Mental health articles

treatment of schizotypal personality disorder Schizotypal personality disorder (SPD)
is characterized by “a pervasive pattern of social and interpersonal defi cits
marked by acute discomfort with, and reduced capacity for, close relationships
as well as by cognitive or perceptual distortions and eccentricities of behavior”People with SPD are seen by
others as eccentric or weird, are extremely anxious around people, and prefer to
remain alone. Th ey may hold odd beliefs and have diffi culty expressing themselves
emotionally or intellectually. Given this presentation, most researchers
now view SPD as a part of a continuum with schizophrenia (Kernberg, 1984;
Livesley, 2003; Millon et al., 2000; Siever, Bernstein, & Silverman, 1995). Additionally,
some studies have found that these individuals oft en are diagnosed
with major depressive order and/or borderline personality disorder (Klaus et
al., 1995; Maxmen & Ward, 1995).
Because SPD oft en fi rst occurs in childhood and adolescence, associated
with underachievement in school, social isolation, poor peer relationships,
eccentricity, and peculiar thoughts and language (American Psychiatric Association,
2000), it is unclear how many individuals actually make it to college.
Persons with SPD may go for treatment more than those with the other Cluster
A disorders because they oft en experience social anxiety (Stone, 2001).

Stanley came to treatment because he felt anxious, suspicious, and tense
around other students and professors. He was 34 years old, living at
home with his parents and taking a couple of classes at the university.
When asked about a dish towel he wore around his neck, Stanley said it
protected him from other students’ germs.

Like other people with SPD, Stanley presented with magical thinking,
ideas of reference, suspiciousness, poor reality testing, and overall odd
behavior— diffi culties that make it hard to succeed at college. Th erapy with
these individuals tends to be diffi cult due to their problems communicating
and the thought disorder and paranoia that block the forming of a therapeutic
relationship. Th erefore, communication should be “simple, straightforward,
shorn of psychological jargon, and require a minimum of inference”
(Millon et al., 2000, p. 367).
Treatment goals in short-term work should be connected to presenting
concerns, focusing on current sources of anxiety. For example, since Stanley
felt severe anxiety in class and around other people, the therapist used social
skills training and, from a cognitive perspective, helped him to objectively
“investigate” the data to prove or disprove his beliefs, in this case that contact
with others made him sick. Common goals of treatment for these students
are to focus on reality testing, provide structure in their everyday lives, and
enhance understanding of interpersonal relationships and boundary issues.
But to accomplish all the necessary gains, a referral for long-term treatment
is necessary, since it takes a long time to establish a therapeutic relationship.
Treatment with a psychiatrist can also be very benefi cial. Fluoxetine and
lithium help with aggression, and neuroleptic treatment has been linked to
improvement in clients with moderate to severe symptoms; however, students oft en are reluctant to take neuroleptic medication (Coccaro, 2001; Markovitz,
2001), partly because of side eff ects, such as sedation. Moleman, van Dam, and
Dings (1999) state that poorly controlled studies make it diffi cult to draw conclusions
about the use of antipsychotic drugs, but in one study roughly half
the subjects on low doses of haloperidol moderately improved, especially with
regard to ideas of reference, social isolation, and odd communication. Stanley,
who showed many odd behaviors, responded well to neuroleptic medication.
Group therapy is oft en not recommended, since clients with SPD typically cannot
tolerate the intense level of social interaction. If the student is not too unusual
or paranoid, however, a very basic social skills group may be recommended, but
only aft er individual treatment reduces the student’s social anxiety.
Workshops can help staff and faculty deal with these students who are
oft en perceived to be “weird.” Th e facilitator stresses the importance of simple,
concrete, and supportive communications and the provision of structure in
the student’s life.

Tags: disorder, Personality Disorder, treatment