History

Fact Explanation
Odd and eccentric behavior [1] Odd and eccentric behavior is common to all cluster A personality disorders. They tend to think about themselves and around themselves. They usually do not appreciate their close contacts and may ignore or detach from them for their own satisfaction and comfort. [1,3,4]
Lack of pleasure Patients with schizoid personality disorder do not enjoy pleasurable life events. [4]
Lack of interpersonal relationships Patients with schizoid personality disorder tend to have only few interpersonal relationships and they do not like to seek further relationships, or to make interactions with others. Often they prefer solitary activities and even refuse sexual relationships. They often sacrifice intimacy in order to maintain autonomy and like to maintain a belief of independence and self sufficiency. [1,3,4,5]
Tendency to form emotional attachments with objects or animals Most schizotypal personalities, opt for a conventional lifestyle. However they are unable to respond appropriately in social situations and thus form bonds with inanimate objects or animals. They are often viewed by society as being withdrawn, reclusive and dull. [5]
Co- morbid anxiety These patients can have comorbid anxiety due to over or under stimulation. [5]
Pre-occupations with fantasy During periods of depersonalization, coupled with relative social isolation these individuals are likely to form elaborate fantasy worlds. May lead to brief psychotic or manic episodes. [5]
References
  1. MORGAN NG, RUMFORD GM, MONTAGUE W. Studies on the role of inositol trisphosphate in the regulation of insulin secretion from isolated rat islets of Langerhans. Biochem J [online] 1985 Jun 15, 228(3):713-8 [viewed 04 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2992453
  2. GRILO CM, SHEA MT, SANISLOW CA, SKODOL AE, GUNDERSON JG, STOUT RL, PAGANO ME, YEN S, MOREY LC, ZANARINI MC, MCGLASHAN TH. Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders J Consult Clin Psychol [online] 2004 Oct, 72(5):767-775 [viewed 04 June 2014] Available from: doi:10.1037/0022-006X.72.5.767
  3. ANGSTMAN KB, RASMUSSEN NH. Personality disorders: review and clinical application in daily practice. Am Fam Physician [online] 2011 Dec 1, 84(11):1253-60 [viewed 04 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22150659
  4. MARTENS WILLEM H.J.. Schizoid personality disorder linked to unbearable and inescapable loneliness. Eur. J. Psychiat. [online] 2010 March [viewed 06 June 2014] Available from: doi:10.4321/S0213-61632010000100005
  5. ESTERBERG ML, GOULDING SM, WALKER EF. A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence. J Psychopathol Behav Assess [online] 2010 Dec 1, 32(4):515-528 [viewed 09 June 2014] Available from: doi:10.1007/s10862-010-9183-8

Examination

Fact Explanation
Mental State Examination: Appearence Unremarkable, may have signs of co-existent anxiety or depression.
Mental State Examination: Speech They tend to have vague, impoverished, or concrete speech. They may avoid or have limited eye contact. Their gesturing, inflection and change of tone of speech may prevent effective communication. [1]
Mental State Examination: Affect Patients have flattened affect and shows no difference in response for praise and criticism. [2]
Mental State Examination: Thoughts Patients may be pre-occupied with elaborate fantasies, there may be brief manic, delusional episodes. [3]
Mental State Examination: Perception Unremarkable.
Mental State Examination: Depersonalization/Derealization May have brief episodes of depersonalization. [3]
Mental State Examination: Cognition Impaired. [1]
Mental State Examination: Insight Impaired.
References
  1. MORGAN NG, RUMFORD GM, MONTAGUE W. Studies on the role of inositol trisphosphate in the regulation of insulin secretion from isolated rat islets of Langerhans. Biochem J [online] 1985 Jun 15, 228(3):713-8 [viewed 04 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2992453
  2. ANGSTMAN KB, RASMUSSEN NH. Personality disorders: review and clinical application in daily practice. Am Fam Physician [online] 2011 Dec 1, 84(11):1253-60 [viewed 04 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22150659
  3. ESTERBERG ML, GOULDING SM, WALKER EF. A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence. J Psychopathol Behav Assess [online] 2010 Dec 1, 32(4):515-528 [viewed 09 June 2014] Available from: doi:10.1007/s10862-010-9183-8

Differential Diagnoses

Fact Explanation
Schizotypal personality disorder [1] This belongs to cluster A personality disorders like the schizoid personality disorders.
Paranoid personality disorder [1] Another cluster A personality disorder. This is characteristic of paranoia- and suspicious-related “positive” symptoms.
Schizophrenia Cluster A personality disorders have similar clinical features. [2]
Anxiety disorders Patients with schizoid type personality disorder have anxiety as a co-morbid disorder, because they are often stressed to maintain social contacts. [2]
Asperger's syndrome An autism spectrum disorder, in which individuals are withdrawn and show little social interaction. They have restricted interests and show repetitive behavior. [3]
References
  1. MORGAN NG, RUMFORD GM, MONTAGUE W. Studies on the role of inositol trisphosphate in the regulation of insulin secretion from isolated rat islets of Langerhans. Biochem J [online] 1985 Jun 15, 228(3):713-8 [viewed 04 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2992453
  2. WARD RK. Assessment and management of personality disorders. Am Fam Physician [online] 2004 Oct 15, 70(8):1505-12 [viewed 06 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15526737
  3. ESTERBERG ML, GOULDING SM, WALKER EF. A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence. J Psychopathol Behav Assess [online] 2010 Dec 1, 32(4):515-528 [viewed 09 June 2014] Available from: doi:10.1007/s10862-010-9183-8

Management - Specific Treatments

Fact Explanation
Patient education Patients should be counseled about the nature of their personality disorder. Relatives and family members are asked to avoid over involvement in personal and social issues. [1]
Cognitive–behavioral therapy Patients who are having symptoms of anxiety benefit from cognitive behavioral therapy. [2] During cognitive behavioral therapy sessions patients are advised to overcome maladaptive beliefs about others and themselves, which may reinforce maladaptive behaviors. Cognitive restructuring, behavior modification, exposure, and skills training are common cognitive behavioral techniques that are practiced. [3]
References
  1. WARD RK. Assessment and management of personality disorders. Am Fam Physician [online] 2004 Oct 15, 70(8):1505-12 [viewed 06 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15526737
  2. DAVISON S. E.. Principles of managing patients with personality disorder. [online] 2002 January, 8(1):1-9 [viewed 06 June 2014] Available from: doi:10.1192/apt.8.1.1
  3. MATUSIEWICZ AK, HOPWOOD CJ, BANDUCCI AN, LEJUEZ CW. The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders Psychiatr Clin North Am [online] 2010 Sep, 33(3):657-685 [viewed 06 June 2014] Available from: doi:10.1016/j.psc.2010.04.007