paranoid and schizoid

MENTAL HEALTH

PARANOID & SCHIZOID

PERSONALITY TYPES DISORDER

GROUP MEMBERS:

ARETHA HECTOR

ASHA POMPEY

DENESHA ALEXANDER

KEZIA WILLIAMS

APRIL JOB

SCHIZOID & PARANOID PERSONALITY DISORDERS

TABLE OF CONTENTS

Introduction………………………………….………………. Page 3

What are Personality disorders?.................................................................. Page 4

Definition and Epidemiological Statistics

Paranoid Personality Disorder (PPD)………………………….page 5

Schizoid Personality Disorder (SPD)…...……………………...page 5

Etiology

Paranoid Personality Disorder (PPD)………………………….page 6-7


Clinical Picture



How is PPD Diagnosed………………………………………………………page 9

How is SPD Diagnosed………………………………………………………page 10

Symptoms



Treatment:

Nursing Management

Paranoid Personality Disorder (PPD)………………………….page 12-13

Schizoid Personality Disorder (SPD)…...……………………...page 13-14

Medical Management


Schizoid Personality Disorder (SPD)…...……………………...page 14-15

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Complication

Paranoid Personality Disorder (PPD)……………………………….page 15

Schizoid Personality Disorder (SPD)………….…………………….page 16

Outlooks For Persons With PPD & SPD ……………………………………page 17

Prevention of PPD & SPD……………………………………………………page 18

Conclusion…………………………………….…………...……...page19

References…………………………………………………..…......page 20

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INTRODUCTIONPersonality is vital in defining who we are as individuals. It involves a unique blend of traits,

attitudes, thoughts, behaviours and moods – as well as how these traits affect the people around

us. Some characteristics of an individual’s personality are inherited, and some are shaped by life

events and experiences. A personality disorder can develop if certain personality traits become

too rigid and inflexible. This research paper is going to focus on only two of the ten types of

personality disorders; schizoid & paranoid. It’s going to educate our reader on what both

schizoid & paranoid personality disorders are, their causes, incidence rates, symptoms,

treatments and more.

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WHAT ARE PERSONALITY DISORDERS?

Personality Disorders, also known previously as character disorders, is a broad term for a

class of personality types and behaviors that describe individuals who have problems dealing with

other people. The patient will typically tend to be rigid and inflexible, finding it harder than other

people to respond as easily to the changes and demands that occur in life. They are seen as

dysfunctional in the way they assess situations and relate to other people.

The American Psychiatric Association (APA) describes a personality disorder as: "An enduring

pattern of inner experience and behavior that deviates markedly from the expectations of the culture

of the individual who exhibits it."

A personality disorder is a mental illness. The patient can become distressed when having to

perform everyday functions in the workplace, school or situations involving other people.

(PsychCentral, 2014)

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Paranoid Personality Disorder (PPD)Definition and Epidemiological Statistics

The DSM-IV-TR defines paranoid personality disorder as “a pervasive distrust and

suspiciousness of others such that their motives are interpreted as malevolent beginning by early

adulthood and present in a variety of contexts.” Sadock and Sadock (2007), identify the

characteristic feature as a longstanding suspiciousness and mistrust of people in general.

Prevalence is difficult to establish because individuals with the disorder seldom seek

assistance for their problem or require hospitalization. When they present themselves for

treatment because of the insistence of others, they may be able to pull themselves together

sufficiently so that their behaviour does not appear maladaptive. The disorder is more commonly

diagnosed in men than in women.(M. Townsend, 2007)

Schizoid Personality Disorder (SPD)Definition and Epidemiological Statistics Schizoid personality disorder is characterized primarily by a profound defect in the ability

to form personal relationships or to respond to others in any meaningful or emotional way

(Skodol& Gunderson, 2008). These individuals display a lifelong pattern of social withdrawal,

and their discomfort with human interaction is apparent.

The prevalence of schizoid personality disorder within the general population has been

estimated at between 3 and 7.5 percent. Significant numbers of people with the disorder are

never observed in a clinical setting. Gender ratio of the disorder is unknown, although it is

diagnosed more frequently in men.(M. Townsend, 2007)

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ETIOLOGY

SCHIZOID PERSONALITY DISORDER

Although the role of hereditary in the etiology of schizoid personality disorder is unclear,

the feature of introversion appears to be a highly inheritable characteristic. Further studies are

required before definitive statements can be made. (M. Townsend, 2007)

Psychosocially, the development of schizoid personality is probably influenced by early

interactional patterns that the person found to be cold and unsatisfying. The childhood of these

individuals have often been characterized as bleak, cold, and notably lacking empathy and

nurturing. A child brought up with this type of parenting may become a schizoid adult if that

child possesses a temperamental disposition that is shy, anxious, and introverted. According to

Skodol and Gunderson (2008), “Clinicians have noted that schizoid personality disorder occurs

in adults who experienced cold neglectful and ungratifying relationships in early childhood,

which leads these persons to assume that relationships are not valuable or worth pursuing. (p.83)

PARANOID PERSONALITY DISORDER

Research has indicated a possible hereditary link in paranoid personality disorder. Studies

have revealed a higher incidence of paranoid personality disorder among relatives of clients with

schizophrenia that among control subjects (Sadock&Sadock, 2007).

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Psychosocially, people with paranoid personality disorder may have been subjected to

parental antagonism and harassment. They likely served as scapegoats for displaced parental

aggression and gradually relinquished all hope of affection and approval. They learned to

perceive the world as harsh and unkind, a place calling for protective vigilance and mistrust.

They entered the world with a “chip-on –the-shoulder” attitude and were met with many rebuffs

and rejections from others. Anticipating humiliation and betrayal by others, the paranoid person

learned to attack first. (T. Basavanthappa, 2000)

CLINICAL PICTURE


Individuals with paranoid personality disorder are constantly on guard, hypervigilant, and

ready for any real or imagined threat. They appear tense and irritable. They have developed a

hard exterior and become immune or insensitive to the feelings of others. They avoid interactions

with other people, lest they be forced to relinquish some of their own power. They always feel

that others are there to take advantage of them.

They are extremely over sensitive and tend to misinterpret even minute cues within the

environment, magnifying and distorting them into thoughts of trickery and deception. Because

they trust no one, they are constantly “testing” the honesty of others. Their intimidating manner

provokes exasperation and anger in almost everyone with whom they come in contact.

Individuals with paranoid personality disorder maintain their self-esteem by attributing

their shortcomings to others. They do not accept responsibility for their own behaviours and

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feelings and project this responsibility on to others. They are envious and hostile toward others

who are highly successful and believe the only reason they are not as successful is because they

have been treated unfairly. People who are paranoid, are extremely vulnerable and constantly on

defense. Any real or imagined threat can release hostility and anger that is fueled by animosities

from the past. The desire for reprisal and vindication is so intense that a possible loss of control

can result in aggression and violence. These outbursts are usually brief, and the paranoid person

soon regains the external control, rationalizes the behaviour, and reconstructs the defenses

central to his or her personality pattern. (M. Townsend, 2007)


People with schizoid personality disorder appear cold, aloof, and indifferent to others. They

prefer to work in isolation and are unsociable, with little need or desire for emotional ties. They

are able to invest enormous affective energy in intellectual pursuits.

In the presence of others they appear shy, anxious, or uneasy. They are inappropriately

serious about everything and have difficulty acting in a lighthearted manner. Their behaviour and

conversation exhibit little or no spontaneity. Typically they are unable to experience pleasure,

and their affect is commonly bland and constricted. (M. Townsend, 2007)

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HOW IS PPD DIAGNOSED?

Family physicians and general practitioners are generally not trained or well-equipped to

make this type of psychological diagnosis. So while you can initially consult a family physician

about this problem, they should refer you to a mental health professional for diagnosis and

treatment. There is no laboratory, blood or genetic tests that are used to diagnose schizoid

personality disorder. (PsychCentral, 2014)

The psychiatrist or psychologist will conduct a psychological assessment. He or she may

ask about childhood, school, work, and relationships. He or she may also ask you several

hypothetical questions. This is to gauge how you react to certain situations. For example, he or

she may ask what you would do if you found somebody’s wallet on the sidewalk. The

psychiatrist or psychologist will use your responses to make a diagnosis and form a treatment

plan. (Healthline, 2014)

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HOW IS SPD DIAGNOSED?

To be diagnosed with schizoid personality disorder, you must meet criteria in the Diagnostic and

Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

Diagnosis of schizoid personality disorder includes four or more of these characteristics: (Mayo Clinic,

2014)

• You neither desire nor enjoy close relationships, including being part of a family.

• You almost always choose solitary activities.

• You have little, if any, interest in sexual experiences with another person.

• You take pleasure in few, if any, activities.

• You don't have any close friends or confidants other than first-degree relatives.

• You seem not to care about praise or criticism.

• You seem emotionally cold, detached or unexpressive.

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SYMPTOMS


A person with a paranoid personality disorder is extremely distrustful and suspicious. Other

symptoms include:

thinking other people are lying to them or trying to manipulate them

feeling they cannot really trust their friends and associates

worrying any confidential information shared with others will be used against them

thinking there are hidden meanings in remarks most would regard as innocent

worrying their spouse or partner is unfaithful, despite a lack of evidence


A person with a schizoid personality disorder may appear cold and detached, and avoid making

close social contact with others. Other symptoms include:

preferring to take part in activities that do not require interaction with others

having little desire to form close relationships, including sexual relationships

being uninterested when receiving criticism or praise

having a limited ability to experience pleasure or joy

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TREATMENT

NURSING MANAGEMENT

(Paranoid Personality Disorder - PPD)

Psychotherapy or “talk therapy” is used by the nurse to treat persons with paranoid personality

disorders. It is a way to treat people with a mental disorder by helping them understand their

illness. It teaches people strategies and gives them tools to deal with stress and unhealthy

thoughts and behaviors (National Institute of Mental Health, 2012). To care for clients with

paranoid personality disorders is challenging for the nurse. The nurse understands that the client

is suspicious and that he has long standing patterns of interactions that will make him unable to

respond to him/her off of communication. Forming an effective working relationship with

suspicious persons is difficult. The nurse has to remember that these clients take everything

seriously and are particularly sensitive to the reactions and motivations of others. Therefore,

nurses approach these clients in a formal, business-like manner and refrain from social chit-chat

or jokes. Being on time, keeping commitments, and being particularly straight forward are

essential to the nurse-client relationships. (Basavanthappa, 2000)

Since these clients need to feel control, it is important to involve them in formulating their

plan of care. The nurse should provide care and information to the clients in a non-emotional and

matter-of-fact manner. If the client agrees to treatment because his behavioural patterns are

making life too difficult; the nurse should focus on the behavior. For example, the client

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frequently doesn’t know how his actions come across to others so the nurse would provide clear

and honest feedback. As for clients who have paranoid delusions, the nurse wouldn’t try to talk

to the client about founded fears. Such discussions will only lead to the client becoming

defensive. (Townsend, 2007)

(Schizoid Personality Disorder - SPD)

People with this personality disorder rarely seek treatment, because their thoughts and behavior

generally do not cause them distress. When treatment is sought, psychotherapy -- a form of

counseling -- is the form of treatment most often used. Treatment likely will focus on increasing

general coping skills, as well as on improving social interaction, communication, and self-

esteem. This type of disorder is always marked by the inability to establish a nurse-client

relationship because people with schizoid personality disorder have difficulty forming

relationships with others. The client will be unable to respond in the way others do. Again, the

nurse must be aware of the fact that the client is unable to change his basic personality. He may

learn to change some behavioural characteristics, and care should be directed to changing

behavior that is causing the most disruption to the client’s life without attempting to change the

client’s personality. (Basavanthappa, 2000)

Group Therapies would also be conducted by the nurse because it can help persons with

SPD to practice their social skills. This helps them to become more comfortable in social

situations.

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Nursing interventions focus on improved functioning in the community. If a client needs

housing or a change in living circumstances, the nurse can make referrals to the social worker for

assistance.

MEDICAL MANAGEMENT

(Paranoid Personality Disorder - PPD)

Medications are usually contraindicated for this disorder, since they can arouse unnecessary

suspicion that will usually result in non-compliance and treatment dropout. Medications which

are prescribed for specific conditions should be given for the briefest time period possible to

bring the condition under management. (PschCentral, 2012)

An anti-anxiety agent, such as diazepam, is appropriate to prescribe if the client suffers

from severe anxiety or agitation where it begins to interfere with normal daily functioning. An

anti-psychotic medication decompensates into severe agitation or delusional thinking which may

result in self-harm or harm to others (PsychCentral, 2012).

(Schizoid Personality Disorder - SPD)

There are no specific drugs to treat schizoid personality disorder, but certain drugs can help with

symptoms. For example, if you have symptoms of anxiety or depression, you doctor may

prescribe a selective serotonin reuptake inhibitor (SSRI). Or while antipsychotics are not a

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routine part of treatment, they may be used to help with flattened emotions and social problems.

(Healthline, 2014)

COMPLICATIONS OF PPD

Any change or increase in stress can create complications, especially if occupational,

financial, or legal problems or personal relationships are involved. The paranoid personality

exaggerates even minimal problems. Examples of stress involving the workplace include a

change of supervisor, moving to another workspace, change in work hours, and / or a shift

change. (PsychCentral, 2014)

Substance abuse is often the individual's way of coping with the distress. Self-medication

can lead to abuse and dependence. Alcoholism, which is often associated with this disorder, leads

to a vicious cycle of paranoid perceptions becoming reality, as it leads to estrangement from

family members, co-workers, and friends. The presence of another personality disorder may also

complicate treatment. (PsychCentral, 2014)

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http://www.mdguidelines.com/alcoholism


COMPLICATIONS OF SPD

A lack of social interaction is the main complication of schizoid personality disorder.

People with this personality disorder are rarely violent, as they prefer not to interact with people.

Persons with schizoid personality disorder are though, at an increased risk of:

• Developing schizotypal personality disorder, schizophrenia or another delusional disorder

• Major depression

• Anxiety disorders

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OULOOK FOR PERSONS WITH

PPD

The outlook for people with PPD varies. It is a chronic disorder, which means it tends to

last throughout a person's life. Although some people can function fairly well with PPD and are

able to marry and hold jobs, others are complete disabled by the disorder. Because people with

PPD tend to resist treatment, the outcome often is poor. (WebMD, 2014)

OULOOK FOR PERSONS WITH

SPD

Although some of their behaviors might be odd, people with schizoid personality disorder

are generally able to function in everyday life. However, they might not form any meaningful

relationships or have families of their own. (WebMD, 2014)

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Prevention (PPD) Although prevention of PDD might not be possible, treatment can sometimes allow a person

who is prone to this condition to learn more productive ways of dealing with situations.

(WebMD, 2014)

Prevention (SPD) Schizoid personality disorder may be prevented if interventions occur early enough in life.

The disorder has both genetic and environmental origins. Obviously, you can't change your

genes. If your parents or another close relative have a schizophrenia-related illness, then you are

more likely to have a similar condition than the average person. To counteract this, adults can

shape the environment for their children, possibly reducing some of the risk factors for schizoid

personality disorder. When adults are warm, supportive, and responsive to their children's needs,

children are more likely to grow up seeking social support and healthy relationships. Those with

schizoid personality disorder often come from abusive upbringings and may have had cold and

distant parents. When parents avoid acting in these abusive ways, their children have a chance to

grow up with a healthier self-image. (WebMD, 2014)

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CONCLUSION In relation to the Schizoid Personality and the Paranoid Personality Disorder, some

individuals may not realize that they have a personality disorder because the way they think and

behave may seem natural to them nor would they want to accept the condition due to its

classification with mental disorder, and the stigma attached.

However, these disorders are very common and most individuals with personality

disorders lead normal lives and often only seek psychotherapeutic treatment during times of

increased stress or social demands. Most people when talking about the signs and symptoms, can

relate to some or all of the personality traits; the difference is that it does not affect most people's

daily functioning to the same degree that it might affect someone who is diagnosed with one of

these disorders. Personality disorders tend to be an integral part of a person, and therefore, are

difficult to treat or "cure." By seeking out information you may come to recognize the signs and

symptoms of a personality disorder and therefore, help yourself or someone you know live a

healthier and fulfilling life.

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References

Mental Health: Paranoid Personality Disorder. (n.d.). Retrieved November 7, 2014, from

http://www.webmd.com/mental-health/paranoid-personality-disorder

Personality Disorders and Personality Traits. (n.d.). Retrieved November 7, 2014, from

http://psychcentral.com/personality/

SYNOPSIS. (n.d.). Retrieved November 7, 2014, from

http://www.mentalhealth.com/home/dx/schizoidpersonality.html

Schizoid Personality Disorder Symptoms, Causes, Treatments. (n.d.). Retrieved November 7,

2014, from http://www.webmd.com/mental-health/mental-health-schizoid-personality-

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disorder

The DSM-IV Personality Disorders. (n.d.). Retrieved November 7, 2014, from

http://books.google.com/books?id=9AqPs9ootqoC&printsec=frontcover&dq=personalit

disorders&hl=en&sa=X&ei=pTZdVIDSMcPugwSxo4HoAw&ved=0CEAQ6AEwBg#v

=onepage&q=personalit disorders&f=false

Townsend, M. (2007). Essentials of Psychiatric Mental Health Nursing (4th ed.). Philadelphia:

F.A. Davis.

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