Schizoid and Schizotypal Personality

Physicians typically feel uninvolved or detached or have a desire to break through the aloofness of schizoid and schizotypal patients. Schizoid patients may give the physician the impression that the patient is a loner. A common physician reaction to schizotypal patients is a feeling that the patient is alone and "weird or strange." Superficially, patients with either diagnosis fear personal contact, emotional involvement, and invasion of their privacy. At the deepest level, they long for emotional contact that is not overwhelming. They may react to suggestions for medical care with avoidance, withdrawal, apparent emotional detachment, or denial of the medical problem. Schizotypal patients function at a psychotic level, with impaired reality testing manifested by magical, odd, or psychotic modes of thinking. Schizotypal patients use regression to schizoid fantasy and, to a lesser extent, denial as their main defenses. They appear increasingly idiosyncratic and withdrawn when stressed. Schizo-typal personality disorder appears to be a significant risk factor for the future development of schizophrenia, although most patients do not go on to develop overt schizophrenia.

Schizoid patients do not appear psychotic or idiosyncratic in their behavior. They are disinterested in intimate contacts with others, appear detached and unemotional, and wish to be left alone. Infrequently, the schizoid personality will also be associated with the future development of schizophrenia. When stressed by a medical problem, schizoid patients will use isolation and intellectualization to hide their emotions. If necessary, they will regress to childlike functioning or use psychotic denial of their illness as their main defenses.

Patients with schizotypal and schizoid personalities tend to experience their physician as intruding into their privacy, which may drive them away from the physician. They are relieved when the physician is not present and prefer fewer medical appointments and contacts. It is generally helpful to accept their lack of sociability at a level that does not demand involvement or permit total withdrawal. Neutral or unemotional expressions of medical information are most likely to be heard and used.

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