Personality Couch

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) unpack the DSM’s Avoidant Personality Disorder (AvPd), exploring its hotly debated history, the DSM criteria, and its overlap with social anxiety. We discuss the developmental aspects of AvPd, the challenges of low self-esteem with this disorder, and how it can cause problems in employment. We end with our own unfiltered thoughts on whether or not we think it should be a diagnosis, questioning the zeitgeist in which it was coined, the lack of historical research, and its overlap with multiple other personality disorders.  

🆘In need of psychodynamic therapy or a psychological evaluation? OR are you a provider stuck on a tricky case? To schedule with us, please visit the practice website and fill out the inquiry form! 👉https://www.questpsych.org/ (Clinicians use the email listed on the website.)

Chapters
00:00 Intro, History, & Controversy
03:42 Avoidant Personality Disorder: DSM
       05:41 Social Inhibition and Fear of Criticism
       08:14 Intimacy Issues and Fantasy 
       10:41 Self-Perception and Feelings of Inadequacy
       14:49 Taking Risks and Employment Issues
17:09 Developmental Implications of Avoidant Personality
19:04 Avoidant Personality vs Social Anxiety
24:29 Unfiltered Thoughts on Avoidant Personality Disorder
35:10 Summary & Conclusion

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) explore the 3 most unstable personality disorders: schizotypal, borderline, and paranoid. All 3 types are at risk of psychosis. We first discuss historical personality classifications of neurotic, psychotic, and borderline, highlighting that the borderline space between neurotic and psychotic is the most prone to instability. This borderline space is where schizotypal, borderline, and paranoid personalities sit. We discuss the risky traits of each personality, including cognitive slippage, emotional instability, and extreme rigidity. We also discuss some of our thoughts and experiences in diagnosing these rather tricky disorders!

🆘Are you a clinician stuck on a case? To schedule a consultation, please visit the practice website! 👉https://www.questpsych.org/

Chapters

00:00 Intro & Psychodynamic Personality Organization
      02:31 Neurotic Personality Organization
      04:47 Psychotic Personality Organization
      05:48 Borderline Personality Organization
07:57 Schizotypal Personality & Instability
      08:57 Why Personalities Are Unstable (according to Millon)
      13:55 Personalities that Coexist with Schizotypal
16:30 Borderline Personality & Instability
      21:16 Personalities that Coexist with Borderline 
23:18 Paranoid Personality & Instability
      26:52 Personalities that Coexist with Paranoid
30:18 Our Experiences with Diagnosing Unstable Personalities
33:39 Summary & Conclusion

In this episode of The Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) unpack the 6 subtypes of schizotypal personality disorder, according to Dr. Theodore Millon. We outline Millon’s take on “structurally defective structures” as being at risk of falling apart into psychosis at all levels of functioning, with the most severe levels of schizotypal deteriorating into schizophrenia. We then discuss the characteristics of mild, moderate, and severe subtypes, specifically: Disengaged Eccentrics, Apprehensive Eccentrics, the Insipid Schizotypal, the Timorous Schizotypal, the Immobile Schizophrenic, and the Disorganized Schizophrenic. 

🆘Are you a clinician stuck on a case? To schedule a consultation, please visit the practice website! 👉https://www.questpsych.org/

Chapters
00:00 Intro & History of Schizotypal Subtypes
02:45 Theodore Millon’s Theory on Schizotypal Personality
07:00 The Mild Eccentric Level 
      08:21 Disengaged Eccentrics
      09:39 Apprehensive Eccentrics
10:48 The Moderate Schizotypal Level
      11:57 Insipid Schizotypal
      18:17 Timorous Schizotypal
21:26 The Severe Schizophrenic Level
       22:56 Immobile Schizophrenic
       26:08 Disorganized Schizophrenic
29:05 Summary & Conclusion

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) dive into the origins, diagnostic criteria, and oddities associated with schizotypal personality disorder and what it means to be almost psychotic, but not quite. We unpack idiosyncrasies and “cognitive slippage” of schizotypals that include odd speech patterns, suspiciousness, emotional expression, and social anxiety. This episode also highlights the importance of cultural context in diagnosis and not overpathologizing trends or religious norms. We also explore the overlap with and risk of schizophrenia in schizotypals, along with long-term implications of living in a quasi-psychotic cognitive space.

🆘Are you a clinician stuck on a case? To schedule a consultation, please visit the practice website! 👉https://www.questpsych.org/

Chapters
00:00 Intro & History of Schizotypal Personality 
01:15 DSM Criteria Schizotypal Personality 
     02:59 Ideas of Reference
     05:35 Odd Beliefs and Magical Thinking
              08:18 Exploring Cultural Oddities vs Psychosis
     11:05 Unusual Perceptual Experiences
     12:44 Odd Thinking & Speech
     17:45 Suspiciousness and Paranoia
     18:34 Emotional Expression, Behavior, and Appearance
     20:13 Lack of Close Relationships and Anxiety
23:42 Schizotypal Differential Diagnosis
24:46 Schizotypals’ Relationship to Schizophrenia
29:33 Summary and Conclusion

In this episode of The Personality Couch, we (licensed clinical psychologists Doc Bok and Doc Fish) explore the origins and nuances of schizotypal personality disorder, its genetic links to schizophrenia, and the clinical observations that define it. We discuss the evolution of the term 'schizotypal' in the DSM, the implications of schizotypy, and how environmental factors and social learning influence its development. We also uncover observable traits of schizotypal individuals, their social interactions, and self-concept, providing a comprehensive overview of this intriguing personality disorder that is not quite psychotic, but close.

🆘Are you a clinician stuck on a case? To schedule a consultation, please visit the practice website! 👉https://www.questpsych.org/

Chapters
00:00 Intro & History of Schizotypal Personality 
01:34 Genetic Research on Schizotypal
05:17 Clinical Research on Schizotypal
08:47 Schizotypal in the DSM
09:29 Schizotypy and Borderline Personality Organization
12:17 Schizotypy Defined
14:32 Schizotaxia Defined
17:39 Schizotypic Endophenotypes Explained
19:57 When Schizotypy Manifests
21:28 Observable Traits of Schizotypal Personality Disorder
30:44 Summary and Conclusion