Schizoid and Schizotypal Personality Disorders Treatment

For didactic purposes, it is easier to address the issue of treatment in the realm of PDs as though patients manifested "prototypic" or textbook instances of the disorder whose DSM criteria they (predominantly) meet. In actual practice, schizoid and schizotypal are better seen, when present, as central tendencies whose ultimate clinical coloration and response to therapy are both modified by the existence of various coexisting traits that would arbitrarily be assigned to different DSM categories.

Certain combinations are much more common than others: schizoid patients are rarely also histrionic or borderline. Schizoid and schizotypal patients are usually shy and ill at ease socially; nevertheless, some have a good sense of humor and can eventually "warm up" to someone (including a therapist) whom they grow to trust over time. Some may show another mixture of socially positive traits, such as conscientiousness and respectfulness, that augur well for eventual improvement in therapy. Still others may be markedly paranoid or secretly grandiose or negativistic, and any one of these combinations creates much greater challenges to the therapist. Schizoid persons are no more prone, and may be even less prone, to antisocial behavior than are persons in the general community. There is nevertheless a small number of psychopathic patients with schizoid PD who, because of their extreme detachment from ordinary human sentiments, engage in antisocial acts of a bizarre or grotesque quality.

Some persons with schizoid or schizotypal personalities lack the schizotypal item "excessive social anxiety." This trait is not necessary for the diagnosis of schizotypal PD, because the latter requires only five of nine items. Such patients may never choose to present themselves to a therapist. Those who are contentedly aloof or who are antisocial and hostile to the very notion of treatment take themselves out of the picture relevant to the issues dealt with in this chapter.