Ah, Personality Disorders. This category of disorders is guaranteed to come up on the exam, both in terms of differential diagnosis and in terms of treatment interventions/approaches. Let's take a look at a sample test item:
A 24 year-old woman presents for an initial appointment wearing what appears to be an afghan and 3-D glasses. She tells the social worker that her mother recommended that she see a therapist for "social issues." With prompting, the woman reports that she does not have any close friends and has never had an intimate relationship. She says, "These glasses give me the ability to see the future, and it seems to freak people out. No one wants to hang out with me because I know what's going to happen." What is the most likely diagnosis in this case?
A. Psychotic Disorder, NOS
B. Schizotypal Personality Disorder
C. Schizoid Personality Disorder
D. Avoidant Personality Disorder
Differential diagnosis among Cluster A Personality Disorders is one of the most frequent topics of conversation with test-takers -- there are several in this category that sound similar, and in which the name doesn't give away the distinguishing characteristics. It's pretty easy to guess at least a few of the symptoms associated with Dependent Personality Disorder, but Schizotypal? What does that mean? In particular, folks seem to get Schizotypal Personality Disorder and Schizoid Personality Disorder confused, so let's break it down.
Schizotypal Personality Disorder involves inappropriate or constricted affect, irrational beliefs, magical thinking, ideas of reference, extreme social anxiety, unusual perceptual experiences (illusions), lack of close friends, paranoid ideation, and eccentric appearance. The eccentric appearance, unusual perceptual experiences and magical thinking all distinguish this disorder from others that might have similar social symptoms.
Schizoid Personality Disorder involves detachment from social relationships, a preference for being alone, restricted range of affect, lack of close friends, flat affect, emotionally cold, lack of desire for relationships, lack of sexual desire, indifference to opinion of others, lack of pleasure in activities. The lack of desire for relationships and overall indifference to others will likely be the distinguishing characteristic that stands out in a test item.
After the description above, it should come as no surprise that the answer to the question is B; the woman's odd appearance, lack of close relationships, and odd belief in her ability to "see the future" all point to a Schizotypal Personality Disorder.
Coming up next week: Mental Retardation
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How do you chose between A. Psychotic Disorder, NOS and B. Schizotypal Personality Disorder for this question? it seems to me that "the woman’s odd appearance, lack of close relationships, and odd belief in her ability to “see the future” " could also potentially be an indication of psychosis.