Straight, No Chaser: Paranoid, Schizoid and Schizotypal Personality Disorders

Cluster A

I’d imagine that if you’re reading this, it’s not necessarily because the topic is interesting but because you may be wondering if these are applicable to someone you know. Whereas it’s important to get friends and family to help if needed, do resist the urge to practice armchair psychology. Although the idea of a personality disorder is something that may lead to playful banter, they can be quite serious. In this Straight, No Chaser, we discuss the disorders that involve odd, eccentric thinking or behavior: paranoid, schizoid and schizotypal personality disorders, with a particular focus on paranoid personality disorder. Collectively, they are known as Cluster A personality disorders. It is important to note that those with personality disorders do not have psychosis. As is the case throughout personality disorders, a single cause is unknown, but a mix of genetic predisposition and environmental triggers appears to play roles.
Paranoid personality disorder is more common in men and families with psychotic disorders. As you might suspect, these individuals have a long history of distrust and suspicion, which can lead to social isolation and poor functioning. Relationships, school, work and other activities may be compromised. Other symptoms may include the following:

  • Constant feeling of being in danger
  • Unjustified belief that others have hidden motives and are trying to harm, deceive or exploit
  • Unjustified suspicion of the loyalty or trustworthiness of others
  • Hesitant to confide in others due to unreasonable fear that others will use the information against you
  • Perception of innocent remarks or unthreatening situations as personal insults or attacks
  • Angry or hostile reaction to perceived slights or insults, with a tendency to hold grudges
  • Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful
  • Inability to work together with others
  • Detachment and social isolation
  • Lack of insight that feelings are unjustified

Treatment is difficult because people with this condition are often very suspicious of doctors. Medications and behavioral (talk) therapy can often be effective; reducing paranoia and limiting its impact on the person’s daily functioning.
The other disorders in Cluster A are schizoid and schizotypal personality disorders. Other considerations (causes, treatments) are similar, but here are some of the defining symptoms of each.
Schizoid personality disorder: Think of an excessively flat personality

  • Appearance of indifference to others
  • Inability to take pleasure in activities or accomplishments
  • Inability to pick up on social cues
  • Little emotional expression
  • Little interest in sex or interpersonal relationships

Schizotypal personality disorder – Think of abnormal thoughts and activities

  • Belief that incidents or events have hidden messages meant specifically for you
  • Belief that you can influence people and events with your thoughts (aka magical thinking)
  • Inappropriately indifferent responses to others
  • Inappropriate or flat emotions
  • Lack of comfort with close relationships
  • Odd perceptual experiences (e.g. hearing a voice say your name)
  • Social anxiety

Remember, it’s not enough to have some symptoms. A level of social dysfunction is necessary to establish a diagnosis.
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