Schizotypal Personality Disorder

SCHIZOTYPAL PERSONALITY DISORDER

Clinical Picture

Schizotypal personality disorder is characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities. Incidence is about 3% to 5% of the population; the disorder is slightly more common in men than in women. Clients may expe-rience transient psychotic episodes in response to extreme stress. An estimated 10% to 20% of people with schizo-typal personality disorder eventually develop schizophre-nia (APA, 2000).

Clients often have an odd appearance that causes oth-ers to notice them. They may be unkempt and disheveled, and their clothes are often ill-fitting, do not match, and may be stained or dirty. They may wander aimlessly and, at times, become preoccupied with some environmental detail. Speech is coherent but may be loose, digressive, or vague. Clients often provide unsatisfactory answers to questions and may be unable to specify or to describe information clearly. They frequently use words incorrectly, which makes their speech sound bizarre. For example, in response to a question about sleeping habits, the client might respond, “Sleep is slow, the REMs don’t flow.” These clients have a restricted range of emotions; that is, they lack the ability to experience and to express a full range of emotions such as anger, happiness, and pleasure. Affect is often flat and sometimes is silly or inappropriate.

Cognitive distortions include ideas of reference, magical thinking, odd or unfounded beliefs, and a preoccupation with parapsychology, including extrasensory perception and clairvoyance. Ideas of reference usually involve the client’s belief that events have special meaning for him or her; however, these ideas are not firmly fixed and delu-sional, as may be seen in clients with schizophrenia. In magical thinking, which is normal in small children, a client believes he or she has special powers—that by think-ing about something, he or she can make it happen. In addition, clients may express ideas that indicate paranoid thinking and suspiciousness, usually about the motives of other people.

Clients experience great anxiety around other people, especially those who are unfamiliar. This does not improve with time or repeated exposures; rather, the anxiety may intensify. This results from the belief that strangers cannot be trusted. Clients do not view their anxiety as a problem that arises from a threatened sense of self. Interpersonal relationships are troublesome; therefore, clients may have only one significant relationship, usually with a first-degree relative. They may remain in their parents’ home well into the adult years. They have a limited capacity for close relationships, even though they may be unhappy being alone.

Clients cannot respond to normal social cues and hence cannot engage in superficial conversation. They may have skills that could be useful in a vocational setting, but they are not often successful in employment without support or assistance. Mistrust of others, bizarre thinking and ideas, and unkempt appearance can make it difficult for these clients to get and to keep jobs.

Nursing Interventions

The focus of nursing care for clients with schizotypal per-sonality disorder is development of self-care and social skills and improved functioning in the community. The nurse encourages clients to establish a daily routine for hygiene and grooming. Such a routine is important because it does not depend on the client to decide when hygiene and grooming tasks are necessary. It is useful for clients to have an appearance that is not bizarre or disheveled because stares or comments from others can increase dis-comfort. Because these clients are uncomfortable around others and this is not likely to change, the nurse must help them function in the community with minimal discom-fort. It may help to ask clients to prepare a list of people in the community with whom they must have contact, such as a landlord, store clerk, or pharmacist. The nurse can then role-play interactions that clients would have with each of these people; this allows clients to practice clear and logical requests to obtain services or to conduct per-sonal business. Because face-to-face contact is more uncomfortable, clients may be able to make written requests or to use the telephone for business. Social skills training may help clients to talk clearly with others and to reduce bizarre conversations. It helps to identify one per-son with whom clients can discuss unusual or bizarre beliefs, such as a social worker or a family member. Given an acceptable outlet for these topics, clients may be able to refrain from these conversations with people who might react negatively.