Personality Disorders 591
is their tendency not to collaborate with the therapist to develop goals for treatment
(Beck, Freeman, & Davis, 2004; Farmer & Nelson-Gray, 2005).
Nevertheless, when such patients do participate in CBT, they can develop moreadaptive strategies, such as improved social skills (which makes them less likely to be
conspicuous, and in turn leads them to feel safer when with others). CBT may also
employ relaxation techniques, exposure to avoided social situations, and cognitive
restructuring of distorted views of self and others and of dysfunctional beliefs (Beck,
Freeman, & Davis, 2004; Farmer & Nelson-Gray, 2005).
Most of the medications that effectively treat symptoms of schizophrenia canalso treat symptoms of schizotypal personality disorder, although the medications
are often taken at a lower doses (Koenigsberg et al., 2003; Raine, 2006; see Chapter
12). The psychosocial treatments employed with people who have schizophrenia—
CBT, social skills training, and family therapy—may be employed with people who
have schizotypal personality disorder, but very few studies have evaluated the use
of such treatments for people diagnosed with schizotypal personality disorder. One
preliminary study investigated such treatments for people who had some symptoms
of schizotypal personality—but not enough symptoms to receive the diagnosis of
the personality disorder; the results suggest that social skills training can be effective
(Liberman & Robertson, 2005).
Key Concepts and Facts About Odd/Eccentric Personality Disorders
- The essential feature of paranoid personality disorder is a per-
sistent and pervasive mistrust and suspiciousness, which is
accompanied by a bias to interpret other people’s motives as
hostile. Although paranoid personality disorder and paranoid
schizophrenia both involve suspicious beliefs, people with the
personality disorder have some capacity to evaluate whether
their suspicions are based on reality; they also tend to be suspi-
cious about people they know. In contrast, the beliefs of people
with paranoid schizophrenia are delusional, and they perceive
threats as coming from strangers or objects. - Schizoid personality disorder is characterized by a restricted
range of emotions in social interactions and few—if any—close
relationships; people with this disorder have poor social skills.
They report rarely experiencing strong emotions, and they pre-
fer to be—and function best when—isolated from others. - Schizotypal personality disorder is marked by eccentric
thoughts, perceptions, and behaviors, as well as by having very
few close relationships. This personality disorder is character-
ized by three groups of symptoms: cognitive-perceptual, inter-
personal, and disorganized. - Schizotypal personality disorder is viewed as a milder form of
schizophrenia. Many of the factors that give rise to schizophre-
nia also appear to give rise to schizotypal personality disorder:
genes and the prenatal environment; problems with attention,
memory, and executive function as well as an impaired theory
of mind; and physical abuse or neglect in childhood, insecure
attachment, and discrimination. - Paranoid, schizoid, and schizotypal personality disorders are
on the spectrum of schizophrenia-related disorders, and close
relatives of people with any of these odd/eccentric personal-
ity disorders are more likely to have schizophrenia. Schizotypal
personality disorder involves neurological abnormalities that
are less severe than those associated with schizophrenia.- People with odd/eccentric personality disorders are reluctant
participants in treatment. Treatment may address fundamen-
tal issues, such as isolation and suspiciousness. Treatment
for schizotypal personality disorder may include antipsychotic
medication (although at lower doses than used for psychotic
disorders), CBT, social skills training, and family therapy.
Making a Diagnosis
- Reread Case 13.2 about Ms. X., and determine whether or not
her symptoms meet the criteria for paranoid personality disor-
der. Specifically, list which criteria apply and which do not. If
you would like more information to determine her diagnosis,
what information—specifi cally—would you want, and in what
ways would the information infl uence your decision? - Reread Case 13.3 about the 33-year-old woman, and determine
whether or not her symptoms meet the criteria for schizoid per-
sonality disorder. Specifi cally, list which criteria apply and which
do not. If you would like more information to determine her di-
agnosis, what information—specifi cally—would you want, and
in what ways would the information infl uence your decision? - Reread Case 13.4 about IK, and determine whether or not his
symptoms meet the criteria for schizotypal personality disorder.
Specifically, list which criteria apply and which do not. If you
would like more information to determine his diagnosis, what
information—specifi cally—would you want, and in what ways
would the information infl uence your decision?