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Schizoid PD. Mnemonic “Sir Safe” Solitary Indifferent to praise and criticism Relationships of little interest Sexual experiences not of interest Activities.

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Presentation on theme: "Schizoid PD. Mnemonic “Sir Safe” Solitary Indifferent to praise and criticism Relationships of little interest Sexual experiences not of interest Activities."— Presentation transcript:

1 Schizoid PD

2 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

3 DSM IV – Essential Features detachment from social relationships restricted range of emotions

4 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?

5 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

6 Schizoid Style Retiring (Millon, 1994) Solitary (Oldham and Morris, 1995)

7 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

8 History Kretschmer (1925) – two types overly sensitive (hyperaesthetic - AVD) insensitive (anesthetic - SZD)

9 History SZD past was an amalgam of the schizoid, avoidant and schizotypal PDs DSM-III – 3 parts avoidant (Millon) schizoid (Bleuler) schizotypal (Rado)

10 Clinical Observations Compulsive masturbation Autistic thinking Fragmented self-identity Depersonalization/Derealization Primitive Defenses - splitting

11 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

12 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

13 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

14 5 “schizo” disorders (1) schizophrenia (2) schizophreniform (3) schizoaffective (4) schizotypal (5) schizoid

15 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)

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

17 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

18 Interview Themes Withdrawn and reclusive Works below potential Observer, not a participant Robotic Aloof, distant, constricted emotions

19 Assessment

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21 NEOAC SZDL AVDHL DEPH HSTH NARHh ANTLL COMh SZTHLl BDLHll PARhL See commentary below slide to understand letters and numbers

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23 Treatment 1) major clinical syndrome (i.e., depression) 2) some major life change and the parents or spouse of the individual recommend therapy

24 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

25 Schizotypal PD

26 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

27 History Kraepelin (1920s) relatives of Schizophrenic patients had traits Bleuler (1924) described latent and simple schizophrenia parallels with SZT Rado (year ?) - coined SZT

28 History DSM-III (1980) - first listed as disorder discomfort in close relationships cognitive or perceptual distortions eccentricities of behavior

29 Media Examples Travis Bickle in film Taxi Driver

30 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

31 Themes ideas of reference emotional reasoning, suspiciousness premonitions alternative/fringe interests magical thinking erratic progress in life

32 Epidemiology 3% of general population slightly more common among males an individual's culture needs to be considered speaking in tongues

33 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

34 Schizophrenia Delusional DisorderSchizoaffective schizophreniform Shared Psychotic Brief Psychosis Boundaries of Schizophrenia

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36 Differential Diagnosis Schizophrenia Spectrum Normal Introversion schizoidschizotypalschizophrenia

37 Schizotypal PAR SZD BDL AVD Boundaries of Schizotypal

38 Assessment

39 NEOAC SZDL AVDHL DEPH HSTH NARHh ANTLL COMh SZTHLl BDLHll PARhL See commentary below slide to understand letters and numbers

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42 MMPI – Three Point Codes profile

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