What Is a Schizoid Personality Disorder?

Personality, or character, is a person's fixed behavioral pattern and habitual manner of dealing with people in daily activities. It is a combination of all psychological characteristics. Personality disorder refers to behaviors that deviate significantly from normal and deep-rooted behaviors. They are maladaptive, and their personality is abnormal in content, qualitative or overall personality. For this reason, the patient suffers and / or causes others to suffer. Suffering, or adversely affecting individuals or society. Although some progress has been made in the treatment of personality disorders, ways to effectively change have been found. However, the treatment of personality disorders is still largely based on the different characteristics of persons with personality disorders, helping them to find a way to reduce conflicts in life.

Ru Shujing	(Deputy Chief Physician)	Department of Clinical Medicine, Beijing Huilongguan Hospital
Li Yanli	(Deputy Chief Physician)	Department of Clinical Medicine, Beijing Huilongguan Hospital

Western Medicine Name: Personality disorder

Affiliated Department: Internal Medicine-
Contagious: Non-contagious

Personality disorders

Personality, or character, is a person's fixed behavioral pattern and habitual manner of dealing with people in daily activities. It is a combination of all psychological characteristics. The formation of personality is closely related to the innate physiological characteristics and acquired living environment. Childhood life plays an important role in the formation of personality, and once personality is formed, it has relative stability, but major life events and personal growth experiences will still cause a certain degree of personality change, indicating that personality has both relative stability and Certain plasticity.

Personality disorder (personality disorder) refers to behaviors that clearly deviate from normal and deep-rooted behaviors, and have maladaptive properties, whose personality is abnormal in content, qualitative or overall personality. Due to this reason, the patient suffers and / or makes others suffer. , Or have an adverse effect on individuals or society. The abnormality of personality hinders their emotional and will activities, destroys the purpose and unity of their behavior, gives people a unique and special feeling, and is particularly prominent in dealing with people. Personality disorders usually begin in childhood, adolescence, or early adulthood, and continue through adulthood and throughout life. Some people with personality disorders have amelioration in adulthood.

Personality disorder may be one of the quality factors for the occurrence of mental illness. It can be seen clinically that a certain type of personality disorder is closely related to a certain mental illness. For example, many patients with schizophrenia have schizophrenic personality before the illness, and paranoid personality easily develops into paranoid mental disorder. Personality disorders can also affect the response of mental illness to treatment.

Personality disorder and personality change cannot be confused. Personality change is acquired, meaning that a person's original personality is normal, and it occurs after severe or persistent stress, severe mental disorder, and brain disease or injury. As the disease is cured and the situation improves, it may recover or partially restore. Personality disorders do not have a clear onset of onset and start in childhood or adolescence and last a lifetime. The reference for personality change is pre-illness; the main criteria for personality disorder come from social and psychological criteria.

The distinction between personality disorder and disease is not always easy to make. The key to the difference is the duration of abnormal behavior. If a person originally behaves normally and then develops abnormalities at a certain stage of life, it can be considered a disease. The behavior has been abnormal since childhood, indicating a personality disorder, and it is not easy to distinguish if the behavior gradually changes (paranoid mental disorder).

Regarding the concept of personality disorder, in the past, some people thought that the mild manifestations of mental illness during personality disorder are the same reaction process as neurosis, but recent research does not support the above insights, and believe that "personality disorder" is "a deep-rooted type of maladaptive behavior" , Can be found in the juvenile stage or earlier, and throughout the life process ^[1] .

Personality disorder epidemiology

To date, little information is available on the prevalence of personality disorders. The epidemiological survey of mental illness in some areas of China in 1982 and 1993 showed that the prevalence of personality disorders was 0.1 . According to surveys conducted abroad, the prevalence of personality disorders is mostly 2% to 10%. From the limited data available, the incidence of personality disorders in China seems to be particularly low compared to western countries, which may be caused by the inconsistencies and cultural differences in the understanding and diagnosis of personality disorders between China and the West.

Causes and pathogenesis of personality disorders

Biological factors of personality disorder

The incidence of personality disorder was higher among relatives of patients with personality disorder, and the abnormal rate of EEG in parents was higher. Multiple studies have reached similar conclusions. Some people counted 12 studies on twin crimes from 1929 to 1977. Among a total of 339 identical twins, the total crime rate was 55%; 426 cases of twin twins had a crime rate of 17%. Prompt the role of biogenetic factors in the criminal behavior of criminals (part of them are personality disorder patients). Introverted or extraverted personality may be genetically related, and the identical rate of identical twins is higher.

Studies on foster children have reported that children with personality disorders are fostered from childhood. Compared with normal controls, the incidence of personality disorders is still higher in adulthood, suggesting the role of genetic factors. Some studies have found that the proportion of chromosomal aberrations with XYY karyotype in criminals exceeds that of the general population. This chromosome aberration may be related to abnormal aggression and antisocial personality. EEG examination found that slow waves often appeared in half of the subjects, which was similar to children's EEG. Therefore, some scholars believe that personality disorder is a manifestation of delayed brain development and maturity. Delayed maturation of the cerebral cortex explains to a certain extent the delayed maturation of impulsive control and social consciousness. Infection, poisoning, malnutrition during pregnancy and infants, especially lack of adequate supply of protein, lipids and vitamins, brain damage and infectious diseases at birth or infants, and viral infections may be the cause of immature brain development. Personality disorders improve after middle age, which may be the result of increased cerebral cortex maturity, which is consistent with clinical observations. Changes in human behavior and mood are related to changes in neurotransmitters and their receptors, such as norepinephrine, serotonin, and dopamine, but there is a lack of consistent conclusions about the biochemical studies of personality disorders.

Personality disorder psychological development effect

Childhood life experience plays an important role in the formation of individual personality. The major mental stimulation or life frustration in the process of young children's psychological development has an adverse effect on the development of young children's personality. Such as divorce of parents, deprivation of fatherly love or motherly love, children who have no father or lack of fatherly love often show timidity and cowardice in adulthood. Deprivation of motherly love may be an important cause of antisocial personality. Data indicate that children who grow up in orphanages have more introverts as adults. Improper rearing style is also an important factor in personality development disorders. Inconsistent parental education attitudes make children live in contradictions and containment, or children step on rockers between parents and form dishonest habits; parents drink alcohol, use drugs, steal, fornicate or have mental illness or personality Obstacles or criminal records play a bad "model" role on children; inappropriate school education has more or less adverse effects on children's psychological development; families and teachers place excessive demands on children, resulting in rebellious psychology of learning ; Failing to meet parents' expectations, children always live in the shadow of "failure"; some students have poor performance, have been suppressed or rejected by teachers for a long time, have been despised by classmates, etc. These factors have a negative impact on personality development .

Personality disorder environmental factors

Poor living conditions, socializing with friends with impediments to character, and social circles that often mingle with the bad habits of most members often play an important role in the formation of personality disorders. Affected by a large number of obscene and murderous novels and film and television culture, young people often have weak legal concepts, coupled with low cognitive and critical abilities, poor self-control ability, and high emotional volatility. They are easily learned through observation, imitation, or instruction Behavior, even transgression. In addition, the negative effects of unhealthy social phenomena such as misfortunes, money worship, and distorted values on the formation of personality disorders cannot be ignored.

Clinical manifestations of personality disorder

Personality disorders have the following common features ^[2] :

1. Personality disorders begin in childhood, adolescence, or early adulthood and persist through adulthood and throughout life. There is no clear onset time, and there is no general process of disease development.

2. There may be impairment of brain function, but generally there is no obvious morphological and pathological changes of the nervous system.

3 Personality deviates significantly and persistently from the scope of the social and cultural environment in which it is located, thus forming a distinctive behavior pattern. Personality is characterized by emotional instability, poor self-control, poor ability to cooperate with others, and poor self-transcendence.

4 Personality disorders are mainly manifested as emotional and behavioral abnormalities, but their consciousness and intelligence are not significantly deficient. There are generally no hallucinations and delusions, which can be distinguished from psychotic disorders.

5. Personality disorders are often unaware of their personality defects, it is difficult to learn from their failures, and make the same mistakes repeatedly, so they are often frustrated in interpersonal communication, professional and emotional life, causing harm to others.

6. Personality disorders are generally able to cope with daily work and life, understand the consequences of their actions, and to a certain extent, understand the evaluation of their behavior by society, often subjectively suffering.

7. Various treatments are not effective, and medical measures are difficult to take effect.

Personality disorder diagnostic criteria

ICD-10 Personality Disorder ICD-10 Standards for Personality Disorder Research

(1) Individual characteristics and persistent behavior patterns clearly deviate from cultural norms, accompanied by cognition (such as attitudes and ways of perceiving and explaining things), emotions, impulse control, desire satisfaction, and ways of getting along with others The above deviates;

(2) Such deviations are widespread, difficult to correct behaviors, and social maladaption or dysfunction in most situations; there is personal pain or adverse effects on others;

(3) This deviation is stable and long-lasting, usually starting in late childhood or adolescence; the deviation is not caused by other mental disorders;

(4) Deviation is not due to brain injury, disease, or dysfunction;

DSM-IV Personality Disorders DSM-IV General Criteria for Personality Disorders

(1) It clearly deviates from the type of enduring inner experience and behavior that the patient's culture should have, and it is manifested in more than two aspects:

Cognition (ie the way of perception and interpretation of self, others and events)

Emotions (ie the scope, intensity, vulnerability, and fitness of emotional reactions);

interpersonal relationships;

Impulse control.

The so-called inconsistency with cultural expectations is used to emphasize that certain behaviors are abnormal from an Asian cultural perspective, and may be normal from another cultural perspective.

(2) This persistent type is immutable and involves many aspects of personal and social situations.

The maladaptive behavioral pattern confined to one area of personal life cannot be caused by personality disorders. Personality disorders involve everyday behaviors that are characteristic of most social situations.

(3) This lasting type causes clinically significant distress or distress in social, professional, or other important aspects.

Here it can be either internal pain or functional impairment. Some unsuitable personality traits involve only minor damage, but there is severe internal pain, while others manifest themselves as indifferent, but can cause serious social functional impairment.

(4) This type is fairly stable over time, at least as far back as adolescents or early adulthood.

In other words, the DSM-IV standard does not recognize personality disorders that begin in adulthood, and must begin at least in adolescents or early adulthood. ICD-10 is more stringent, indicating that they "always appear in childhood or adolescence"; behavioral patterns are stable, not Onset. For young people, if their maladaptive behavior begins at the age of 18, the diagnosis of personality disorders should be used with caution. The pattern of maladaptive behavior in a short period of time may be a developmental response that reflects situational or will soon disappear.

(5) This type of behavior cannot be attributed to the manifestation or consequences of other mental disorders.

(6) This type of behavior is not a direct physiological effect caused by a substance (such as a substance abuse drug, a therapeutic drug), or a general physical condition (such as a traumatic brain injury).

Differential diagnosis of personality disorder

Mainly the identification with personality changes. In some cases, serious personality changes can also occur in adulthood, as opposed to temporary behavioral changes caused by stress or disease. Situations that cause this lasting change are:

(1) Brain injury or brain organic lesions;

(2) severe mental illness, especially schizophrenia;

(3) Particularly severe stressful experiences, such as prisoners held hostage or tortured.

In ICD-10, personality changes caused by organic disease in the brain are classified as organic mental disorder (F00), which includes a type of personality and behavioral disorders caused by brain disease, injury, or dysfunction. Personality changes such as encephalitis or head injury. DSM-IV diagnoses this condition as a change in personality caused by a systemic disease.

In ICD-10, the other two forms of personality change listed above are divided into adult personality and behavioral disorders (F60). To diagnose a lasting personality change after a mental illness, the personality change must last at least 2 years, have a clear relationship with the illness, and do not appear before the illness. Individuals in this situation may be dependent, passive, and demanding, or they may exhibit social withdrawal and social isolation due to (non-delusional) belief in change and denigration. The authors of the ICD emphasize that this change must be understandable based on the patient's experience in the disease, his past attitude, adaptability, and living situation. However, it is generally believed that schizophrenia can directly or indirectly change personality.

In ICD-10, lasting personality changes after a catastrophic experience must also last at least 2 years. This stressful experience must be extremely intense, such as disasters, prolonged imprisonment with the possibility of being killed at any time, victims of terrorist activity, torture or detention in concentration camps. Individuals in this category are mostly hostile, irritable, suspicious, socially withdrawn, empty, hopeless, solitary and nervous. These characteristics were not present before the stressful experience, and although this condition can be seen in post-traumatic stress disorder, there is a difference between the two.

All in all, personality disorder is a rooted type of maladaptive behavior that can be found in adolescence or earlier, and runs through life. Personality changes caused by stress or disease have relatively clear onset of onset.

Personality disorder treatment

Overall goals for personality disorder treatment

Although some progress has been made in the treatment of personality disorders, ways to effectively change have been found. However, the treatment of personality disorders is still largely based on the different characteristics of persons with personality disorders, helping them to find a way to reduce conflicts in life. Regardless of the treatment method, the treatment goals set should be appropriate, and sufficient time should be given to complete the goals. It is important to establish a good doctor-patient relationship with patients. For people with personality traits that depend on traits, it is not appropriate to arrange interviews frequently, or they will become overly dependent. These patients are prone to create contradictions in the treatment planning process and use contradictions to divert attention from their own problems. Interventions for personality disorders usually require at least one professional and work closely to avoid inconsistencies in treatment. Many people with personality disorders respond poorly to staff changes, which allows them to re-experience the painful loss, rejection, and isolation of early life experiences.

A treatment plan should include attempts to help patients avoid difficult situations and increase their chances of developing advantages in their personality. Patients should be helped to avoid substance abuse or alcoholism or become involved in unsatisfactory relationships and further increase the problem. They should also be encouraged to develop amateur interests, receive continuing education or participate in club activities. Even if there is no improvement, these basic steps can stabilize until some occasional turn in the patient's life promotes improvement. The final improvement usually comes from a series of small improvements, and the patient gradually changes to a satisfactory change. In the process of trying to change, frustration can often occur, but it can be used constructively in treatment because it is at these times that patients are most likely to face their problems. Although the therapist goes to great lengths to help these patients, it should be recognized that no matter how skilled the therapist is, some patients will not improve.

Personality disorder medication

In general, it is difficult to change the personality structure with medication, but a small amount of medication can still help when there is abnormal stress and emotional response. Generally do not advocate long-term application and routine use, because the long-term effect is difficult to be sure.

For example, those who are emotionally unstable can apply a small amount of antipsychotic drugs; those who have aggressive behaviors can give a small amount of lithium carbonate, and can try other mood stabilizers as appropriate; those with anxiety behaviors can give a small amount of benzodiazepines or other anxiolytic drugs. Studies have reported that the selective 5HT recovery inhibitor fluoxetine with potential anti-impact action is effective for schizotypal personality disorder and borderline personality disorder.

Personality disorder psychotherapy

People with personality disorders usually do not seek medical treatment, and often go to the hospital very helplessly when they are in conflict with the environment and society and experience symptoms of emotional sleep. Through in-depth contact, doctors and patients establish a good relationship with them, help them understand the personality defects, encourage them to change their behavior patterns and encourage and strengthen their positive changes. One of the purposes of personality disorder treatment is to help patients establish good behavior patterns and correct bad habits. It is quite difficult to directly change the patient's behavior, but it can prevent the patient from being exposed to the situation that induces bad behavior as much as possible. For example, aggressive people do not appear to be aggressive on any occasion, and shy people are not ashamed everywhere. Finding occasions or factors that trigger abnormal behaviors is important for management and prevention. For example, compulsive personality has a "perfectionist" tendency, which allows him to engage in less intense work and less responsibilities. In addition, avoid unsuccessful hints and provide more opportunities to develop normal personality.

(1) Consulting

Problem-solving Counselling may help patients cope with stressful situations that lead to abnormal behavior or painful emotions. Counseling that combines current distress and past experience should be selectively applied to personality disorders. This approach is most likely to help young people who lack self-confidence, have trouble with interpersonal communication, or are unsure of their goals in life. It is important to inspire them to solve their problems by ignoring their attitudes and emotions. Confusion counselling is often more effective than non-guided therapy in improving personality disorders, especially for marginal and antisocial personality.

(2) Supportive psychotherapy

Psychological support is often helpful for people with personality disorders. After months of psychological support for some people with personality disorders, some effective progress can be achieved. Supportive treatment for people with antisocial personality disorders can take years. Support can be provided by a doctor, social worker, psychiatric nurse or supervisory officer. For antisocial actors who are initially reluctant to receive treatment, regulatory procedures may be useful external controls.

(3) Dynamic psychotherapy

The psychodynamic therapy of personality disorder is slightly different from other forms of psychodynamic therapy. Psychodynamic psychotherapy for personality disorders is more instructive, with less emphasis on the reconstruction of past events, and more emphasis on how to interact with people, cope with external difficulties, and handle personal internal feelings. Empathy and counter-empathy analysis is essential to clarify issues that exist in interpersonal relationships.

(4) Cognitive therapy

Therapists focus on thinking and belief patterns, which are characteristic of personality disorders and cause of emotional and behavioral problems. They try to change the cognition of people with personality disorders with conventional cognitive therapy techniques. Although some people think that this treatment is very effective, no controlled trial has evaluated its efficacy. Cognitive analysis therapy is a combination of techniques of cognitive therapy and analytical psychotherapy. This treatment has been used for borderline personality disorder, but its value has not been determined in clinical trials.

Personality Disorder Education and Training

Personality disorders, especially those with antisocial personality disorders, often have behaviors that endanger the society at different levels. Being hosted in a work school or reeducation through labor institution can help to correct their behavior. Normal personality will change with age, and some personality disorders may gradually ease with age. For example, although anti-social personality disorder still has interpersonal conflicts after middle age, the offensive behavior is greatly reduced, and it can be further transformed by active guidance.

Personality disorder prognosis

Personality disorder is defined as a permanent state of life, so little change is expected. There is currently little credible evidence for its outcome. A review of nine follow-up studies showed that only two of them were more than 4 years old. These studies differ greatly in their methods of sample collection and evaluation, and most of them have relatively small sample sizes. A large follow-up study underway at the National Institute of Mental Health should provide more valuable data.

Clinical impressions suggest that people with personality disorders can slowly produce subtle improvements, especially in aggressive and antisocial actors. If the number of arrests or contacts with other social management departments is used as the criterion, it is found that about one third of those who have continued anti-social personality in early adulthood will improve. However, they still have some problems with their relationships, which is manifested in their hostility towards their wives and neighbors and their high suicide rate.

Outcome studies of borderline personality disorder have varied results. Studies have found that only a quarter of people who meet the diagnostic criteria in the twenties age group still meet the same diagnosis by middle age, although most of them meet the diagnosis of another personality disorder at this time (including the performing type). , Evasive, and forced). People who consistently meet the original diagnosis often have a substance abuse or criminal record. Another study found that approximately 60% of people with borderline personality disorder still follow this diagnosis. Some studies have found that this type of suicide rate is high, but other studies have not found this result.

In general, the treatment of personality disorders has limited effectiveness and poor prognosis, so it is especially important to cultivate a healthy personality in childhood.