16 PERSONALITYDISORDERS 381
they believe they have something to gain. One of the
most effective interventions is helping clients to learn
to validate ideas before taking action; however, this
requires the ability to trust and to listen to one person.
The rationale for this intervention is that clients can
avoid problems if they can refrain from taking action
until they have validated their ideas with another per-
son. This helps prevent clients from acting on para-
noid ideas or beliefs. It also assists them to start bas-
ing decisions and actions on reality.
SCHIZOID PERSONALITY DISORDER
Clinical Picture
Schizoid personality disorderis characterized by
a pervasive pattern of detachment from social rela-
tionships and a restricted range of emotional expres-
sion in interpersonal settings. It occurs in approxi-
mately 0.5% to 7% of the general population and is
more common in men than in women. People with
schizoid personality disorder avoid treatment as
much as they avoid other relationships, unless their
life circumstances change significantly (APA, 2000).
Clients with schizoid personality disorder dis-
play a constricted affect and little, if any, emotion.
They are aloof and indifferent, appearing emotionally
cold, uncaring, or unfeeling. They report no leisure or
pleasurable activities, because they rarely experience
enjoyment. Even under stress or adverse circum-
stances, their response appears passive and disinter-
ested. There is marked difficulty experiencing and ex-
pressing emotions, particularly anger or aggression.
Oddly clients do not report feeling distressed about
this lack of emotion; it is more distressing to family
members. Clients usually have a rich and extensive
fantasy life, although they may be reluctant to reveal
that information to the nurse or anyone else. The
ideal relationships that occur in the client’s fantasies
are rewarding and gratifying; these fantasies though
are in stark contrast to real-life experiences. The fan-
tasy relationship often includes someone the client
has met only briefly. Nevertheless, these clients can
distinguish fantasies from reality, and no disordered
or delusional thought processes are evident.
Clients generally are accomplished intellectually
and often involved with computers or electronics in
hobbies or work. They may spend long hours solving
puzzles or mathematical problems, although they see
these pursuits as useful or productive rather than fun.
Clients may be indecisive and lack future goals
or direction. They see no need for planning and really
have no aspirations. They have little opportunity to
exercise judgment or decision-making because they
rarely engage in these activities. Insight might be de-
scribed as impaired, at least by the social standards
of others: these clients do not see their situation as a
problem and fail to understand why their lack of emo-
tion or social involvement troubles others. They are
self-absorbed and loners in almost all aspects of daily
life. Given an opportunity to engage with other peo-
ple, these clients will decline. They also are indiffer-
ent to praise or criticism and are relatively unaffected
by the emotions or opinions of others. They also expe-
rience dissociation from or no bodily or sensory plea-
sures. For example, the client has little reaction to
beautiful scenery, a sunset, or a walk on the beach.
Clients have a pervasive lack of desire for in-
volvement with others in all aspects of life. They do
not have or desire friends, rarely date or marry, and
have little or no sexual contact. They may have some
connection with a first-degree relative, often a par-
ent. Clients may remain in the parental home well
into adulthood if they can maintain adequate sepa-
ration and distance from other family members.
They have few social skills, are oblivious to the social
cues or overtures of others, and do not engage in so-
cial conversation. They may succeed in vocational
areas provided that they value their jobs and have
little contact with others in work such as computers
or electronics.Nursing Interventions
Nursing interventions focus on improved functioning
in the community. If a client needs housing or a
change in living circumstances, the nurse can make
referrals to social services or appropriate local agen-
cies for assistance. The nurse can help agency person-
nel find suitable housing that will accommodate the
client’s desire and need for solitude. For example, the
client with a schizoid personality disorder would func-
tion best in a board and care facility, which provides
meals and laundry service but requires little social in-
teraction. Facilities designed to promote socialization
through group activities would be less desirable.
If the client has an identified family member as
his or her primary relationship, the nurse must as-
certain if that person can continue in that role. If that
person cannot, the client may need to establish at
least a working relationship with a case manager in
the community. The case manager then can help the
client to obtain services and health care, manage fi-
nances, etc. The client has a greater chance of success
if he or she can relate his or her needs to one person
instead of neglecting important areas of daily life.SCHIZOTYPAL PERSONALITY
DISORDER
Clinical Picture
Schizotypal personality disorderis characterized
by a pervasive pattern of social and interpersonal