back to Personality Disorders

Cluster (A) Disorders (Odd/Eccentric Cluster)


The disorders in "Cluster A" are generally characterized as involving "odd or eccentric behaviors." People with Cluster A personality disorders come across as having odd ways of thinking and or behaving.
Three disorders are included in this cluster:
  1. Paranoid Personality Disorder
  2. Schizoid Personality Disorder
  3. Schizotypal Personality Disorder.


Paranoid Personality Disorder (DSM-IV-TR code 301.0)


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Those who suffer with Paranoid Personality Disorder are suspicious of others. This suspicion influences relationships with family, colleagues, and friendships. They expect to be mistreated or exploited by others and thus are secretive and continually on the lookout for signs of any reason to mistrust some one. They are often hostile and react angrily to perceived insults, because they think that they are leveled at them. They tend to read between the lines, and might take a normal, everyday saying as a threatening remark. For example, they might believe that someone they know who offers to help them move is actually trying to get a chance to steal their belongings.

This disorder is different from Paranoid Schizophrenia because symptoms such as hallucinations are not present, and there are not always impairments in social and occupational functioning. Also absent is the cognitive disorganization that is characteristic such as disorganized speech. It differs from Delusional Disorder in that full-blown delusions are not present. Paranoid Personality Disorder co-occurs most often with Schizotypal, Borderline, and Avoidant Personality Disorders.

DSM-IV-TR Criteria for Paranoid Personality Disorder

Presence of four or more of the following:
1. Pervasive suspiciousness of being harmed, deceived, or exploited
2. Unwarranted doubts about the loyalty or trustworthiness of friends or associates
3. Reluctance to confide in others because of suspiciousness
4. The tendency to read hidden meanings into the innocuous actions of others
5. Bears grudges for perceived wrongs
6. Angry reactions to perceived attacks on character or reputation
7. Unwarranted suspiciousness of the fidelity of partner

Key Characteristics
  • Overly suspicious
  • Secretive
  • Jealous
  • Distrustful
  • Vigilant
  • Wariness



Schizoid Personality Disorder (DSM-IV-TR Code 301.20)


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People with Schizoid Personality Disorder for the most part do not express desire or enjoy social relationships and usually have no close friends. To most They appear dull, bland, and aloof. They also appear to have no warm, tender feelings for other people, except for a possible few close first degree relatives. Most of these individuals prefer abstract tasks such as computer programming or some type of engineering. Individuals with Schizoid Personality Disorder generally score lower on school testing, and are often diagnosed as children/adolescents with some form of learning disability. They rarely experience strong emotions, are generally not interested in sex, and have few pleasurable activities. They are indifferent to praise, criticism, and the sentiments of others, people with this disorder are loners, pursuing solitary interests. They are best fit for occupations that involve a high amount of isolation. Comorbidity for having other disorders is highest for Schizotypal, Avoidant, and Paranoid Personality Disorders; these are most likely because of the similar diagnostic criteria. For varying reasons, the diagnosis rate for Schizoid Personality Disorder has been found to be slightly higher in men than women.

DSM-IV-TR Criteria for Schizoid Personality Disorder

Presence of four or more of the following

1. Lack of desire for or enjoyment of close relationships
2. Almost exclusive preference for solitude
3. Little interest in sex with others few if any pleasures
4. Lack of friends
5. Indifference to praise or criticism from others
6. Flat affect, emotional detachment
7. Symptoms not explained by Schizophrenia, Psychotic Depression, or pervasive Developmental disorder

People with Schizoid Personality Disorder do not have Schizophrenia, but it is thought that many of the same risk factors cause someone to develop Schizophrenia. People with this disorder are able to function in everyday life, but will typically not develop meaningful relationships with others. Controversially, there is some evidence to indicate that Schizoid Personality Disorder may be the beginning of Schizophrenia; this may be explained using the diathesis stress model.

Key Characteristics
  • Aloof
  • Indifferent
  • Lacks connectedness



Schizophrenic Spectrum Disorders

There is a family of disorders that appear to be related to Schizophrenia, but whose symptoms are distinct from those of Schizophrenia. This group of disorders is referred to as Schizophrenic Spectrum Disorders. The Schizophrenic Spectrum Disorders consist of: Paranoid Personality Disorder, Schizotypal Personality Disorder, Delusional Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizophrenia, and Schizoaffective Disorder.

People with Schizoid Personality Disorder for example, do not have Schizophrenia, but it is thought that many of the same risk factors cause someone to develop Schizophrenia. People with this disorder are able to function in everyday life, but will not develop meaningful relationships with others. Controversially, there is some evidence to indicate that Schizoid Personality Disorder may be the beginning of Schizophrenia; this may be better explained using the diathesis stress model.

Family studies also suggest that Paranoid Personality Disorder is weakly related to Schizophrenia and other psychotic disorders. Although no clear pattern has emerged from behavior-genetics research on Schizoid Personality Disorder. Overall, though, researchers know little at this point as to the etiology of Paranoid Personality Disorder or Schizoid Personality Disorder as it can be difficult to obtain research on test clients, because as you can imagine, people with these disorders are not always compelled to complete lengthy research interviews.

At this point there seems to be more known as to the etiology of Schizotypal Personality Disorder than of the other disorders in the odd/eccentric cluster. Schizotypal Personality Disorder appears to be tied in some way to the neurobiological vulnerability for Schizophrenia, as shown even by some genetic, neuropsychological, and brain-imaging studies.


Schizotypal Personality Disorder (DSM-IV-TR Code 301.22)


People with Schizotypal Personality Disorder are often socially isolated, like those with Schizoid Personality Disorder, but they also express other, more eccentric symptoms, which are milder versions of the symptoms that define Schizophrenia. People with this disorder might have odd beliefs or magical thinking for instance, the belief that they are clairvoyant and telepathic. It is also common for them to have ideas of reference (the belief that events have a particular and unusual meaning for them personally). They might also disclose recurrent illusions (inaccurate sensory perceptions), such as sensing and explaining that they sence something that is not even there. Their speech, might also be affected, any use of unusual speech, that does not flow in the normal pattern of communication, which may come across as very unclear. Their behavior and appearance might also be eccentric for example, they might talk to themselves or wear dirty or clothes that are not suitable for the situation that they are in. Most of the time their affect appears to be constricted and they might not be able to show appropriate emotions.

The signs of Schizotypal Personality Disorder first show up in childhood, and generally are expressed by isolating activity and behaviors, they may also express social anxiety, poor peer relationships, social anxiety, and they may also exhibit problems in school. Comorbidity with other personality disorders is particularly high. On average, people with Schizotypal Personality Disorder meet the diagnostic criteria for at least two other personality disorders, usually Avoidant Personality Disorder and Paranoid Personality Disorder, perhaps because of overlapping criteria. As stated in a previous section: it has been found in family studies that relatives of patients with Schizophrenia are at increased risk for Schizotypal Personality Disorder.

DSM-IV-TR Criteria for Schizotypal Personality Disorder

Presence of five or more of the following:

1. Ideas of reference
2. Peculiar beliefs or magical thinking, e.g., belief in extrasensory perception
3. Unusual perceptions, e.g., distorted feelings about one's body
4. Peculiar patterns of speech
5. Suspiciousness or paranoia
6. Inappropriate or restricted affect
7. Odd behavior or appearance
8. Lack of close friends
9. Anxiety around other people, which does not diminish with familiarity

Key characteristics
  • Social Anxiety
  • Eccentric
  • Magical thinking

Common coexisting disorders
  • Narcissistic Personality Disorder
  • Borderline Personality Disorder
  • Avoidant Personality Disorder
  • Paranoid Personality Disorder
  • Schizoid Personality Disorder


Treatment


Therapy
People with this disorder rarely seek treatment. The treatment can be difficult due to their initial reduced capacity or just a lack of desire to form a relationship with a health professional. For example it can be extremely tough to earn the therapeutic trust of a client with Paranoia, and without that trust therapy is likely to never get to the real problem, and thus treatment is likely to be non effective.

Group therapy may be helpful for people suffering with Schizoid Personality Disorder. Although patients may initially withdraw from the therapy group, they often become more participatory as a comfort level is gradually established. In this case the group is the therapy. Protected by the therapist who must safeguard schizoids from criticism from other group members, patients have the opportunity to conquer fears of intimacy by engaging in communication, and making social contact in a supportive atmosphere.

Medications
Medications are not usually recommended as treatment for Schizoid Personality Disorder. However, they are sometimes used for short-term treatment of extreme anxiety states associated with the disorder in order to be able to treat them with conventional therapy. Psychotherapy and Individual therapy that successfully attains a long-term trust level can be useful in some cases of Schizoid Personality Disorder by providing an outlet for patients to transform their false perceptions of friendships into a genuine relationship. As a therapist-client relationship develops, the patient may begin to reveal imaginary friendships and terrors of dependency. Individual psychotherapy can gradually effect the formation of a true relationship between therapist and patient.

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