Schizoid and Schizotypal Personality Disorders -Outcome

Studies of outcome, especially in the long term, of schizoid or schizotypal patients are few in number. These have been reviewed by M. H. Stone (1993). Wolff and Chick noted that 80% of 22 boys considered to be schizoid at ages 5-14 were still diagnosed as such 10 years later. These authors did not comment on changes in levels of function. McGlashan reported that a group of formerly hospitalized schizotypal patients did less well at long-term follow-up than did a comparison group of patients who showed both schizotypal and borderline features. In that study, the “pure” schizotypal patients worked at occupations below their potential, remained socially impaired, and seldom achieved closeness with a sexual partner. In my private practice, of a series of five schizoid and five schizotypal patients (only one of the latter was ever hospitalized), seven have been traced after intervals ranging from 14 to 26 years. The three traced schizotypal patients are all working full-time; one is married, and the others are in long-term sexual partnerships. Of the four traced schizoid patients, only one is married and working at the expected level of function. The other three lead marginal, isolated lives and are working at jobs below what would have been predicted from their educational level.

What can be reasonably expected of therapeutic efforts depends greatly on the complexion of the personality as a whole. The rare patient who exemplifies region I traits shown in

Figure 81-1 (the “pure” schizoid patient) will probably have come to treatment only at the urging of others and is likely to drop out of treatment quickly.

More commonly, therapists will encounter schizotypal patients with some schizoid and paranoid features. If the paranoid features are not prominent, the therapist’s task will be easier and the outlook better. Improvement is apt to be more rapid and impressive in the occupational sphere than in the area of social, let alone intimate, relationships.

Although brief psychotherapy can be effective in resolving specific problems, there is no “quick fix” of any thorough-going kind for any PD. This is doubly true within the eccentric cluster. As the above-mentioned research corroborates, many schizotypal patients habitually misinterpret the social field, misreading other people’s intentions and then behaving in an unrealistic manner. They may, in the process, alienate co-workers and potential friends. To help remedy this situation, therapists will often find themselves functioning as an “auxiliary ego,” enlightening the schizotypal patient about what might be more probable interpretations concerning the various interpersonal events in the patient’s current life. With help of this sort, the schizotypal patient may be kept sufficiently “on the track” whether at work or in social settings, so as to fit in better with other people and be more readily accepted by them.

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Revision date: July 4, 2011
Last revised: by Sebastian Scheller, MD, ScD