In Norway we have a facebook-group called “psychologist” where we share interesting videos, articles and questions that we`d like to discuss. Two days ago someone posted a youtube-video that I actually started to watch (I don`t always have time for this) and I had to continue since I really liked it. The start was a bit tiresome, but when they start to discuss psychotherapy, I learnt so much and felt really happy afterwards. The theme revolves around questions that counselors often get in therapy: Do I need this? And what will happen here? Many also feel psychotherapy is the last resort: It proves that their “defeated”. They discuss these questions in a matter-of-fact way, and in my opinion, they do this brilliantly. I hope you`ll like it as well! Unfortunately it was impossible to embed it, so please follow the link I`ve provided to see it.
Schizotypal personality disorder
Schizotypal personality disorder is characterized by an ongoing pattern in which the affected person distances him- or herself from social and interpersonal relationships. Affected people typically have an acute discomfort when put in circumstances where they must relate to others. These individuals are also prone to cognitive and perceptual distortions and a display a variety of eccentric behaviors that others often find confusing.
People with schizotypal personality disorder are more comfortable turning inward, away from others, than learning to have meaningful interpersonal relationships. This preferred isolation contributes to distorted perceptions about how interpersonal relationships are supposed to happen. These individuals remain on the periphery of life and often drift from one aimless activity to another with few, if any, meaningful relationships.
A person with schizotypal personality disorder has odd behaviors and thoughts that would typically be viewed by others as eccentric, erratic, and bizarre. They are known on occasion to have brief periods of psychotic episodes. Their speech, while coherent, is marked by a focus on trivial detail. Thought processes of schizotypals include magical thinking, suspiciousness, and illusions. These thought patterns are believed to be the schizotypal’s unconscious way of coping with social anxiety. To some extent, these behaviors stem from being socially isolated and having a distorted view of appropriate interpersonal relations.
Causes and symptoms
Schizotypal personality disorder is believed to stem from the affected person’s original family, or family of origin. Usually the parents of the affected person were emotionally distant, formal, and displayed confusing parental communication. This modeling of remote, unaffectionate relationships is then reenacted in the social relationships encountered in the developing years. The social development of people with schizotypal personality disorder shows that many were also regularly humiliated by their parents, siblings, and peers resulting in significant relational mistrust. Many display low self-esteem, self-criticism and self-deprecating behavior. This further contributes to a sense that they are socially incapable of having meaningful interpersonal relationships.
The Diagnostic and Statistical Manual of Mental Disorders , a professional manual, specifies nine diagnostic criteria for schizotypal personality disorder:
- Incorrect interpretations of events. Individuals with schizotypal personality disorder often have difficulty seeing the correct cause and effect of situations and how they affect others. For instance, the schizotypal may misread a simple non-verbal communication cue, such as a frown, as someone being displeased with them, when in reality it may have nothing to do with them. Their perceptions are often distortions of what is really happening externally, but they tend to believe their perceptions more than what others might say or do.
- Odd beliefs or magical thinking. These individuals may be superstitious or preoccupied with the paranormal. They often engage in these behaviors as a desperate means to find some emotional connection with the world they live in. This behavior is seen as a coping mechanism to add meaning in a world devoid of much meaning because of the social isolation these individuals experience.
- Unusual perceptual experiences. These might include having illusions, or attributing a particular event to some mysterious force or person who is not present. Affected people may also feel they have special powers to influence events or predict an event before it happens.
- Odd thinking and speech. People with schizotypal personality disorder may have speech patterns that appear strange in their structure and phrasing. Their ideas are often loosely associated, prone to tangents, or vague in description. Some may verbalize responses by being overly concrete or abstract and insert words that serve to confuse rather than clarify a particular situation, yet make sense to them. They are typically unable to have ongoing conversation and tend to talk only about matters that need immediate attention.
- Suspicious or paranoid thoughts. Individuals with schizotypal personality disorder are often suspicious of others and display paranoid tendencies.
- Emotionally inexpressive. Their general social demeanor is to appear aloof and isolated, behaving in a way that communicates they derive little joy from life. Most have an intense fear of being humiliated or rejected, yet repress most of these feelings for protective reasons.
- Eccentric behavior. People with schizotypal personality disorder are often viewed as odd or eccentric due to their unusual mannerisms or unconventional clothing choices. Their personal appearance may look unkempt—clothing choices that do not “fit together,” clothes may be too small or large, or clothes may be noticeably unclean.
- Lack of close friends. Because they lack the skills and confidence to develop meaningful interpersonal relationships, they prefer privacy and isolation. As they withdraw from relationships, they increasingly turn inward to avoid possible social rejection or ridicule. If they do have any ongoing social contact, it is usually restricted to immediate family members.
- Socially anxious. Schizotypals are noticeably anxious in social situations, especially with those they are not familiar with. They can interact with people when necessary, but prefer to avoid as much interaction as possible because their self-perception is that they do not “fit in.” Even when exposed to the same group of people over time, their social anxiety does not seem to lessen. In fact, it may progress into distorted perceptions of paranoia involving the people with whom they are in social contact.
Schizotypal personality disorder appears to occur more frequently in individuals who have an immediate family member with schizophrenia . The prevalence of schizotypal personality disorder is approximately 3% of the general population and is believed to occur slightly more often in males.
Symptoms that characterize a typical diagnosis of schizotypal personality disorder should be evaluated in the context of the individual’s cultural situation, particularly those regarding superstitious or religious beliefs and practices. (Some behaviors that Western cultures may view as psychotic are viewed within the range of normal behavior in other cultures.)
The symptoms of schizotypal personality disorder may begin in childhood or adolescence showing as a tendency toward solitary pursuit of activities, poor peer relationships, pronounced social anxiety, and underachievement in school. Other symptoms that may be present during the developmental years are hypersensitivity to criticism or correction, unusual use of language, odd thoughts, or bizarre fantasies. Children with these tendencies appear socially out-of-step with peers and often become the object of malicious teasing by their peers, which increases the feelings of isolation and social ineptness they feel. For a diagnosis of schizotypal personality disorder to be accurately made, there must also be the presence of at least four of the above-mentioned symptoms.
The symptoms of schizotypal personality disorder can sometimes be confused with the symptoms seen in schizophrenia. The bizarre thinking associated with schizotypal personality disorder can be perceived as a psychotic episode and misdiagnosed. While brief psychotic episodes can occur in the patient with schizotypal personality disorder, the psychosis is not as pronounced, frequent, or as intense as in schizophrenia. For an accurate diagnosis of schizotypal personality disorder, the symptoms for schizotypal cannot occur exclusively during the course of schizophrenia or other mood disorder that has psychotic features.
Another common difficulty in diagnosing schizotypal personality disorder is distinguishing it from other the schizoid, avoidant, and paranoidpersonality disorders . Some researchers believe that schizotypal personality disorder is essentially the same disorder as schizoid, but many feel there are distinguishing characteristics. Schizoids are deficient in their ability to experience emotion, while schizotypals are more pronounced in their inability to understand human motivation and communication. While avoidant personality disorder has many of the same symptoms as schizotypal personality disorder, the distinguishing symptom in schizotypal is the presence of behavior that is noticeably eccentric. The schizotypal differs from the paranoid by tangential thinking and eccentric behavior.
The diagnosis of schizotypal personality disorder is based on a clinical interview to assess symptomatic behavior. Other assessment tools helpful in confirming the diagnosis of schizotypal personality disorder include:
- Minnesota Multiphasic Personality Inventory (MMPI-2)
- Millon Clinical Multiaxial Inventory (MCMI-II)
- Rorschach Psychodiagnostic Test
- Thematic Apperception Test (TAT)
The patient with schizotypal personality disorder finds it difficult to engage and remain in treatment. For those higher-functioning individuals who seek treatment, the goal will be to help them function more effectively in relationships rather than restructuring their personality.
Psychodynamically oriented therapies
A psychodynamic approach would typically seek to build a therapeutically trusting relationship that attempts to counter the mistrust most people with this disorder intrinsically hold. The hope is that some degree of attachment in a therapeutic relationship could be generalized to other relationships. Offering interpretations about the patient’s behavior will not typically be helpful. More highly functioning schizotypals who have some capacity for empathy and emotional warmth tend to have better outcomes in psychodynamic approaches to treatment.
Cognitive approaches will most likely focus on attempting to identify and alter the content of the schizotypal’s thoughts. Distortions that occur in both perception and thought processes would be addressed. An important foundation for this work would be the establishment of a trusting therapeutic relationship. This would relax some of the social anxiety felt in most interpersonal relationships and allow for some exploration of the thought processes. Constructive ways of accomplishing this might include communication skills training, the use of videotape feedback to help the affected person perceive his or her behavior and appearance objectively, and practical suggestions about personal hygiene, employment, among others.
Treatment using an interpersonal approach would allow the individual with schizotypal personality disorder to remain relationally distant while he or she “warms up” to the therapist. Gradually the therapist would hope to engage the patient after becoming “safe” through lack of coercion. The goal would be to develop trust in order to help the patient gain insight into the distorted and magical thinking that dominates. New self-talk can be introduced to help orient the individual to reality-based experience. The therapist can mirror this objectivity to the patient.
Group therapy may provide the patient with a socializing experience that exposes them to feedback from others in a safe, controlled environment. It is typically recommended only for schizotypals who do not display severe eccentric or paranoid behavior. Most group members would be uncomfortable with these behavioral displays and it would likely prove destructive to the group dynamic.
Family and marital therapy
It is unlikely that a person with schizoid personality disorder will seek family or marital therapy. Many schizoid types do not marry and end up living with and being dependent upon first-degree family members. If they do marry they often have problems centered on insensitivity to their partner’s feelings or behavior. Marital therapy ( couples therapy ) may focus on helping the couple to become more involved in each other’s lives or improve communication patterns.
There is considerable research on the use of medications for the treatment of schizotypal personality disorder due to its close symptomatic relationship with schizophrenia. Among the most helpful medications are the antipsychotics that have been shown to control symptoms such as illusions and phobic anxiety, among others. Amoxapine (trade name Asendin), is a tricyclic antidepressant with antipsychotic properties, and has been effective in improving schizophrenic-like and depressive symptoms in schizotypal patients. Other antidepressants such asfluoxetine (Prozac) have also been used successfully to reduce symptoms of anxiety, paranoid thinking, and depression.
The prognosis for the individual with schizotypal personality disorder is poor due to the ingrained nature of the coping mechanisms already in place. Schizotypals who depend heavily on family members or others are likely to regress into a state of apathy and further isolation. While some measurable gains can be made with mildly affected individuals, most are not able to alter their ingrained ways of perceiving or interpreting reality. When combined with poor social support structure, most will not enter any type of treatment.
Since schizotypal personality disorder originates in the patient’s family of origin, the only known preventative measure is a nurturing, emotionally stimulating and expressive caretaking environment.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition, text revision. Washington, DC: American Psychiatric Association, 2000.
Beers, Mark H., M.D., and Robert Berkow, M.D., eds. The Merck Manual of Diagnosis and Therapy. 17th edition. Whitehouse Station, NJ: Merck Research Laboratories,1999.
Millon, Theodore, Ph.D., D.Sc. Disorders of Personality: DSM IV and Beyond. New York: John Wiley and Sons, Inc., 1996.
Sperry, Len, M.D., Ph.D. Handbook of Diagnosis and Treatment of DSM-IV Personality Disorders. New York: Brunner/Mazel, Inc., 1995.
International Society for the Study of Personality Disorders. Journal of Personality Disorders. Guilford Publications, 72 Spring St., New York, NY 10012. <http://www.guilford.com> . (800) 365-7006.
American Psychiatric Association. 1400 K Street NW, Washington D.C. 20005. <http://www.psych.org> .
Gary Gilles, M.A.
Where do I put all my energy? Where do I shelve my excitement, or am I free to jump up and down with simple joy? My clients see my jumpy side all the time, since it`s not unusual that they see me standing on my chair, kicking invisible enemies or plumping down on the floor. And why not?
There`s much to be excited about. Sometimes I simply MUST show this excitement, even if it demands a flapping hand or two. I`m not the only one either (not with hands, I know most people have them). I`m not alone! Actually, there`s many in the secret “ecstasy-class”. Instead of discussing the fix we won`t take, we discuss how we can shoot more of life`s fixes, WITHOUT hiding. We have certain steps we go through, and one of the last ones (that transform us, of course) is spreading the fixes to lots of others. When we do that, we feel even more ecstatic.
Can you imagine the jumping glee I felt when I just discovered another person perfect for the ecstasy group? I immediately spotted her ecstasy queen jumping in all directions while shouting something that sounds like: yeeeeaaahhhhiiiiiaaaaahhhhh!
The Fault In Our Stars by John Green is probably one of my favorite books that I read this summer. I thought I’d include some of my favorite quotes from the book.
- “I fell in love the way you fall asleep: slowly, then all at once.”
- “Sometimes, you read a book and it fills you with this weird evangelical zeal, and you become convinced that the shattered world will never be put back together unless and until all living humans read the book.”
- “I’m in love with you, and I’m not in the business of denying myself the simple pleasure of saying true things. I’m in love with you, and I know that love is just a shout into the void, and that oblivion is inevitable, and that we’re all doomed and that there will come a day when all our labor has been returned to dust, and I know the sun will swallow the only earth we’ll ever have, and I am in love with you.”
- “Some infinities are bigger than other infinities.”
- “Some people don’t understand the promises they’re making when they make them,” I said.“Right, of course. But you keep the promise anyway. That’s what love is. Love is keeping the promise anyway.”
- “The marks humans leave are too often scars.”
- “Oh, I wouldn’t mind, Hazel Grace. It would be a privilege to have my heart broken by you.”
- “May I see you again?” he asked. There was an endearing nervousness in his voice.I smiled. “Sure.”“Tomorrow?” he asked.“Patience, grasshopper,” I counseled. “You don’t want to seem overeager.“Right, that’s why I said tomorrow,” he said. “I want to see you again tonight. But I’m willing to wait all night and much of tomorrow.” I rolled my eyes. “I’m serious,” he said.
- “You are so busy being YOU that you have no idea how utterly unprecedented you are.”
- “The pleasure of remembering had been taken from me, because there was no longer anyone to remember with. It felt like losing your co-rememberer meant losing the memory itself, as if the things we’d done were less real and important than they had been hours before.”
- “You realize that trying to keep your distance from me will not lessen my affection for you. All efforts to save me from you will fail.”
- “Maybe ‘okay’ will be our ‘always”
- “You gave me a forever within the numbered days, and I’m grateful.”
- “And then the line was quite but not dead. I almost felt like he was there in my room with me, but in a way it was better, like I was not in my room and he was not in his, but instead we were together in some invisible and tenuous third space that could only be visited on the phone.”
- “That’s the good thing about pain. It demands to be felt.”
Three words: Best. Book. Ever. Seriously, go read it. It’s amazing!
Inspiration comes from a variety of sources
We have many great therapists in Norway, and through courses and education I sometimes meet some of them. It`s usually very inspiring, since they knit their theories together with their work in exciting tapestries. Last year we were on a lecture by a therapist called Per Isdal. He tried to help violent men, and told us about burn-out or compassion fatigue in that regard.
Yesterday we had a meeting were one of the lead psychiatrist at our clinic, talked about the same theme, and we had to fill out a questionnaire that asked about felt tiredness, stress and satisfaction with our work. Luckily I was in the “no risk” group, which I think comes from the meaning I derive from my work. I truly feel that I can help, and nothing is better than seeing my clients blossoming. To see them walking forwards through strive, and to be there when its extra rough, is an honor, and I try to remember that every time I`m afraid, have too much to do, or just think about everything that is wrong with the world. I also think that going to lectures and reading relevant books, has helped support my sanity and ability to help.
Help for the helper
I`ve read many good books this year, and one of them is “Help for the helper”. It is packed with quality advice and knowledge, and is also easy to read. P. Isdal recommended it himself, so I immediately ordered it and prioritized reading it. The ideas from the book were reawakened today, after reading “treating complex PTSD`by Courtis and Ford. I came to a part about sensorimotor psychotherapy, and it reminded me on features from “help for the helper”. I then remembered one of the sessions where I applied the theory, and wanted to share it with you. Some have said it would be good if I shared more from my clinical practice, and I want to do that, at the same time as I keep the privacy of my client and duty of confidentiality.
Working with abuse is a lot about listening to signals from the body again, and that means that we have to explore memories and feelings that might awaken fright or terror.
Unfortunately, I can`t go back in time, but I can do everything I can to help them live the life they never had.
By being observant on what happens inside me, I actually help them realize what happens with them. It can be subtle things: That I suddenly breathe slower, or that I need to push my chair back, or maybe that I feel uncomfortable. When I get unusual reactions like, I ask myself like Rotschild recommends: What is going on right now? Maybe I have picked up on something they are feeling?
We are mirrors
When we see someone play the piano, some of the same nerve-cells for moving the fingers are activated in our brain as in theirs. When I subconsciously register that my client feel scared, I will “mirror” this and start FEELING scared myself, and often too a degree where my heart starts to speed up or my breathing starts to change. Monkeys who never showed fear toward some object, might actually feel fear for the same object later if they see another monkey react that way.
- Intriguing Trauma Treatment (lilyscot.com)
- Fighting Apathy by becoming a Helper (pretendyouregoodatit.com)
- Homeostasis Refers to More Than Just The Planet
- Interview with Patricia Smith: Founder of the Compassion Fatigue Awareness Project
- Video about the discovery of mirror neurons
- Ramachandran Essay –– If you don’t read the whole thing, check out his thought experiment at the end.
- How Stuff Works – Article about mirror-touch synesthesia.
- Monkey Do, Monkey See –Very interesting interview with Daniel Glaser
Department of Psychology, Columbia University, New York, NY, USA.
Social Cognitive and Affective Neuroscience (Impact Factor: 6.13). 04/2007; 2(1):3-11. DOI:10.1093/scan/nsm005
- Review: Hem Helpers Do Their Job at a Great Price (stilettojungleblog.com)
- You is kind. You is smart. You is important. You is brave. (lifeanditswhatnots.wordpress.com)
- How Do You Know Your Shrink Is Helping You? (psychologytoday.com)
My journey through treatment
by Dee MultipleMeThe story you are about to read contains subject matter than may not be easy to read and was not easy to write. It is a story of familial abuse and systems abuse. It is the story of a girl who did the best she knew how at the time. The story of a girl who kept on fighting for her life even as the system set up to protect and do no harm failed her on multiple levels. It is the story of deep pain, incredible strength, and steadfast hope.
Comment Tom Cloyd MS MA:
This document exists because once I heard parts of the author’s story, I urged her to write it out, for the benefit it would have for others who’ve had similar experiences. As a story of perseverance and ongoing struggle, it simply strikes me as extraordinary.
It also raises many questions – such as how the sort of systems abuse she experienced could have possibly happened, and that of how many others in our society experience the sort of familial abuse she did, and what are the consequences? These are good questions, and we have good answers. I address these and other matters in an Afterword. I hope you find this useful and informative.