A CASE OF Schizotypal Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the case
“meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Neal
Neal
was mandated to six months’ mental health treatment as a condition of his probation. He had been
found in possession of a small quantity of crack cocaine when the house he
rents a room in was raided. After testing
negative for drugs, he was released, given
probation, and sent for counseling. “I’ve thought for some time they wanted to set me up,” he noted. “They kept looking
at me from outside the cell, although they tried
to hide it, (5) so I know they were talking about me.” (1)
Police report that his neighbors state that Neal
has no friends and that he seems frightened of people. (9) No one came to bail Neal out of jail. (8)
Neal
is 32 years old and has a tall, almost emaciated frame. His eyes are deeply set, and he rarely meets
the gaze of others. There is a disjointed quality to his movements, as though his
body is not solely within his own control. From
the start of the interview, he seemed incapable
of responding to the simplest questions. Only after
a long silence could some answer be produced, and even these were often rambling and only tangentially related
to the inquiry, as if he were free-associating midway through his own
responses. (4)
Moreover,
his emotions seem at odds with the substance of his words, sometimes smiling at a sad
story. (6) He claims to know the “true purpose” of the interview; it was “told to
him,” and he has “glimpsed the future.” (2) Further inquiries designed to determine whether
his responses might only seem pathological because of poor word choice or
phrasing show instead that Neal is being literal: He believes that he can occasionally see
the future in a visual form. He also claims that
he can sometimes see what is going on in other
places and what might happen if he were to go
there. (3)
Getting
an accurate and full history from Neal is difficult. According to a neighbor,
Neal was born when his mother was in her mid to late-40s. The identity of his
father is unknown, and, to the neighbor’s knowledge, no male has ever come around their
home. His mother’s whereabouts are unknown, but
a neighbor believes she may live somewhere in
the city. She abandoned Neal at age 12. The
neighbor states that he did well in school, at least before his mother left. Nevertheless, “Neal was never normal,” she
says. “After his mother left, he became
stranger, twisting his body up into knots and
having conversations with himself.” (7)
No
information is
available concerning whether he received treatment for these behaviors. Also unclear is how Neal supports himself
currently. He claims to have worked as a window
washer for downtown shop owners until his
bizarre hair and unkempt appearance began to frighten
customers. Currently, Neal is fixated on his run-in with police, occasionally
mumbling something under his breath about “busting
heads.” (7) Therapy will be difficult,
even if he finds it possible to keep a schedule.
DSM-IV Criteria
A. Pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:(1) ideas of reference (excluding delusions of reference)
(2) odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations)
(3) unusual perceptual experiences, including bodily illusions
(4) odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
(5) suspiciousness or paranoid ideation
(6) inappropriate or constricted affect
(7) behavior or appearance that is odd, eccentric, or peculiar
(8) lack of close friends or confidants other than first-degree relatives
(9) excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder with Psychotic Features, or another Psychotic Disorder, and is not due to the direct physiological effects of a general medical condition.Note: If criteria are met prior to the onset of Schizophrenia, add “Premorbid,” e.g. “Schizotypal Personality Disorder (Premorbid).”
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
No comments:
Post a Comment