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Cluster A Personality Disorders

by Helen Farrell, MD
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    00:01 Let us look closer now at the Cluster A personality disorders.

    00:05 These are commonly seen in a variety of clinical settings.

    00:10 The international prevalence is 6%, and in the United States, Cluster A personality disorders have a 15% prevalence.

    00:19 They tend to affect the young adults, those who are less educated and unemployed.

    00:25 In many theories abound including biological and genetic factors that give way to why they are Cluster A personality disorders.

    00:35 But psychoanalytic theory is the best to recognize for explaining the ideology of personality disorders. Let us start with the Schizoid personality.

    00:46 Schizoid and avoidant personality disorders are often confused.

    00:51 So let's start with this important note. The difference is that the schizoid individual does not want any friends. Remember they're odd, and eccentric and fine being alone, while is the avoidant personality does want friends but they're too shy to go out and make any. So the criteria for schizoid personality disorder include detachment from social relationships and a restricted range of expression of emotions. They neither desire nor enjoy close relationships including being part of a family. They prefer solitary activities, they have little sexual interest, they take pleasure in few, if any activities.

    01:34 They lack close friends or confidants, and they are indifferent to praise or criticism of others and they're emotionally cold often being described as detached.

    01:48 The schizoid personality disorder is more common in males than in females, and there's a higher incidence of this disorder in people who have solitary jobs.

    01:59 Psychotherapy is very helpful because patients actually do have the capacity for introspection. One to one therapy is the best because these types of people really prefer not to be part of a group and although it could provide a means for providing social support, it will take quite a bit of time to get this type of patient willing to participate in group therapy.

    02:25 Let's move on now to schizotypal personality disorder.

    02:30 This is an acute discomfort with and reduced capacity for close relationships, as well as cognitive or perceptual distortions and eccentricities of behavior.

    02:43 There are ideas of reference, possibly delusions, odd beliefs or magical thinking, unusual perceptual experiences including bodily illusions, odd thinking, and speech.

    02:57 For example, these people are usually vague, circumstantial, or they talk in metaphors.

    03:03 They're suspicious and paranoid. They're inappropriate or have a constricted affect.

    03:09 They lack close friends or confidants other than first-degree relatives.

    03:13 Their behavior and appearance is odd and eccentric, often being described as peculiar.

    03:19 And they have excessive social anxiety associated with paranoid fears rather than negative judgments about themselves.

    03:28 There is an acute discomfort with and reduced capacity for close relationships.

    03:34 It does not occur exclusively during the course of schizophrenia, or bipolar disorder, or depressive disorder with psychotic features, or any other psychotic disorder or autistic spectrum disorder. So note this, if the criteria are met prior to the onset of schizophrenia, so let us say you have a patient who developed schizophrenia but before that diagnosis, they had traits of schizotypal personality disorder.

    04:01 Then you can add then a note that it was premorbid.

    04:04 For example, schizotypal personality disorder premorbid to schizophrenia, or whatever other psychiatric disorder there might be later.

    04:15 The schizotypal personality is associated with superstitiousness, beliefs and clairvoyance, telepathy and sometimes having a sixth sense.

    04:26 Children or teens might actually have some bizarre fantasies or preoccupations when they're experiencing schizotypal personality, and the differential diagnosis actually includes schizophrenia, so make sure to rule that out because they can be linked. And how would you separate these from one another? Well, which one has good reality testing? Right, that is gonna be schizotypal personality.

    04:53 In schizophrenia, an individual is actually detached from reality.

    04:58 And which patient is actually probably at least psychotic? That's the patient with schizophrenia. People with schizotypal personality are quite odd and eccentric but they're not actually psychotic.

    05:13 About 3% of the population are affected by schizotypal personality and it's more common in men than in women. The prognosis is guarded.

    05:22 Some patients will establish really good connections and relationships despite their oddities, but others can't. So it is really a case by case basis.

    05:31 And in schizotypal personality, there's actually a 10% suicide rate.

    05:37 Psychotherapy tends to emphasize the therapeutic alliance, support, and social skills training. Pharmacotherapy and low dose of antipsychotics might be useful for this group of patients.

    05:53 The paranoid personality is the third and final disorder in the Cluster A personality disorders. This is a pervasive, distrust and suspiciousness of others such that their motives are interpreted as malevolent.

    06:09 They suspect without sufficient basis that others are exploiting or harming them in some way. They doubt the loyalty or trustworthiness of friends and associates.

    06:20 There are fears in confiding in others. There is misinterpretation of very small benign remark and they often perceived others as threatening.

    06:31 This type of patient will persistently bear a grudge.

    06:35 They really don't let something go. They're unforgiving of insults and injuries and they perceive attacks on his or her character as being intentional, and they're very quick to be angry and even counter attack.

    06:52 They're recurrent suspicions without justification regarding fidelity of spouses or sexual partners. And there's also a pervasive distrust and suspiciousness, and also it does not occur exclusively during the course of schizophrenia, bipolar disorder, depressive disorder, or any psychotic disorder, and it also is not attributable to substances or general medical condition.

    07:23 The preferred defense mechanisms for Cluster A personality disorders are projection, denial, and rationalization.

    07:32 So, a lot of immature and erratic defenses happening.

    07:36 In paranoia, the course is long and the best prognosis is for individuals who have a good support system and good ego strength.

    07:45 A poorer prognosis is associated with individuals who have poor insight, and, also, a co-morbid disorder, such as substance abuse or schizophrenia.

    07:55 Psychotherapy can be helpful, taking a supportive approach being consistent and straightforward with the patient. One to one therapy is best.

    08:05 Paranoid patients don't do well in group therapy because of their trust issues.

    08:10 And medications should be use very cautiously. Sometimes a very low dose antipsychotic or short-term benzodiazepine might help with some paranoid ideation at times of severe anxiety or hostility. But, again, you should be very much limited in the focus on psychotherapy.

    08:29 Let's go through a quiz now to see how well you understand Cluster A personality disorders.

    08:35 So there's a woman who finds herself with few friendships because she has held many grudges and says that her husband told her she tends to make mountains out of mole hills. She now believes that her husband is in on it with her friends, and probably having an affair with one of them, too, despite lacking any evidence for this. What personality do you think she has? The answer is paranoid personality disorder.

    09:04 Here is another case example.

    09:07 A 44-year-old man works at a technology company where he engages with the computer all day long instead of people.

    09:13 His hair is often uncombed and he sometime wears his sweater inside out.

    09:18 When he does interact with people, he is aloof and disinterested.

    09:22 He has never had a long-term girlfriend and has very little interest in finding a sexual romance. He lives alone and usually declines social invitations because he prefers to be at home playing computer games.

    09:37 What personalty disorder do you think he has? Right, Schizoid personality.

    09:45 And finally, a man with long hair is wearing a floor-length black velvet cape.

    09:51 He appears to be talking to himself and laughing.

    09:54 As you approach him on the street he says, I had a feeling about you, and asks if he can read your palm and tell your fortune.

    10:02 What personality disorder do you think he has? He has schizotypal personality.

    10:10 Now you have some background understanding of the cluster A personality disorders: Schizoid, schizotypal, and paranoid. We'll move on now to learn about the others.


    About the Lecture

    The lecture Cluster A Personality Disorders by Helen Farrell, MD is from the course Personality Disorders. It contains the following chapters:

    • Cluster A
    • Schizoid Personality
    • Assessment – Schizotypal Personality
    • Assessment – Paranoid Personality

    Included Quiz Questions

    1. Extreme sensitivity to the praise or criticism from others
    2. Take pleasure in doing activities by themselves
    3. Neither desires nor enjoys close relationships, including being part of a family
    4. 1:1 psychotherapy is the best way to manage, as the patients have a capacity for introspection
    5. It is more common in males than in females
    1. Schizotypal
    2. Schizoid
    3. Obsessive compulsive
    4. Avoidant
    5. Narcissistic
    1. The differential diagnosis includes schizoaffective disorder
    2. Children have bizarre fantasies or preoccupations
    3. Suspiciousness or paranoid ideation
    4. Ideas of reference, excluding delusions of reference
    5. The patient often believes in clairvoyance and telepathy
    1. Paranoid personality disorder
    2. Schizoid personality disorder
    3. Schizotypal personality disorder
    4. Avoidant personality disorder
    5. Borderline personality disorder
    1. Projection
    2. Intellectualization
    3. Reaction formation
    4. Passive aggression
    5. Acting out
    1. Paranoid personality disorder
    2. Schizoid personality disorder
    3. Avoidant personality disorder
    4. Pervasive personality disorder
    5. Narcissistic personality disorder

    Author of lecture Cluster A Personality Disorders

     Helen Farrell, MD

    Helen Farrell, MD


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