schizoid personality disorder.
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5) How can schizoid personality disorder be treated? Discuss the methods of
treatment.
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4.3.2 Causes
The specific cause of paranoid personality disorder is unknown, but the incidence
appears increased in families with a schizophrenic member. There seem to be more
cases of in families that have one or more members who suffer from such psychotic
disorders as schizophrenia or delusional disorder (Bernstein et. al., 1993). Although
evidence for biological contribution to paranoid personality disorder is limited, some
studies of identical and fraternal twins suggest that genetic factors may also play an
important role in causing the disorder. Twin studies indicate that genes contribute to
the development of childhood personality disorders, including paranoid personality
disorder (Bernstein et. al., 1995; Kendler et.al 2006).
Psychological and social factors have also been considered for the development in
paranoid personality disorder. Some psychologists point directly to the thoughts of
people with paranoid personality disorder as a way of explaining their behaviour.
One view is that people with this disorder make the following basic mistaken
assumptions about others: “People are malevolent and deceptive,” “They will attack
you if they get the chance” and “You can OK only if you stay on your toes”
(.Freeman, Pretzer, Fleming, & Simon, 1990). This maladaptive way to view the
world results in the development paranoid personality disorder. Paranoid personality
disorder can also result from negative childhood experiences fostered by a threatening
domestic atmosphere. It is prompted by extreme and unfounded parental rage and/
or condescending parental influence that cultivate profound child insecurities. 57
Personality Disorders 4.3.3 Treatment
As it has been stated that people with paranoid disorder are mistrustful of everyone,
they are unlikely to seek professional help when they need it and also have difficulty
developing the trusting relationships necessary for successful therapy. Therapists try
to provide an atmosphere that is conducive to developing a sense of trust (Freeman
et. al., 1990). Cognitive therapy is widely used to counter the person’s mistaken
assumptions about others (Tukat & Maisto, 1985), focusing on changing the person’s
belief that everyone is malevolent and that most people cannot be trusted. Group and
family therapy, not surprisingly, is not of much use in the treatment of paranoid
personality disorder due to the mistrust people with paranoid personality disorder
feel towards others.
As personality is a relatively stable, deeply rooted aspect of self, the long-term
projection for those with paranoid personality disorder is often bleak. Most patients
experience the symptoms of their disorder for their entire life and, in order to manage
their symptoms of paranoia, require consistent therapy (Dobbert 2007, Kantor 2004).
Medication generally is not used to treat paranoid personality disorder. However,
medications, such as anti-anxiety, antidepressant or anti-psychotic drugs, might be
prescribed if the person’s symptoms are extreme, or if he or she also suffers from
an associated psychological problem, such as anxiety or depression.
4.3.4 Prognosis
Personality disorder is a chronic disorder, which means it tends to last throughout a
person’s life. Although some people can function fairly well with paranoid personality
disorder and are able to marry and hold jobs, others are complete disabled by the
disorder. Because people with paranoid personality disorder tend to resist treatment,
the outcome often is poor. Since paranoid personality disorder is often a chronic,
lifelong condition; the long-term prognosis is usually not encouraging. Feelings of
paranoia, however, can be controlled to a degree with successful therapy.
Self Assessment Questions
1) Discuss the nature of paranoid personality disorder.
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2) Explain the diagnostic criteria of paranoid personality disorder.
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3) How does paranoid personality disorder differ from other mental disorders?
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Schizoid and Paranoid
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4) Explain the causes of paranoid personality disorder.
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5) Can paranoid personality disorder be treated? Discuss the methods of treatment.
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4.6 GLOSSARY
Antisocial personality disorder: A personality disorder featuring a pervasive
pattern of disregard for and violation of rights
of others.
Avoidant personality disorder : A personality disorder featuring a pervasive
pattern of social inhibition, feeling of inadequacy,
and hypersensitivity to criticism.
Borderline personality disorder: Personality disorder involving extreme “black
and white” thinking, instability in relationships,
self-image, identity and behaviour. Borderline
personality disorder occurs in 3 times as many
females than males.
Cognitive-behavioural therapy : Group of treatment procedures aimed at
identifying and modifying faulty thought
processes, attitudes and attributions, and
problem behaviours.
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Delusion : False belief about reality but maintained in spite Schizoid and Paranoid
Personality Disorder
of strong evidence to the contrary.
Dependent personality disorder: Personality disorder characterised by pervasive
psychological dependence on other people.
Depression : Pervasive feeling of sadness that may begin after
some loss or stressful event, but that continue
long afterwards.
Empathy : Ability to understand and to some extent share
the feelings and emotions of another person.
Family therapy : Specialised type of group therapy in which the
members of the family of the client all participate
in group-treatment session.
Group therapy : Psychotherapy of several persons at the same
time in small groups.
Hallucination : False perception; things seen or heard that are
not real or present.
Histrionic personality disorder: Personality disorder characterised by
pervasive attention-seeking behaviour including
inappropriate sexual seductiveness and shallow
or exaggerated emotions.
Introversion : Tendency to be shy and withdrawn.
Narcissistic personality disorder: personality disorder involving a pervasive
pattern of grandiosity need for admiration, and
a lack of empathy.
Paranoia : Person’s irrational beliefs he or she is especially
important or that other people are seeking to
do him or her harm.
Paranoid personality disorder : Cluster A (odd or eccentric) personality disorder
involving pervasive distrust and suspiciousness
of others such that their motives are interpreted
as malevolent.
Personality disorders : Characterised by enduring maladaptive patterns
for relating to the environment and oneself,
exhibited in a wide range of contexts that cause
significant functional impairment or subjective
distress.
Psychotherapy : Treatment of mental disorders by psychological
methods.
Schizoid personality disorder : Cluster A (odd or eccentric) personality disorder
featuring a pervasive pattern of detachment from
social relationships and a restricted range of
expression of emotions.
Schizophrenia : Psychoses characterised by the breakdown of
integrated personality functioning, withdrawal
from reality, emotional blunting and distortion,
and disturbances in thought and behaviour. 61
Personality Disorders
4.7 SUGGESTED READINGS
Carson, R., Butcher, J.N., & Mineka, S. (2005). Abnormal Psychology and Modern
Life (3rd Indian reprint). Pearson Education (Singapoer).
Durand, V. K. & Barlow, D. H. (2000). Abnormal Psychology: An Introduction.
Stamford: Thomson Learning.
Sarason, I.G. Sarason, B.R. (1996). Abnormal psychology: The problem of
maladaptive behaviour. New Jersey: Prentice Hall Inc.
References
American Psychiatric Association (1994). Diagnostic and Statistical Manual of
Mental Disorders. ( 4th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of
Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric
Association.
Bernstein, D. P., Useda, D. & Siever, L. J. (1993). Paranoid personality disorder:
Review of the literature and recommendations for DSM-IV. Journal of Personality
disorders, 7, 53-62.
Bernstein, D. P., Useda, D. & Siever, L. J. (1995). Paranoid personality disorder.
In W. J. Livesley (Ed). The DSM-IV personality disorders. Diagnosis and treatment
of mental disorders, New York: Guilford.
Bleular, E. (1924). Textbook of psychiatry. A. A. Brill, Trans. New York: Macmillan.
Dobbert, D. (2007) Understanding Personality Disorders: An Introduction. Greenwood
Press.
Freeman, A., Pretzer, J., Fleming, B. & Simon, K. M. (1990). Clinical applications
of cognitive therapy. New York: Plenum Press.
Kalus, O., Burnstein, D. O., & Siever, L. J. (1993). Schizoid personality disorder:
A review of current status and implications for DSM-IV. Journal of Personality
Disorders, 7, 43-52.
Kantor, M. (2004) Understanding Paranoia: A Guide for Professionals, Families,
and Sufferers. Greenwood Publishing Group.
Kendler KS, Czajkowski N, Tambs K, et al (2006). Dimensional representations of
DSM-IV cluster A personality disorders in a population-based sample of Norwegian
twins: a multivariate study. Psychological Medicine, 36, 11.
National Epidemiologic Survey on Alcohol and Related Conditions - NESARC
(2002) Journal of Clinical Psychiatry, 65.
Overholser, J. C. (1989). “Differentiation between schizoid and avoidant personalities:
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Paranoid personality disorder – International Statistical Classification of Diseases and
Related Health Problems 10th Revision (ICD- 10).
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Tukat, I. D. & Maisto, S. A. (1985). Personality disorders: Applications of the
experimental method to the formulation and modification of personality disorders. In
D. H. Barlow (Ed.), Clinical handbook of psychological disorders. New York:
Guilford Press.
Weismann, M. M. (1993). “The epidemiology of personality disorders. A 1990
update.”. Journal of Personality Disorders (Spring issue, Suppl.): 44–62.
Widiger, T. A. & Frances, A. J. (1994). Toward a dimensional model for the personality
disorders. In P. T. Costa, Jr., & Widiger (Eds.), Personality Disorders and the
Five-Factor Model of Personality. Washington: American Psychological Association
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