Oxford Textbook of Psychotherapy by Glen O Gabbard & Judith S Beck & Jeremy Holmes

Author:Glen O Gabbard & Judith S Beck & Jeremy Holmes
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2005-03-06T16:00:00+00:00

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‘Cluster A’ personality disorders

Paul Williams

Rex Haigh

David Fowler

‘Cluster A’ comprises paranoid personality disorder (PPD), schizoid personality disorder (SPD), and schizotypal personality disorder (StPD). These disorders affect 2%, slightly less than 1%, and 4% of the Western population, respectively, and can be highly disabling. Their incidence is higher in men than in women and the conditions are characterized by odd, eccentric, or ‘cold’ behavior (particularly SDP and StPD). It is thought that a biological relationship may exist between the disorders and the schizophrenias, although of the three, StPD is more demonstrably linked to schizophrenia phenomenologically and genetically (McGlashan, 1983). SPD and StPD are sometimes grouped as part of a continuum, given the similarity of certain symptoms. No distinctive set of psychoanalytic, cognitive-behavioral therapy (CBT) or group theories is applicable to these conditions. More research is needed before specific psychological theories can be established. Conceptualization of Cluster A disorders tends to utilize theories developed from the study of psychosis.

Paranoid personality disorder

The main characteristic of PPD is distrust and suspiciousness. The motives of others are construed as hostile and exploitative. The PPD patient's thoughts and feeling are preoccupied by conflicts and threats felt to emanate from outside. They experience doubts about the loyalty of others and anticipate betrayal. Given their preoccupation with threats, they are highly vigilant. Negative stereotyping can occur and this may lead to a search for security through contact with people who share the patient's paranoid beliefs. Individuals can express PPD through hostility, sarcasm, stubbornness, or a cynical world view. A beleaguered, self-righteous attitude conceals deep sensitivity to obstacles or setbacks, an unwillingness to forgive, inflation of subjective judgment, and difficulty in accepting another's viewpoint. These defenses reflect feelings of inferiority based on low self-esteem. Humiliation, shame, and depressive feelings are underlying affective characteristics of PPD. Encounters with PPD can leave others offended and disoriented or even provoked into conflict. History-taking may indicate that in childhood the patient withdrew from relationships and became preoccupied with ruminative, conflict-based fantasies. PPD can be differentiated from psychotic illness by an absence of delusions or hallucinations (Sperry, 1995). It is advisable to differentiate symptoms of PPD from those produced by substance abuse; they can appear similar but have different origins. Medication—usually neuroleptics or SSRI antidepressants—may be given, often in combination with psychotherapy. PPD patients struggle with any treatment regimen due to their distrust.

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