II. Definition
- Odd or eccentric personalities
III. Signs: General features for all cluster A personalities
- Fantasy to eccentric
- Lonely to schizoid
- Distortion or Delusion to Paranoid
- Projective identification
- Projection of guilt (blame someone else)
IV. Type: Paranoid Personality
- Characteristics (onset as adult)
- Aloof and emotionally cold
- Pervasive mistrust and suspicion without sufficient cause, that others are exploiting, harming or deceiving him or her
- Unjustified doubts about other's loyalty or trustworthiness
- Reads into benign remarks or events, hidden demeaning or threatening meanings
- Persistently bears grudges (not forgiving insults or slights)
- Fear of intimacy with sense of vulnerability
- Usually isolated and disliked
- Often blame others and does not accept criticism
- Altered interpretation of illness and physician
- Rigid and initiate conflict: may be litigious
- Worries that physician may attempt to harm them
- Recommended physician approach
- Professional stance with clear explanations
- Empathic approach to patient's fears
- Do not confront paranoia directly
- Evaluate for comorbid conditions
- Drug Abuse (e.g. Amphetamine abuse)
- Obsessive Compulsive Disorder
V. Type: Schizoid Personality
- Characteristics
- Socially detached and does not enjoy social contact
- Chooses solitary activities
- Not interested in sex with others
- Takes pleasure in few if any activities
- Indifferent to praise or criticism from others
- Lacks close friends or confidants other than first degree relatives
- Anxious when forced into contact with others
- Restricted emotional range, flat, cold, humorless, aloof
- Often daydream
- Altered interpretation of illness and physician
- Appear not to appreciate a physician's care
- Often wait to pursue medical care
- Recommended physician approach
- Professional stance with clear explanations
- Do not become overly involved in personal issues
- Evaluate for comorbid conditions
- Not associated with Schizophrenia
VI. Type: Schizotypal Personality
- Characteristics
- Similar to Schizoid Personality, but also peculiar
- Social and interpersonal deficits, isolated
- Perceptual distortion and eccentricity
- Odd reasoning and speech (vague, stereotyped, overelaborate, circumstantial)
- Relates strange experiences
- May be superstitious
- May believe in clairvoyance, telepathy or a sixth-sense
- Children may relate bizarre fantasies or preoccupations
- Altered interpretation of illness and physician
- Anxious when forced into contact with others
- Odd illness interpretation, and odd behavior
- Often wait to pursue medical care
- Recommended physician approach
- Professional stance with clear explanations
- Do not become overly involved in personal issues
- Do not focus on odd behavior or beliefs
- Evaluate for comorbid conditions
- Falls on spectrum with Schizophrenia
VII. Management
- Target symptoms
- Cognitive or perceptual distortion
- Interpersonal mistrust
- Medications
- Atypical Antipsychotic
- Consider SSRIs
VIII. References
- Tomb (1992) Psychiatry, p. 147-52
- (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Washington D.C., APA
- Angstman (2011) Am Fam Physician 84(11): 1253-60 [PubMed]
- Ward (2004) Am Fam Physician 70(8):1505-12 [PubMed]