34 Cluster A Personality Disorders
Cluster A is described as the odd/eccentric cluster and consists of paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. The common feature of these three disorders is social awkwardness and social withdrawal (APA, 2013). Often these behaviors are similar to those seen in schizophrenia. In fact, there is a strong relationship between cluster A personality disorders among individuals who have a relative diagnosed with schizophrenia (Chemerinksi & Siever, 2011). However, the symptoms of cluster A personality disorders tend to be less extensive and less impactful on daily functioning relative to those experienced in schizophrenia.
Clinical Descriptions
Paranoid Personality Disorder
Paranoid personality disorder is characterized by a severe distrust or suspicion of others. Individuals interpret and believe that other’s motives and interactions are intended to harm them, and therefore, they are skeptical about establishing close relationships outside of family members — although at times even family members’ actions are believed to be malevolent (APA, 2013). Individuals with paranoid personality disorder often feel as though they have been deeply and irreversibly hurt by others even though there is little to no evidence to support that others intended to, or actually did, hurt them. Because of these persistent suspicions, they will doubt relationships that show true loyalty or trustworthiness.
Individuals with paranoid personality disorder are also hesitant to share any personal information or confide in others as they fear the information will be used against them (APA, 2013). Additionally, benign remarks or events are often interpreted as demeaning or threatening. For example, if an individual with paranoid personality disorder was accidentally bumped into at the store, they would interpret this action as intentional, with the purpose of causing them injury. Because of this, individuals with paranoid personality disorder are quick to hold grudges and unwilling to forgive insults or injuries – whether intentional or not (APA, 2013). They are known to quickly, and angrily counterattack either verbally or physically in situations where they feel they were insulted.
Paranoid Personality Disorder
Case vignette
A 36 year old divorced worker developed a severe depression after he was fired from his job and subsequently had severe alcohol problems. He presented himself to the general practitioner with somatic complaints, anxiety, compulsively washing his hands, fatigue, disturbing inner feelings of hatred towards other people. His troubles started in his childhood. He reported that he was very aggressive towards other children and he was involved in recurrent conflicts. At home he was constantly on guard. In his work relations he was involved in severe interpersonal conflicts, reacting with aggressive attacks at the slightest offences. The last years he spent working, he was continuously involved in conflicts with his colleagues. After a short contact with a female colleague who terminated the relationship with him. The only person he stayed friends with was his brother-in-law who lived a hundred miles away.
Schizoid Personality Disorder
Individuals with schizoid personality disorder display a persistent pattern of avoidance from social relationships along with a limited range of emotion among social relationships (APA, 2013). Similar to those with paranoid personality disorder, individuals with schizoid personality disorder do not have many close relationships; however, unlike paranoid personality disorder, this lack of relationship is not due to suspicious feelings, but rather, the lack of desire to engage with others and the preference to engage in solitary behaviors. Individuals with schizoid personality disorder are often viewed as “loners” and prefer activities where they do not have to engage with others (APA, 2013). Established relationships rarely extend outside that of the family as those diagnosed with schizoid personality disorder make no effort to start or maintain friendships. This lack of establishing social relationships also extends to sexual behaviors, as those with schizoid personality disorder report a lack of interest in engaging in sexual experiences with others.
With regard to the limited range of emotion, individuals with schizoid personality disorder are often indifferent to criticisms or praises of others and appear to not be affected by what others think of them (APA, 2013). They will rarely show any feelings or expression of emotions and are often described as having a “bland” exterior (APA, 2013). In fact, individuals with schizoid personality disorder rarely reciprocate facial expressions or gestures typically displayed in normal conversations such as smiles or nods. Because of this lack of emotions, there is limited need for attention or acceptance.
Schizoid Personality Disorder
Case vignette
Jacob is a 26 year old man. Despite extraordinary intelligence Jacob was not able to complete or participate in any educational program. He wanted to have a normal life with a family and friends, but thought that he was rootless and he felt that other people thought that he was peculiar or odd. He felt that he was outside. As a child he went to various schools because his parents moved around. He was thought of as a lonely wolf and did not participate in the social life or games of sports with his peers. During school class he was often absent minded being absorbed in his own thoughts and fantasies. From around the age of thirteen he became interested in computers and was quite advanced in his understanding of mathematics. He became exceedingly isolated with his computer as his sole companion.
This vignette schizoid personality illustrates the difficulties how to establish a stable relationship to significant others like peers and family. Often it is regarded as unusual that a person with schizoid personality disorder complains by himself or herself to be isolated. Many schizoid patients, in the contrary, claim to be quite satisfied with their loneliness and it is quite unusual that he wish to have a family. Also schizoid persons usually accept their situation or even deny any desire for closer relationships.
Schizotypal Personality Disorder
Schizotypal personality disorder is characterized by a range of impairment in social and interpersonal relationships due to discomfort in relationships, along with odd cognitive and/or perceptual distortions and eccentric behaviors (APA, 2013). Similar to those with schizoid personality disorder, these individuals also seek isolation and have few, if any established relationships outside of family members.
One of the most prominent features of schizotypal personality disorder is ideas of reference or the belief that unrelated events pertain to them in a particular and unusual way. This is a milder version of the delusions of reference that were discussed in the previous chapter. Ideas of reference also lead to superstitious behaviors or preoccupation with paranormal activities that are not generally accepted in their culture (APA, 2013). The perception of special or magical powers such as the ability to mind read or control other’s thoughts has also been documented in individuals with schizotypal personality disorder. Unusual perceptual experiences such as sensing the presence of another person or hearing one’s name (subthreshold hallucinations), as well as unusual speech patterns such as derailment or incoherence are also symptoms of this disorder.
Similar to the other personality disorders within cluster A, there is also a component of paranoia or suspiciousness of other’s motives in schizotypal personality disorder. Additionally, individuals with this disorder also display inappropriate or restricted affect, thus impacting their ability to appropriately interact with others in a social context. Significant social anxiety is often also present in social situations, particularly in those involving unfamiliar people. The combination of limited affect and social anxiety contributes to their inability to establish and maintain personal relationships; most individuals with schizotypal personality disorder prefer to keep to themselves in efforts to reduce this anxiety.
Schizotypal Personality Disorder
Case vignette
A 37 year old, unemployed man claimed of recurrent irrational thoughts, compulsive behavior, and social isolation. Since his childhood he had always been eccentric, withdrawn with no real friends anxiously fearing closer relationships, preoccupied with reading stories about Dracula and other myths. He didn’t share his inner thoughts or feeling with anybody, including his parents. He never finished an education, but worked in factories, often at night. Some years earlier he started doubting if his work was accurate enough. Although he recognized these thoughts as irrational, he started spending a lot of time controlling his work over and over again. Soon these compulsive controls took so much time that he could not finish his work, was continuously annoyed by intrusive vivid homosexual images, was preoccupied with doubts concerning almost everything at home and also he had to look persistently at people in order to be sure to maintain their images in his memory. He started fearing that people could notice his behavior, and he felt that unknown people were staring at him and that they secretly were making fun of him. He complained of being unable to reveal his feelings and thoughts to other people and felt isolated. He started drinking alcohol to control his increasing anxiety. He adopted different peculiar strategies, which ended in new vicious circles of obsessive symptoms and suspiciousness.
This case is diagnosed with obsessive-compulsive disorder (OCD), Alcohol abuse and Schizotypal Personality Disorder. He had long lasting personality difficulties like suspiciousness, odd behavior and social anxiety prior to the OCD symptoms. Comorbidity is often seen in Schizotypal Disorder.
Epidemiology
The cluster A personality disorders have a prevalence rate of around 3-5%. More specifically, paranoid personality disorder is estimated to affect approximately 4.4% of the general population, with no reported diagnosis discrepancy between genders (APA, 2013). Schizoid personality disorder occurs in 3.1% of the general population, whereas the prevalence rate for schizotypal personality disorder is 3.9%. Both schizoid and schizotypal personality disorders are more commonly diagnosed in males than females, with males also reportedly being more impaired by the disorder than females (APA, 2013).
Treatment
Individuals with personality disorders within cluster A often do not seek out treatment as they do not identify themselves as someone who needs help (Millon, 2011). Of those that do seek treatment, the majority do not enter it willingly. Furthermore, due to the nature of these disorder, individuals in treatment often struggle to trust the clinician as they are suspicious of the clinician’s intentions (paranoid and schizotypal personality disorder) or are emotionally distant from the clinician as they do not have a desire to engage in treatment due to a lack of overall emotion and desire for relationships (schizoid personality disorder; Kellett & Hardy, 2014, Colli, Tanzilli, Dimaggio, & Lingiardi, 2014). Because of this, treatment is known to move very slowly, with many clients dropping out of treatment before any resolution of symptoms can be met.
When clients are enrolled in treatment, cognitive behavioral strategies are most commonly used with the primary intention of reducing anxiety-related symptoms. Additionally, attempts at cognitive restructuring – both identifying and changing maladaptive thought patterns – are also helpful in addressing the misinterpretations of other’s words and actions, particularly in those with paranoid personality disorder (Kellett & Hardy, 2014). Clients with schizoid personality disorder may be engaged in CBT techniques to help them experience more positive emotions and engage in more satisfying social experiences; whereas the goal of CBT for schizotypal personality disorder is to evaluate unusual thoughts or perceptions objectively and to ignore the inappropriate thoughts (Beck & Weishaar, 2011). Finally, behavioral techniques such as social-skills training may also be implemented to address ongoing interpersonal problems displayed in the disorders.
Key Takeaways
Cluster A (“odd and eccentric”)
Includes paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.
Paranoid
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.
Schizoid
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.
Schizotypal
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as perceptual distortions and eccentricities of behavior.
“Cluster A Personality Disorders” is adapted from Abnormal Psychology by Coursehero, used under CC BY-SA: Attribution-ShareAlike.
