Schizotypal personality disorder

Introduction Schizotypal disorder has schizophrenia-like thinking and emotional abnormalities and behavioral bizarre, but there is no typical schizophrenic disorder and exact onset, and its evolution and course of disease are usually characterized by personality disorder. Splitting personality disorder is a personality disorder characterized by obvious defects in concept, appearance and behavior, and interpersonal relationship, and emotional coldness. Such people are generally lonely, silent, hidden, do not love interpersonal relationships, and do not gregarious. There are no friends, and they rarely participate in social activities, and they are isolated from the world. Often daydreaming, indulging in fantasy. Such people can adapt to a small work environment, but it is difficult to adapt to a large number of units and environments and work that requires communication.

Cause

(1) Causes of the disease

Personality refers to the overall mental activity (thinking, emotion, and behavior) pattern determined by genetics, that is, the innate quality of the individual and acquired development, acquisition, and organic integration. Personality characteristics can be expressed in social activities, dealing with interpersonal relationships, and can also be shaped and developed in social life practices. Such as mild or impatient temper, quick or slow response to things, honesty or falsehood, enthusiasm or indifference, trust or suspiciousness, obedience or aggressiveness, strictness or tolerance, self-esteem or inferiority, diligence or laziness, serious responsibility or sloppy Laissez-faire, conservative or radical, pragmatic or empty talk, slack or nervous, lonely or gregarious.

From the perspective of physiological-psychological-social medical model, personality disorder is often formed by the following factors, in which the family psychological factors play a major role in childhood.

Biological factors

Italian criminal psychologist Rombroso has conducted a large sample of the families of many criminals and found that many of the offenders have antisocial personality disorder, and the crime rate is much higher than other people. Some scholars have found that the proportion of personality disorder among the relatives with personality disorder is significantly higher than that of the normal population. Therefore, the genetic factors of personality disorder cannot be ignored. There are also reports of a higher rate of EEG abnormalities in people with personality disorders than normal people, suggesting that biological factors have a certain impact on personality disorders.

2. Psychological developmental influence

The psychological development process of children is traumatic and has a major impact on the development of personality. It is the main factor in the formation of personality disorder in the future. Common as follows:

(1) The deprivation of the mother's mother's love or father's love. Discarded or discriminated by stepfathers and mothers; parents and relatives are over-loving, making their self-centered ideas expand, and abnormally develop to despise school rules and social discipline. This provides a breeding ground for the development of antisocial personality disorder.

(2) If a child has the function of quickly eliminating the autonomic nervous system of fear response, it must have rapid, powerful and good acquired inhibition ability; on the contrary, if the autonomic nervous system is slow, the acquired inhibition ability is slow. And weak. Personality disorders and the autonomic function of the perpetrator are abnormal. It has been suggested that autonomic responsiveness is low and skin electrical recovery is slow, which can be used as a susceptibility to criminals and personality disorders.

(3) Child abuse and adolescent abuse lead to hatred and hostility to society or human psychology.

(4) Parents or other caregivers, kindergarten or primary school teachers have inadequate educational methods or expectations. Excessive coercion and reprimanding may cause mental stress or rebellious psychology and form a bad personality.

(5) Parents' own conduct or bad behavior has a great impact on children's personality development.

3. Bad social environment impact

Unhealthy attitudes, irrational phenomena, and money worship in the society will affect the moral values of young people, and they will develop confrontation, anger, depression, self-destruction and other bad psychology and develop into personality disorders.

At present, it is generally believed that the relationship between personality disorder and mental illness is: personality traits can become a susceptibility factor or incentive for mental illness; some personality traits are latent or residual manifestations of mental illness; personality disorder and clinical syndrome can have a common Quality and environmental background, both can coexist, but not necessarily the cause of the cause. Europe, especially the psychiatrists in Germany and the United Kingdom, believe that personality disorders are closely related to neurosis. They emphasize that "persons diagnosed with neurosis, we can completely find the characteristics of pathological personality, and in people with morbid personality, The characteristics of neurosis can also be found."

"The symptoms of neurosis and the behavior of morbid personality can be considered as a kind of reaction, depending on the quality tendency on the one hand and the pressure in the environment on the other." "There is no theoretical difference between the so-called pathological personality and the so-called neurosis personality. Come". Tolle (1996) pointed out that "personal disorder can show a large number of neurotic reactions, and many patients with neurosis also have personality disorders. There is no clear boundary between personality disorder and neurosis."

The so-called "neuropathy personality" comes from the theory of psychoanalysis. Horney thinks that patients with neurosis are those whose behavior, emotions, mentality, and way of thinking are not normal. They are full of anxiety in the fierce competition and establish for fighting anxiety. The defense mechanism that comes up, this is the personality of neurosis. Jasper believes that the symptoms of neurosis are abnormal personality, and the response to stress, that is, in normal cases, only behavioral (personal personality) is abnormal, and in the case of stress, neurosis responds, showing symptoms of neurosis. "Personal neurosis" refers to those individuals who are similar to the cause of neurosis, and whose patients may have no neurological symptoms. Freud speculates that the factors that determine the process of personality development are the causes of neurosis. Kolb (1973) pointed out that each neurosis has its own unique personality structure, which is often called personality neurosis. ICD-9 juxtaposes personality disorder with personality neurosis. This is not the case with ICD-10.

At present, it is believed that although the relationship between personality disorder and neurosis is close, that is, personality disorder contributes to the occurrence of neurosis, and neurosis also contributes to the formation of personality disorder, and the chance of comorbidity is higher, but in essence, both Belong to different disease categories.

(two) pathogenesis

Personality disorder is clearly a heterogeneous collection, each type has a common pathogenic factor, and now only the general pathogenesis is described as follows:

Genetic factor

Certain aspects of personality or personality psychological characteristics are genetically affected. The single-oval twin study by Shields (1962) indicated that the twin-child personality test scores that were raised separately after birth were similar to those grown together. Can be supported. In addition, the results of the schizophrenia lineage study showed that the prevalence of schizophrenic personality disorder in the immediate relatives of the foster families was significantly higher than that of the control foster flocks (10.5% vs. 1.5%), and the prevalence of paranoid personality disorder was also significantly higher. In the control group (3.8% vs. 0.7%).

2. Body type

Kretschmer (1936) created the theory of body type and temperament, but his conclusion comes from the subjective judgment of personality, which has no practical significance. Sheldon et al. (1940) applied more accurate measurement methods and modern statistical techniques. Although their research improved, they did not find a correlation between body type and personality.

3. Psychosocial factors

The study of personality biology based on objective diagnostic criteria and fixed-scale examinations has led to a significant increase in the credibility of personality disorder assessment.

According to the four dimensions of cognition, emotion, impulsive control and anxiety regulation, personality disorder can be divided into four categories (Siever et al., 1991), which are respectively associated with mental illness, thus forming a lineage concept: 1 cognitive/perceptual disorder and schizophrenia Connected with quirky type personality disorder (split type); 2 impulsive poor control and performance type (marginal, antisocial) personality disorder; 3 emotional instability and severe affective disorder and other performance types (edge type, performance Type) Personality disorder is spectrally related; 4 anxiety/depression (referred to as inhibition with anxiety) is associated with anxiety disorder and anxiety type (avoidance) personality disorder.

4. Cognitive/perceptual structural disorder

The disorder manifests in mental illness as thinking disorder, mental symptoms and social isolation. Minor barriers to cognitive control often occur in the form of quirks, special words, and social disengagement. The cognitive/perceptual structure is a ability to reflect a person's stimuli and attention to entry, and to process information according to his past experience and to appropriately select responses. Splitting personality disorder and schizophrenia belong to the two poles of this dimension band. The test of the attention/information process shows similar obstacles (Kendler et al., 1981). Eye movement dysfunction is not only seen in patients with chronic schizophrenia and their relatives (Holzman et al., 1984), but also in patients with schizophrenic personality disorder (Siever et al., 1984), and is associated with defective symptoms of schizophrenic personality. Splitting personality, schizophrenia patients and their relatives can find visual or auditory attention damage, such as reverse masking test, continuous operation test, sensory sluice test, etc., the results are consistent with the defect symptoms. In the blood and cerebrospinal fluid of schizophrenia and schizophrenic personality, the dopamine metabolite HVA is increased.

5. Impulsive / attack damage

Impulsive control is characterized by reduced ability to delay or inhibit movement, reflected in mental illness: such as intermittent outbreak disorder, pathological gambling or thief; as persistent and severely impulsive, it is manifested as destructive behavior and counter- Social behaviors such as marginal and antisocial personality disorders. Claridge (1985) found that cortical inhibition and alertness were reduced in socially ill patients, with more slow waves in the EEG and a lower sedation threshold. Psychophysiological studies have found that impulsive and socially ill patients have reduced ability to suppress motor responses, sympathetic responses are diminished, and skin electrical responses are rapidly formed (Hare, 1978). Animal studies have shown that the serotoninergic system mediates behavioral inhibition and the serotoninergic system is destroyed, leading to a reduction in disciplinary behavior. Similar findings were found in suicide attempters (Asberg et al., 1987), violence and aggressive behavior (Brown et al., 1982).

Decreased prolactin response to seroflurane, a serotoninergic releaser, in patients with borderline personality disorder suggests a decrease in serotoninergic function in such individuals (Coccaro et al., 1990). Drugs that enhance serotonergic function can improve or mitigate criminal aggressiveness and suicidal behavior (Meyendorff et al., 1986; Sheard et al., 1976). Norepinephrine (NE) is hyperactive in patients with personality disorder, and its growth hormone response to NE agonist: clonidine (clocite) is also increased, in addition to elevated levels of metabolites (Coccaro, 1991). It is known that the NE system mediates the alertness and orientation of the environment, strengthens the NE activity, and can increase the outward aggressiveness. Attacks are prone to occur when NE activity is enhanced and 5-HT activity is reduced (Hodge et al., 1975).

6. Emotional instability

This type of condition is characterized by changes in mood and intensity. Affective disorders manifest as persistent and endogenous disorders. Very short-lived emotional fluctuations related to the environment are seen in borderline personality disorder.

Emotional instability is a major feature of borderline personality disorder, and many of these patients later developed into a state of depression (Silverman et al., 1991; Zanarini et al., 1988; Links et al., 1988). Among relatives of patients with borderline personality disorder, the incidence of emotionally unstable personality is higher (Silverman et al., 1991). Data from biological studies suggest that affective disorder is associated with emotionally unstable or marginal personality, both of which show a shortened REM latency and a variable latency; the response to the muscarinic agonist arecoline is further REM The latency is shortened (Nurnberger et al., 1989; Bell et al., 1983); the DST test shows de-inhibition; the NE energy system is too reactive (Suhulz et al., 1988).

7. Anxiety / inhibition

In the event of unpleasant consequences, fear and autonomic alert thresholds are reduced, often accompanied by behavioral inhibition. Anxiety disorders, forced rituals, or fear and avoidance groups of personality disorders have the above characteristics. There are few studies linking avoidance group personality disorder with mental illness. Some studies have shown that anxiety/inhibition populations show higher levels of cortical and sympathetic alertness, lower sedation thresholds, and reduced habituation of new stimuli (Claridge, 1985; Gray, 1982; Kagon, 1988).

In short, psychobiology research has evolved along a number of personality disorders related to some mental illnesses. The relationship between personality disorder and mental illness is still under discussion. The following opinions exist:

1 certain personality characteristics increase the susceptibility of some mental illnesses and induce them;

2 Some personality traits are the hidden manifestations of some mental illness or their residues;

3 Personality characteristics and clinical syndromes are not yet clear, but they are the common background and environmental impact;

4 The simultaneous occurrence of personality disorder and clinical syndrome is purely coupled, and there is no etiology connection between the two.

8. Psychosocial factors

As we all know, family upbring can affect the development of normal personality, but how much do these effects play a role in the configuration of abnormal personality? And what is the nature of abnormal personality configuration? There is still little understanding. Unreasonable parenting during childhood can lead to the morbid development of personality. Children's brains have greater plasticity, and some personality tendencies can be corrected through normal education. If you let them go, you can develop abnormal personality. The family environment is also vital. Any parent who is not jealous, often quarrels, or even separates or divorces will have a negative impact on the child's personality development. The way parents educate their children is also a factor that affects the normal development of personality. Rough and fierce, indulgence of love and excessive demand are not conducive to the formation and development of personality.

an examination

Related inspection

Neurological examination of brain CT examination

Non-social, exceptionally quiet, cautious, conservative, serious, unintelligible, quirky, etc., can also be said to be closed self-esteem. On this basis, one end is characterized by rickets, excessive shyness, oversensitivity, small intestines, nervousness, easy impulse, relying on nature and books to kill time, solitude, and inaccessibility. Although there are subtle differences in performance, they are all characterized by excessive sensitivity. The other end is characterized by suppleness, good character, integrity, slow feeling, and low mental activity, which is characterized by spontaneous dysfunction.

Differential diagnosis

Neurosis

In Europe, especially in Germany and the United Kingdom, psychiatrists believe that personality disorders are closely related to neurosis. They emphasize that "persons diagnosed with neurosis, we can completely find the characteristics of morbid personality, while in morbid personality People can also find the characteristics of neurosis." "The symptoms of neurosis and the behavior of pathological personality can be considered a reaction, depending on the quality of the trend, on the other hand, depending on the pressure in the environment", "in theory It is impossible to distinguish the so-called morbid personality from the so-called neurotic personality." Tolle (1996) pointed out that "personal disorder can show a large number of neurotic reactions, and many patients with neurosis also have personality disorders. There is no clear boundary between personality disorder and neurosis."

The so-called "neuropathy personality" comes from the theory of psychoanalysis. Horney thinks that patients with neurosis are those whose behaviors, emotions, mentality, and way of thinking are not normal. They are full of anxiety in the fierce competition and built up to fight anxiety. The defense mechanism, this is the personality of neurosis. Jasper believes that the symptoms of neurosis are the reactions of people with abnormal personality to stress, that is, in normal cases, only behavior (personality) is abnormal, and in the case of stress, neurosis responds, showing symptoms of neurosis. "Personal neurosis" refers to those individuals who are similar to the cause of neurosis, and whose patients may have no neurological symptoms. Freud speculates that the factors that determine the process of personality development are the causes of neurosis. Kolb (1973) pointed out that each neurosis has its own unique personality structure, which is often called personality neurosis.

At present, it is believed that although the relationship between personality disorder and neurosis is close, that is, personality disorder contributes to the occurrence of neurosis, and neurosis also contributes to the formation of personality disorder, and the chance of comorbidity is higher, but in essence, both Belong to different disease categories. The difference between personality disorder and neurosis is that most of the neurosis develops when the personality has been formed, that is, it has a disease course characteristic, and the personality disorder lasts for a lifetime from the early years. Neurosis patients have good ability to adapt to the environment, while personality disorders have obvious social adaptation disorders. Clinically, snoring and performance personality disorder can be seen, and obsessive-compulsive disorder and obsessive-compulsive personality disorder coexist.

2. Manic depression

Light mania can mainly be irritating, picky, irritating, arguing with others, arbitrarily arbitrarily, arbitrarily arbitrarily, arbitrarily arguing, attacking or invading surrounding behavioral disorders. If the past history is unknown, it may sometimes be misdiagnosed as a personality disorder. Although mild or atypical cases of mania may have similar personality disorder, careful observation can reveal symptoms such as high emotion, excitability, and increased speech. It is not difficult to distinguish between the disease course and the previous personality characteristics.

3. Schizophrenia

Early or anaplastic cases of schizophrenia are easily confused with personality disorders, and attention should be paid to identification. Early schizophrenia can be characterized by personality and behavioral changes, such as slack in labor discipline, emotional instability, easy quarreling with people, bad attitude towards family members, poor sense of responsibility, and reduced learning and work efficiency. Hoch and Donaif (1955) have proposed the concept of "pseudo-pathological personality schizophrenia", which is characterized by repeated deviant behaviors that are incompatible with social requirements, such as crime or sexual metamorphosis, etc., these early or pseudo-pathological personality If you examine the case carefully, you may find inappropriate emotions and behaviors as well as unreasonable delusions.

Schizophrenia may be incompletely relieved of personality defects. In the absence of a previous history of mental illness (or lack of attention), the distinction is often difficult, and can be diagnosed in combination with past personality traits and family history. In cases of schizophrenia remission, in addition to showing personality changes, there are also obstacles in terms of emotion, thinking, and will. They often lack spontaneous and natural nature, which is possessed by personality disorders.

Mild or quiescent paranoid schizophrenia can be misdiagnosed as paranoid personality disorder, but the latter mainly manifests misunderstanding of everyday things and interpersonal relationships on the basis of excessive sensitivity, thus creating certain implicatures, but generally not Hallucinations and delusions can be distinguished from schizophrenia.

4. Personality changes

Personality disorder needs to be differentiated from personality changes caused by brain organic diseases (cerebral arteriosclerosis, senile dementia, encephalitis, multiple sclerosis), also known as pseudo-pathological personality. Most patients with brain organic diseases have brain function (including intelligent) disorders and neurological signs, combined with EEG, computed tomography (CT) and other auxiliary examinations, identification is not difficult.

5. Differential diagnosis of paranoid personality disorder

Paranoid personality disorder does not have hallucinations, delusions and other psychotic symptoms, so it is not difficult to distinguish between paranoid psychosis and paranoid schizophrenia. Paranoid personality disorder lacks long-term antisocial behavior, which can be distinguished from antisocial personality disorder. This type has no self-harming behavior and no unstable characteristics, which can be distinguished from the edge type. Paranoid personality disorder seems to be associated with paranoid, paranoid schizophrenia (including late-onset delusional dementia). onoB (1961) has observed cases in which paranoid personality develops into paranoia. About half (45%) of patients with late-onset delusional dementia have a paranoid personality. The relationship between paranoid personality disorder and these two diseases remains to be further studied. The process of paranoid personality disorder is long, some of them are lifelong, and some may be a prelude to paranoid schizophrenia. With age, personality tends to mature or stress decreases, and paranoid features are mostly moderate. Such people are not difficult to distinguish from paranoid mental illness, the former lacks a fixed paranoia. Paranoid personality does not have hallucinations and delusions that can be distinguished from paranoid schizophrenia.

6. Differential diagnosis of antisocial personality disorder

First, we should rule out the personality changes associated with brain organic diseases, schizophrenia, and affective disorders. If you carefully understand the medical history, it is easier to distinguish. In addition, although anti-social personality disorder patients often have disciplinary behaviors, they are different from general crimes. Although both are fully responsible for crimes committed, judicial psychiatrists and judicial workers should distinguish between antisocial personality crimes. And criminals commit crimes:

1 The general perpetrators often have plans and premeditated crimes, and there are many anti-social personalities;

2 The criminals have obvious illegal purposes, and the anti-social personality is more dominated by emotional impulses, and the criminal motive is more vague;

3 The perpetrators are concealed and deceitful when committing others to be victimized, attempting to evade guilt, and anti-social personality harms others, and is especially harmful to themselves;

4 Those with antisocial personality are less likely to cause murder or other serious cases and sentenced to capital punishment;

5 The general criminal's personality is flawed, but does not reach the level of personality disorder, while antisocial personality has a heavy impact on all aspects of psychological activities, reflecting continuous and long-term behavioral obstacles on all sides of life.

7. Differential diagnosis of impulsive personality disorder

It is mainly related to the anti-social personality disorder. In addition to the impulsive nature, the latter often has behaviors that are ruthless and often violate social norms.

8. Differential diagnosis of anxiety personality disorder

Identify with social phobia. Patients with anxiety disorder are characterized by persistent, extensive stress and anxiety experiences. Although patients often evade social behavior, there is no fear of avoidance.

9. Differential diagnosis of dependent personality disorder

Some scholars believe that this type of proposing seems to be due to the prejudice of women in social systems and should not be classified as a type of personality disorder (Gelder, 1983). The main point of diagnosis is that these patients lack self-confidence, can't move independently, feel awkward, and are willing to subordinate themselves. What should be noted in the differential diagnosis is that in the patriarchal society, women are mostly subordinate, but not because of their wishes.

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