rubys-delusions

[rubys-delusions]

awhile ago i read that if someone is schizoid/schizotypal then they can't be schizophrenic. i've seen some people refer to those personality disorders as "the beginning of schizophrenia" yet i highly doubt that that is true. would the flattening effect in schizophrenia be considered schizoid traits or something? if i remember correctly, those two pds are on the schizophrenic spectrum. is it possible for someone to be both schizophrenic and schizoid/schizotypal?

Hey, thanks for the question!! 

I wouldn’t really consider them the beginning of Schizophrenia. Though some people with these disorders will go on to develop Schizophrenia, that’s not an absolute must, and many will never go on to develop it.  And yeah, they are on the Schizophrenia spectrum, so there’s definitely similarities between both disorders and different symptoms of Schizophrenia.

But no, it doesn’t seem like they would usually be diagnosed together, though it is possible. In both of the criteria it says that neither should be diagnosed if they occur exclusively during the course of Schizophrenia. It seems like in most cases it probably wouldn’t be necessary to diagnose both, like if someone with diagnosable Schizophrenia also had Schizotypal traits, they probably wouldn’t need to be diagnosed with both since those traits could just be attributed to the Schizophrenia. It seems like mostly they could be ruled out or something.

But  (As shown below. I only screen-capped the one for StPD,  but it says the same thing in the differential diagnosis section for both StPD and SzPD) 

 they still technically can both be diagnosed, but the PD symptoms have to have been present before the onset of Schizophrenia and still persist when symptoms are in remission. So they are probably both diagnosed occasionally. I’m not sure exactly how common this is though. Most things I find just say stuff like this (taken from here)  :

So I mean it makes it seem like it doesn’t happen very often but it’s also not technically impossible so I guess it just depends on the person diagnosing you. I am led to believe that it’s not incredibly common though.  

Anyways, I hope that is enough to answer your question! Have a great day, anon! - Luca

[rubys-delusions]

Hi so this is a bit different from my usual content, but I figured more people will see it here than if I were to say it on my main since I rarely do anything there.

If you ever feel like your friends secretly hate you, or are scared of you, or are upset with you but aren't telling you, and you have absolutely no proof to back it up,

Keep a happy folder.

Here are some things you can fill it with:

Screenshots of times your friends have said good things to/about you

.txt files where you write down different times your friends have done good things for you

Photos from spending time with your friends

Photos or .txt about your friends celebrating your birthday

Photos of presents you've gotten from your friends

Whenever you have those unjustified fears, look in your folder and remind yourself that they care.

[rubys-delusions]

My personal useful links on Cluster A PDs

This is just a long post where I can post useful stuff I've found in one place. Oriented more towards ppd but there's a lot of general cluster A stuff here too. Will be updated whenever I find something I want to add.

Tumblr posts are admittedly not the end all be all of information but most of these are cited

Schizotaxic model

Splitting in different disorders (bpd vs npd vs szpd)

PPD subtypes and other pd subtypes (tumblr vers)

SzPD vs Autism (Highlighted symptoms are either SzPD exclusive or have different root causes than autism) - unsure of source

[rubys-delusions]

Cluster A Personality Disorders

LINK 1, 2, 3, 4

Personality disorders are characterized by four criteria:

1. Distorted thinking patterns: People with PDs have distorted thought patterns about themselves and the world around them. These extreme and strange ways of thinking are generally most evident when interacting with non-disordered personalities. Distorted thinking can often be sorted into five categories:

Black-and-white thinking: For the person, everything is all-or-nothing. They either always get their way, or never. In an argument, the person is absolutely right and the other person is absolutely wrong, there is no room for nuance or both parties to be correct/incorrect.

Idealization and devaluation: Similar to black and white thinking, the person fluctuates between seeing others as flawless and perfect, or hopelessly incompetent and flawed, even malicious or evil. These fluctuations can be triggered by even minor-seeming events.

Suspiciousness and distrust: The person has a heightened sense of suspicion of others. They may believe that humans are inherently manipulative or harmful, and constantly search for these motives in others’ actions. For example, a small gift may seem to them like an act of manipulation or bribery.

Odd and unusual beliefs: The person believes in strange things, contrary to the person’s culture. 

Perceptual distortions: The person experiences brief “glitches,” such as hearing their name called in an empty building or seeing another’s face change before their eyes. These distortions are not considered hallucinations or delusions because the sufferer can often distinguish them from reality.

2. Problematic emotional responses: People with PDs often have emotional reactions, contrary to their culture, that are either too modulated or too exteme. For example, people with schizoid PD are very over-regulated and consequently cold and indifferent, while people with histrionic PD are very under-regulated and thus prone to extreme mood swings and reactions.

3. Over/under-regulated impulse control: Similar to the above, people with PDs are either over- or under- constrained in controlling impulses. For example, people with avoidant and obsessive-compulsive PD are over-regulated and consequently extremely controlling over their environment, while people with antisocial or borderline PD are under-regulated and prone to risky, reckless behavior.

4. Interpersonal difficulties: As a result of the above characteristics, a person with a PD often experiences considerable difficulty in relationships of all types. For example, a person with borderline PD may often frustrate their partner by starting arguments, acting on their distorted thoughts and under-controlling their impulses.

Cluster A: The Odd, Eccentric

Cluster A disorders are characterized by social awkwardness and withdrawal. Disorders within the same cluster have a high comorbidity; if you have one PD, it is very likely that you have some symptoms, or even another fully-developed PD from the same group. Note that these symptoms are not checklists; every case is unique and not everyone will experience the same symptoms.

SCHIZOID: 

Primary features: detachment, flat affect, disconnection

From within

Little to no social drive, urges.

Does not develop attachment; it’s debated whether this is an inability or a choice not to, most likely varies with the individual 

Emotions are shallower, more fleeting - default state is virtually emotionlessness

May have trouble identifying emotions and/or putting them into words

Apathetic, listless, detached

Anhedonia (lit. lack of pleasure) , avolition (lit. lack of want, desire)

Lacks affective empathy, the ability to “walk a mile in one’s shoes” and feel as someone else does. However, most schizoid people still posses cognitive empathy, or the ability to recognize, categorize, and name emotions in others.

Indifferent towards praise and criticism

May have a rich, detailed inner world OR be somewhat unimaginative, prefer mechanical and scientific pursuits [citation needed - contributions welcome]

From without

Overt schizoids do not disguise their personality and often appear cold, aloof, indifferent, callous, dull, uninterested, boring. Often speaks tersely and/or in a monotone.

Covert or “secret schizoids” present themselves through a persona that is sociable, friendly, and engaged. 

Few/no friends or confidants - if any, they’re probably first-degree relatives

Seem listless, directionless, without goals

May avoid things like seeking a job or higher education due to avolition, a desire to avoid engaging with society

Will probably not seek out professional help on their own or for being schizoid per se - most see a psychologist only at the urgings of a family member and for an unrelated illness, such as depression 

Due to these factors, SzPD appears to be among the rarest PDs but is probably underdiagnosed

SCHIZOTYPAL:

Primary features: odd beliefs, unusual thought patterns/speech, social discomfort

From within

Holds suspiciousness and paranoid ideations about other people or the human species in general, especially based on fears of physical/verbal/sexual violence - contrast to social anxiety, which is based on fears of embarrassment and misreading social cues

Feels acute discomfort in social situations and interpersonal relationships that does not diminish with familiarity - usually due to paranoid ideations, but a certain level of / comorbidity with social anxiety is not uncommon

Experiences minor cognitive and perceptual distortions such as movement in the corner of the eye, a sensation of weightlessness/melting limbs, hearing their called name in a crowd - as stated in the introduction, these are generally not considered to be delusions or hallucinations.

Experiences magical thinking, or the belief that their thoughts influence reality - a development of Obsessive-Compulsive Disorder may result, as the schizotypal person struggles to control certain malicious or frightening thoughts and develops rituals to pacify or neutralize them

Experiences ideas of reference; believes that other people notice them, notes passing events (ex. a popular advertisement) as having a hidden message or meaning

Holds odd beliefs and superstition (that are unusual for the patient’s culture and upbringing) . An American example would be a person that believes they can read minds, that their thoughts are being stolen, or that they are targeted for alien abductions. 

May experience psychotic episodes (e.g delusions, hallucinations) when under extreme duress - frequent, non-stress related psychosis is indicative that the schizotypal person has progressed to schizophrenia.

From without

Dresses oddly and inappropriately; may be mismatched, ill-fitting, dirty, or inappropriate for the occasion/setting

Odd thinking and speech patterns - may be overly abstract, metaphorical, vague, elaborate, ornate, or focus on the “wrong things” in conveying a message - schizotypal people can be hard to understand or follow in a conversation 

Inappropriate or flat affect, an inability to express conventional emotions or depths thereof

PARANOID:

Primary features: pervasive distrust and suspiciousness

Paranoid Personality Disorder is generally not diagnosed if the person has already been diagnosed with a psychotic disorder, such as schizophrenia.

From within

Strong, constant assumption that others are out to hurt, manipulate, and/or humiliate them

Puts tremendous effort in maintaining safety, distance

Tends to ruminate over past slights

Tends to hold grudges, jealousy, envy - includes romantic/erotic jealousy and suspicions of infidelity

Constantly worries over and/or questions the loyalty of others

Reluctance to confide in others - fears that the confidant may use that information against the paranoid person

Constantly searching for malicious intent in others - to the paranoid person, a simple apology can be an attempt to re-earn their trust and manipulate/hurt them again and again in the long run

Emotional state dominated by suspicion, distrust, and hostility

Hypervigilant

Places importance on self-reliance, autonomy

From without

May pre-emptively attack someone they feel threatened by

Expresses psychic distress through: complaining/criticism, argumentativeness, aloofness, stubbornness, sarcasm, a desire to control their environment

Keeps self guarded, secretive - may appear devious, cold, callous, even cruel

Combative and suspicious nature provokes others  ► reinforces the original belief that other people are out to hurt them ► becomes more combative and suspicious, provoking others ► reinforces the original belief… and so on and so on, creating a feedback loop of hostility

[rubys-delusions]

Being schizophrenic but trained to hide your negative symptoms is just like. Sometimes u r tired and u forget to be a Not Schizo Person and everyone in ur life thinks ur upset about something but actually u just dont have the energy to perform normal affect/speech/social and cognitive input

[rubys-delusions]

list of cognitive distortions

Cognitive distortions are biased and negative thinking patterns not based on fact or reality. They impact how we see ourselves/others and are usually associated with depression, anxiety, or trauma. (Note: this list was given to me by my therapist and is not my original writing.)

All-or-nothing thinking — You see things in black-and-white categories. If your performance falls short of perfect, you see yourself as a total failure.

Overgeneralization — You see a single negative event as a never-ending pattern of defeat.

Mental filter — You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.

Disqualifying the positive — You reject positive experiences by insisting they “don’t count” for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.

Jumping to conclusions — You make a negative interpretation even though there are no definite facts that convincingly support your conclusion. A) Mind reading: You arbitrarily conclude that someone is reacting negatively to you, and you don’t bother to check this out. B) Fortune telling: You anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact.

Magnification (catastrophizing) or minimization — You exaggerate the importance of things (such as a goof-up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or other people’s imperfections). This is also called the “binocular trick.”

Emotional reasoning — You assume that your negative emotions necessarily reflect the way things really are. “I feel it, therefore it must be true.”

Should statements — You try to motivate yourself with should and shouldn’t, as if you had to be whipped and punished before you could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequences are guilt. When you direct “should” statements towards others, you feel anger, frustration, and resentment.

Labeling and mislabeling — This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself. “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to them. Mislabeling involved describing an event with language that is emotionally loaded.

Personalization — You see yourself as the cause of some negative external event, which in fact you were not primarily responsible for.

[rubys-delusions]

one aspect of schizophrenia i dont see talked about very much is one that is, in my experience, the most personally upsetting. and thats the breakdown of word articulation. as i write this i'm havign trouble even putting words to describe how its hard to put words.

i used to be a prolific (fanfiction) writer. i can barely formulate tumblr posts at this point. it's not even that i was a particularly good writer, but it came so easily to me to put words on paper. i've always been a little bad at talking out loud due to my autism, but that used to be much better too.

it's just genuinely upsetting to me. i would trade my medication out in a heartbeat if there was one that treated this instead of my positive symptoms, my ability to pass as 'normal' be damned.

[rubys-delusions]

Reading these StPD snippets (x) and finding interesting things.

"The differential diagnosis for schizotypal personality disorder includes schizophrenia and several personality disorders. Paranoid and schizoid personality disorders share many of the core features of schizotypal personality disorder, but differ by degree or absence of eccentricity. Borderline personality disorder shares some of the unusual speech and perceptual style, but it demonstrates stronger affect and connection to others. Patients with avoidant personality disorder, while uncomfortable and inept in social settings, are not eccentric and crave contact with others. Schizophrenia differs from schizotypal personality disorder in that the schizotype possesses good reality testing and lacks psychosis."

"Treatment of persons with STPD should be cognitive, behavioral, supportive, and/or pharmacologic, as they will often find the intimacy and emotionality of reflective, exploratory psychotherapy to be too stressful (Kwapil and Barrantes-Vidal, 2012). Practical advice and social skills training are usually helpful and often necessary, as their social decision-making may itself be problematic."

"Like the person with a borderline personality, the individual with a schizotypal personality seems to lack a core. This person also is stalked by a rather unsettling sensation that he or she is somehow empty. This blandness becomes an invitation to an in-pouring of vivid fantasy and psychotic-like process. The world becomes peopled with clairvoyant messages, ghost-like presences, magical hunches, and secretive glances. Like a child withdrawn into a world peopled with pretend playmates, the person with a schizotypal personality silently retreats from life. Unlike a person with a schizoid personality described earlier, a person struggling with a schizotypal personality disorder is frequently sensitive to rejection. This person wants contact but does not know how to make it."

"Regarding language, there are unclear, strange, or stereotyped expressions and incorrect use of words, though not to the point of associative loosening and incoherence."

"Patients with schizotypal personality disorder also can appear aloof, apprehensive, and suspicious. They may be hypersensitive or hostile if they are distressed. However, they generally appear interpersonally inhibited. These patients show evidence of cognitive distortions, for example, nondelusional ideas of reference. They show a lack of social skills and are not able to accurately perceive social discourse... As with schizoid personality disorder patients, these patients are difficult to engage, and one must attend to appropriate boundaries and interpersonal distance. Their odd speech and behavior may be off-putting, and you may need to monitor your own responses to such behavior. However, once these patients are engaged, they tend to form a strong dependent relationship with their clinician."

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Anhedonia

an·he·do·ni·a (noun) The inability to feel pleasure.

"Many everyday acts are likely performed because of their intrinsically reinforcing consequences. Recent research has suggested that different types of anhedonia may be operative in schizophrenia and major depression." —World Psychiatry

In major depression, the modal phenomenon seems to be the reduced ability to experience pleasure after engaging in potentially pleasant acts (consummatory anhedonia).

In schizophrenia, there seems to be preserved ability to experience pleasure, while deficits in the ability to anticipate pleasureable consequences (anticipatory anhedonia) apparently predominate. In anticipatory anhedonia, the positive consequences of previously performed behavior are difficult to recall and the motivation to repeat these acts is therefore reduced.

[...] Individuals with persistent cognitive deficits such as those seen in schizophrenia may also be unable to volitionally retrieve their memories of previous positive experiences, leading to an increase in the inability to anticipate the pleasurable consequences of every action

(photo credit)

[rubys-delusions]

Chronic $/h addixtion

If you're starting out s/h please get help before it becomes a full blown addiction. I started at 12 and now at 21 I have permanent nerve damage in both arms that makes writing and holding utensils hard. I have hit several veins nearly bleeding out and needed blood transfusions. I've had countless trips to the ER for stitches and staples where you get treated like a criminal for needing medical resources.

I literally scare children if I wear short sleeves or shorts and look like I've been thrown through a window due to the severity of my scars.

I will never be able to wear short sleeves comfortably ever again. My scars are raised, purple/red and thick years after when I caused them; they are visible through tight clothing and unless I get expensive laser to flatten them I'm stuck with them for life ://

[rubys-delusions]

Treatment of Schizoid Personality by Zachary Wheeler

I’m either at one or two extremes.

“I’m not interested in friendship with others. I care more about my freedom. Other people are intrusive and overwhelming and I lose a part of myself each time I get into a friendship or relationship of any kind. What would I need a friend for anyway? Fantasies are my substitute.”

Me during the rare time I get attached to someone (it’s only happened twice):

“I love you so much. I’m so attached to you I feel like I’m going to actually die if you abandon me. It feels like a bomb going off. It feels like the world is ending. I’m terrified, I can’t breathe, please don’t leave me. Stay close, but don’t get too close.“

[rubys-delusions]

could it be a schizoid thing to be capable of strong emotions but never show them to anyone? like i do cry, but i do so alone in my room and don't tell anyone about it afterward, as if it never happened

no lmao thats like … normal

[rubys-delusions]

Symptoms of Schizoid Personality Disorder

The DSM isn’t accurate. That only represents schizoids on the severe end who have completely given up on relationships with people. Below are the symptoms from the Psychodynamic Diagnostic Manual (PDM) which is much more accurate. PDM Criteria for Schizoid Personality Disorder: 

Highly sensitive and shy – They may seem completely nonreactive, yet suffer an exquisite level of sensitivity. They may look affectively blunted while internally coping with what one of my schizoid friends calls “protoaffect,” the experience of being frighteningly overpowered by intense emotion (McWilliams 2006).

Easily overstimulated – As a result of the impingement, the schizoid child’s immature ego functions are overwhelmed, his capacity to be alone fails to develop, and he is chronically overstimulated (Guntrip 1969).

Fear of closeness/Longing for closeness –  The central conflict of the schizoid is between his immense longing for relationship and his deep fear and avoidance of relationships (PDM Task Force, 2006). As Akhtar (1987) notes, while the schizoid is outwardly withdrawn, aloof, having few close friends, impervious to others’ emotions, and afraid of intimacy, secretly he is exquisitely sensitive, deeply curious about others, hungry for love, envious of others’ spontaneity, and intensely needy of involvement with others.

Splitting (In-and-Out Program) –  When in relationships, the schizoid maintains a pattern of oscillating towards and away from intimacy, alternatively desiring, and being excited at the chance for contact, and becoming claustrophobic, smothered, choked, imprisoned and terrified of being devoured or smothered by the other. The schizoid then must break free and recover independence (Guntrip, 1969).

General emotional pain when overstimulated, affects so powerful they feel they must suppress them – for most schizoid people, the smallest surge of emotion feels like a bomb going off. Fearful that any feeling can quickly become overwhelming, the schizoid denies and isolates all his feelings so that this does not occur (Doidge 2001).

The view that dependency and love are dangerous –  Schizoids come to believe that it is their love, rather than their anger, that is destructive, dangerous, and best kept out of sight (Fairbairn, 1940).

The belief that the social world is impinging and dangerously engulfing – When a loss of self occurs, the schizoid becomes estranged from his needs and feelings and is unable to be assertive, even in relatively harmless situations he fears that he is vulnerable to being controlled, appropriated, or taken over by another person. Laing (1960) describes the subjective experience of engulfment to being buried alive, being drowned, being caught in quicksand, losing one’s self, being absorbed by another person, being placed under unsolicited obligation, enclosed, swallowed up, eaten up, suffocated, smothered, and stifled.

Withdrawal, both physically and into fantasy and indiocyncratic preoccupations – The schizoid’s tendency for withdrawal and preoccupation are noted as primary defensive functions. Withdrawal is a process that has both physical and emotional components. Identifying the signs of withdrawal requires attention to body language, the quality and quantity of communication, and the emotional experience of the patient. Physical withdrawal is associated with closed body language, limited eye contact, slumped or shrinking posture, and the orienting of the body away from others. The withdrawn individual seeks to create distance between the self from others, be it moving back a few steps, moving to the perimeter of the room, or becoming reclusive and cloistered within the home. Physical activity reduces often to the point of inactivity, and the person may report feeling weak, tired, sleepy, or exhausted. The emotional experience of withdrawal often includes an increase in fantasy life, feeling boredom or apathy, or  even disgust, revulsion and aversion. The emotional state of the withdrawn self is passive, disconnected and lacking the energy to make emotional contact, which over time leads to depersonalization and emptiness.

Schizoids are far from indifferent and unemotional.

Source

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Schizoid Automatic Thoughts

It is important for me to be free and independent of others.

I enjoy doing things more by myself than with other people.

In many situations, I am better off to be left alone.

It’s better to be alone than to feel “stuck” with other people.

I can use other people for my own purposes as long as I don’t get involved.

I am a social misfit.

Intimate relations with other people are not important to me.

My privacy is much more important to me than closeness with people.

Relationships are messy and interfere with freedom.

Life is less complicated without other people.

It is better for me to keep my distance and maintain a low profile.

I shouldn’t confide in others.

It doesn’t matter what people think of me.

I am not influenced by others in what I decide to do.

I set my own standards and goals for myself.

What other people think doesn’t matter to me.

I can manage things on my own without anybody’s help.

I’d rather do it myself.

I prefer to be alone.

I have no motivation.

I’m just going through the motions.

Why bother?

Who cares?

[rubys-delusions]

Personality Disorder Concepts: Defining Characteristics

These are the defining characteristics of PDs, each of which are different depending on the PD in question.

Triggering event(s).

The situations that trigger a maladaptive response that is reflected in the person’s behavioral, interpersonal, cognitive, and affective styles. Triggering events can be intrapersonal (e.g. failing an exam), or interpersonal (e.g. being criticised).

ASPD: Social standards and rules.

AVPD: Close relationships; being social/in public.

BPD: The expectation of meeting goals; maintaining close relationships; real or imagined abandonment.

DPD: The expectation that they can rely on themselves; being alone.

HPD: Relationships, particularly with those they’re attracted to.

NPD: Self-evaluation, either by themselves or others.

OCPD: Unstructured situations; meeting other’s standards (in all aspects of life: work, family, etc).

PPD: Close relationships; personal questions.

STPD: Close relationships.

SZPD: Close relationships.

Behavioral style

The way in which the person reacts to a triggering event.

ASPD: Impulsive, irritable, aggressive; irresponsible and struggles to keep commitments; relies on themselves, uses cunning and force; risk-taking and thrill-seeking.

AVPD: Tense and self-conscious; controlled speech & behaviour; appear apprehensive and awkward; self-criticising and overly humble.

BPD: Self-damaging behaviours (self-harm, self-sabotage, suicidal ideation); aggression; achieve less than they could (e.g. in work or school); chronic insomnia & irregular circadian rhythms (”body clocks”); feel helpless & empty void.

DPD: Docile, passive, non-assertive, insecure, and submissive; doubts themselves & lacks self-confidence.

HPD: Charming, dramatic, expressive; demanding, self-indulgent, inconsiderate; attention-seeking, mood swings, impulsive, unpredictable, and superficial.

NPD: Self-centred, egotistical, self-assured; dominates conversations; seeks approval and attention; impatient, arrogant, hypersensitive.

OCPD: Perfectionists; workaholics; dependable, stubborn, possessive; indecisive, prone to procrastination.

PPD: Always tense and hypervigilant; defensive, argumentative, guarded.

STPD: Eccentric, bizarre; strange speech; struggles with work and school and often become drifters and wanderers; avoids long-term commitment and looses touch with society’s expectations; dissociative.

SZPD: Lethargic, inattentive, eccentric; slow and monotone speech; rarely spontaneous; indifferent.

Interpersonal style

The way they relate to others.

ASPD: Deceitful; irritable, antagonistic and aggressive; disregards their and other’s safety; distrustful; lacks empathy; competitive.

AVPD: Sensitive to rejection; want acceptance but are too scared; withdraw and avoid when afraid; test people to see if they’re safe to interact with.

BPD: “Paradoxical instability”; splitting (idealise & cling vs devalue & dismiss); sensitive to rejection; “abandonment depression” & separation anxiety; superficial yet quickly developed and intense relationships; “extraordinarily intolerant” of being alone.

DPD: People-pleasers, self-sacrificing, clingy & needs reassurance; over-compliant & over-reliant on others; want others to be in control of their lives; avoids arguments; puts themselves down so they can receive the support of others; urgently seeks a new relationship when one ends.

HPD: Needs attention; flirtatious, manipulative; lacks empathy; overestimates intimacy of relationships.

NPD: Exploitative; self-indulgent; charming, pleasant & endearing; lacks empathy; irresponsible; jealous; needs approval and admiration.

OCPD: Very aware of social hierarchy; deferential to superiors and haughty to subordinates; polite and loyal; insist that their way is the right way to do things, because they are anxious to ensure perfection; stubborn; devoted to work which interferes with relationships.

PPD: Distrustful, secretive, suspicious, tend to isolate themselves and avoid intimacy; hypersensitive to criticism; bears grudges and blames others; reluctant to open up for fear of vulnerability.

STPD: Loners; socially anxious, apprehensive, suspicious and paranoid, which doesn’t fade as they get to know people; tends to live on the margins of society and relationships; often choose jobs with minimal social interaction that are usually below their skill level; indifferent to social norms.

SZPD: Aloof, loners, reserved, solitary; socially awkward; tend to fade into the background; happy to remain alone.

Cognitive style

How the person perceives and thinks about a problem and its solution.

ASPD: Impulsive; realistic; very aware of social cues; prone to executive dysfunction.

AVPD: Hypervigilant; distracted and preoccupied with their fears of rejection.

BPD: Inflexible (splitting) & impulsive; difficulty learning from the past; external loss of control leads them to blame others to avoid feeling powerless; emotions fluctuate between hope and despair; unstable self-image and fragmented sense of self; unable to tolerate frustration; brief psychotic episodes; dissociation; intense rage; difficulty focusing & processing information.

DPD: Suggestible and persuadable; optimistic, sometimes to the point of naïveté; uncritical; minimises difficulties and are easily taken advantage of.

HPD: Impulsive, dramatic; vague; suggestible; relies on intuition; avoids reflection and introspection as so to avoid realising their dependency on others; needs approval from others; has separate real/inner/private & constructed/outer/public selves; tendency to mimic speech patterns.

NPD: Focuses on feelings rather than facts; compulsive lying (to themselves as well as others); inflexible, impatient, persistent; superiority; unrealistic goals of success, power, ideal love.

OCPD: Rule & detail oriented; difficulty with prioritising; inflexible, unimaginative; conflicted between assertiveness & defiance vs obedience & pleasing people.

PPD: Mistrustful; hypervigilant; focuses on feelings (of paranoia) rather than facts; brief psychotic episodes; their need to find evidence for their paranoid suspicions gives them a tendency for authoritarianism.

STPD: Scattered; obsessive and tends to ruminate; superstitious, bizarre fantasies; vague ideas of reference (thinking things are about them when they’re not, e.g. someone laughing is directed at them) and magical thinking (thinking they caused something to happen by thinking about it); dissociative.

SZPD: Distracted; difficulty organising their thoughts; vague and indecisive; difficulty with introspection and reflection.

Affective style

How the person expresses and experiences emotions.

ASPD: Superficially expresses emotions; avoids emotions that will make them vulnerable; rarely feels guilt, shame or remorse; unable to tolerate boredom, depression, & frustration and needs stimulation.

AVPD: Shy & apprehensive; feels empty, sad, lonely & tense; depersonalisation.

BPD: Mood swings; inappropriately intense anger; feelings of emptiness, boredom, a “void”; emotional dysregulation.

DPD: Insecure & anxious; lacks self-confidence & fears being alone; fears abandonment & rejection; often sad or somber.

HPD: Displays intense, extreme emotions but may only feel them shallowly; sensitive to rejection; mood swings; need reassurance that they are loved.

NPD: Presents as self-confident and nonchalant; when criticised or rejected (”narcissistic injury”) they experience extreme shame which is often redirected into anger (”narc rage”/shame redirect); splitting; lacks empathy and so has difficulty with commitments.

OCPD: Somber, difficulty expressing feelings; avoids emotions that will make them vulnerable; comes across as stiff and stilted.

PPD: Cold, aloof, humourless; difficulty expressing feelings; tendency for anger and jealousy.

STPD: Cold, humourless, aloof; difficult to engage with; suspicious and mistrustful; hypersensitive; may react inappropriately for the situation or not at all.

SZPD: Humourless, cold, aloof; indifferent; lacks empathy; emotionally and socially distant; difficulty responding to other people’s feelings.

Temperament

The response pattern that reflects the person’s energy level, emotions and intensity of emotions, and how quick they react.

ASPD: Irresponsible, aggressive and impulsive.

AVPD: Irritable.

BPD: Passive (dependent subtype); hyperreactive (histrionic subtype); irritable (passive-aggressive subtype).

DPD: Low energy; fearful, sad or withdrawn; melancholic.

HPD: Hyperresponsive; needs attention from others.

NPD: Active and responsive; has special talents and developed language early.

OCPD: Irritable, difficult, anxious.

PPD: Active and hyperresponsive (narcissistic subtype); irritable (obsessive-compulsive and passive-aggressive subtypes).

STPD: Passive (schizoid subtype); fearful (avoidant subtype).

SZPD: Passive, difficulty experiencing pleasure and motivation (anhedonia).

Attachment style

Discussed in this post.

ASPD: Fearful-dismissing.

AVPD: Preoccupied-fearful.

BPD: Disorganised.

DPD: Preoccupied.

HPD: Preoccupied.

NPD: Fearful-dismissing.

OCPD: Preoccupied.

PPD: Fearful.

STPD: Fearful-dismissing.

SZPD: Dismissing.

Parental injunction

The expectation (explicit or implied) from caregivers for how the child should be or act.

ASPD: “The end justifies the means.”

AVPD: “We don’t accept you, and probably nobody else will either.”

BPD: “If you grow up, bad things will happen to me [caregiver].”; overprotective, demanding or inconsistent parenting.

DPD: “You can’t do it by yourself.”

HPD: “I’ll give you attention when you do what I want.”

NPD: “Grow up and be wonderful, for me.”

OCPD: “You must do/be better to be worthwhile.”

PPD: “You’re different. Keep alert. Don’t make mistakes.”

STPD: “You’re a strange bird.”

SZPD: “Who are you, what do you want?”

Self view

The way they view and conceptualise themselves.

ASPD: Cunning & entitled.

AVPD: Inadequate & frightened of rejection.

BPD: Identity problems involving gender, career, loyalties, and values; self-esteem fluctuates with emotions.

DPD: Pleasant but inadequate, fragile.

HPD: Needs to be noticed.

NPD: Special, unique and entitled; relies on others for self-esteem.

OCPD: Responsible for anything that goes wrong, so they must be perfect.

PPD: They’re alone and disliked because they’re different and better than others.

STPD: Different than other people.

SZPD: Different from others; self-sufficient; indifferent to everything.

World view

The way they view the world, others, and life in general.

ASPD: Life is dangerous and rules get in the way of their needs. They won’t be controlled or degraded.

AVPD: Life is unfair; even though they want to be accepted, people will reject them, so they’ll be vigilant & demand reassurance; escapes using fantasies and daydreams.

BPD: Splits between people and the world as either all-good or all-bad, resulting in commitment issues.

DPD: Other people need to take care of them because they are unable to.

HPD: Life makes them nervous, so they need attention and reassurance that they’re loved.

NPD: Life is full of opportunities; they expect admiration and respect.

OCPD: Life is unpredictable and expects too much, so they manage this by being in control and being perfectionists.

PPD: Life is unfair, unpredictable, demanding, and dangerous; they need to be suspicious and on guard against others, who are to blame for failures.

STPD: Life is strange and unusual; others have special magic intentions, so they are curious but also cautious when interacting with the world.

SZPD: Life is difficult and dangerous; if they trust no one and keep their distance from others, they won’t get hurt.

Maladaptive schema

Discussed in this post.

ASPD: Mistrust/abuse; entitlement; insufficient self-control; defectiveness; emotional deprivation; abandonment; social isolation.

AVPD: Defectiveness; social isolation; approval-seeking; self-sacrifice.

BPD: Abandonment; defectiveness; abuse/mistrust; emotional deprivation; social isolation; insufficient self-control.

DPD: Defectiveness; self-sacrifice; approval-seeking.

HPD: Approval-seeking; emotional deprivation; defectiveness.

NPD: Entitlement; defectiveness; emotional deprivation; insufficient self-control; unrelenting standards.

OCPD: Unrelenting standards; punitiveness; emotional inhibition.

PPD: Abuse/mistrust; defectiveness.

STPD: Alienation; abandonment; dependence; vulnerability to harm.

SZPD: Social isolation; emotional deprivation; defectiveness; subjugation; undeveloped self.

Optimal diagnostic criterion

One key criterion for each personality disorder, based on its ability to summarise all criteria for that PD, accurate description of behaviour, and the predictive value (ability to predict if the person has the PD or not).

ASPD: Aggressive, impulsive, irresponsible behavior.

AVPD: Avoids activities that involve being social out of fear of criticism, disapproval, or rejection.

BPD: Frantic efforts to avoid real or imagined abandonment.

DPD: Needs other people to be responsible for most major parts of their lives.

HPD: Uncomfortable not being the centre of attention.

NPD: Grandiose sense of self-importance.

OCPD: Perfectionism that interferes with life.

PPD: Paranoia, without evidence, that others are trying to harm, exploit or deceive them.

STPD: Thinking, speech, behavior, or appearance that is odd, eccentric, or peculiar.

SZPD: Doesn’t want or enjoy close relationships.

- From Sperry, Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders (2016)

[rubys-delusions]

Schizoid people are overtly detached, yet they describe in therapy a deep longing for closeness and compelling fantasies of intimate involvement. They appear self-sufficient, and yet anyone who gets to know them well can attest to the depth of their emotional need. They can be absent-minded at the same time that they are acutely vigilant. They may seem completely nonreactive, yet suffer an exquisite level of sensitivity. They may look affectively blunted while internally coping with what one of my schizoid friends calls “protoaffect,” the experience of being frighteningly overpowered by intense emotion. They may seem utterly indifferent to sex while nourishing a sexually preoccupied, polymorphously elaborated fantasy life. They may strike others as unusually gentle souls, but an intimate may learn that they nourish elaborate fantasies of world destruction.

McWilliams (2006)

[rubys-delusions]

Please be careful with what you say to someone who has opened up to you about harming themselves.

I still distinctly remember the two comments that escalated the severity of my cutting. The first one was when I showed a close friend of mine at the time, explaining that I was ashamed and didn't know what else to do. I'd used one of those plastic shavers to do it, the one with the three small blades because it was the closest thing available to me.

His response upon seeing this was "What did you use? A cheese grater? That's hilarious."

The next day, I changed to a kitchen knife.

The second time was at a concert I was performing at. A friend of mine told me that they were scared about performing because their parents made them wear a dress and so everyone could see their scars. In an attempt to show my support, I showed them my own and told them that I'd do the same so they didn't feel so alone.

Their response? "Mine are way worse than yours, it's not the same."

Over the following weeks, the cuts on my arm quickly began to get deeper because I thought that maybe this was what I needed to do to be taken seriously.

I still think about those comments regularly. Please be kind. It would genuinely be better, in my opinion, to say nothing than to insult or belittle someone's experiences because they're not as bad as you'd like them to be.