Cluster A Personality Disorder

1. See Also
   1. Personality Disorder
2. Definition
   1. Odd or eccentric personalities
3. Signs: General features for all cluster A personalities
   1. Fantasy to eccentric
   2. Lonely to schizoid
   3. Distortion or Delusion to Paranoid
   4. Projective identification
   5. Projection of guilt (blame someone else)
4. Type: Paranoid Personality
   1. Characteristics (onset as adult)
      1. Aloof and emotionally cold
      2. Pervasive mistrust and suspicion without sufficient cause, that others are exploiting, harming or deceiving him or her
      3. Unjustified doubts about other's loyalty or trustworthiness
      4. Reads into benign remarks or events, hidden demeaning or threatening meanings
      5. Persistently bears grudges (not forgiving insults or slights)
      6. Fear of intimacy with sense of vulnerability
      7. Usually isolated and disliked
      8. Often blame others and does not accept criticism
   2. Altered interpretation of illness and physician
      1. Rigid and initiate conflict: may be litigious
      2. Worries that physician may attempt to harm them
   3. Recommended physician approach
      1. Professional stance with clear explanations
      2. Empathic approach to patient's fears
      3. Do not confront paranoia directly
   4. Evaluate for comorbid conditions
      1. Drug Abuse (e.g. Amphetamine abuse)
      2. Obsessive Compulsive Disorder
5. Type: Schizoid Personality
   1. Characteristics
      1. Socially detached and does not enjoy social contact
      2. Chooses solitary activities
      3. Not interested in sex with others
      4. Takes pleasure in few if any activities
      5. Indifferent to praise or criticism from others
      6. Lacks close friends or confidants other than first degree relatives
      7. Anxious when forced into contact with others
      8. Restricted emotional range, flat, cold, humorless, aloof
      9. Often daydream
   2. Altered interpretation of illness and physician
      1. Appear not to appreciate a physician's care
      2. Often wait to pursue medical care
   3. Recommended physician approach
      1. Professional stance with clear explanations
      2. Do not become overly involved in personal issues
   4. Evaluate for comorbid conditions
      1. Not associated with Schizophrenia
6. Type: Schizotypal Personality
   1. Characteristics
      1. Similar to Schizoid Personality, but also peculiar
      2. Social and interpersonal deficits, isolated
      3. Perceptual distortion and eccentricity
         1. Odd reasoning and speech (vague, stereotyped, overelaborate, circumstantial)
         2. Relates strange experiences
         3. May be superstitious
         4. May believe in clairvoyance, telepathy or a sixth-sense
         5. Children may relate bizarre fantasies or preoccupations
   2. Altered interpretation of illness and physician
      1. Anxious when forced into contact with others
      2. Odd illness interpretation, and odd behavior
      3. Often wait to pursue medical care
   3. Recommended physician approach
      1. Professional stance with clear explanations
      2. Do not become overly involved in personal issues
      3. Do not focus on odd behavior or beliefs
   4. Evaluate for comorbid conditions
      1. Falls on spectrum with Schizophrenia
7. Management
   1. Target symptoms
      1. Cognitive or perceptual distortion
      2. Interpersonal mistrust
   2. Medications
      1. Atypical Antipsychotic
      2. Consider SSRIs
8. References
   1. Tomb (1992) Psychiatry, p. 147-52
   2. (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Washington D.C., APA
   3. Angstman (2011) Am Fam Physician 84(11): 1253-60
   4. Ward (2004) Am Fam Physician 70(8):1505-12