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Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the "severity continuum hypothesis", in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment.

By tracing a portion of close process of a patient's shifts from a relatively silent and inhibited stance to one in which he is beginning to verbalize more about his experience and fantasy, I will illustrate some tensions between the analyst's role as facilitating expressiveness and as occupying a place in the patient's internalized world. Since the analyst's functions as facilitator and as internal object (often an obstacle to the patient's expressiveness) are sometimes in conflict with one another, it is important for the analyst to be able to work internally with this conflict as he works with his patient. Splitting processes between these two functions may provide the analyst with cues related to the patient's and the analyst's resistance to understanding the patient's communication of unconscious conflict and the patient's recruitment of the analyst into the patient's internalized world.

Each of the films, Shutter Island (Scorsese, 2010), Inception (Nolan, 2010) and Memento (Nolan, 2000), is influenced by psychoanalytic thinking. Each involves, to some degree or another, matters of...

In order to treat patients with a narcissistic structure showing a rigid shell of defence together with a lack of inner differentiation - insufficient subject/object constitution - one has to deal with a split kind of transference. Their compelling need for distance corresponds to their fragile self-esteem. They feel threatened by the analysis and the analytic relationship. Because the seeming normality of these patients' thinking and language is deceptive, a variation of psychoanalytic technique to facilitate the work with them is described and explained in detail. To transform their two-dimensional 'inner' world, which functions in a PS modus, it is helpful to show them, with changing viewpoints step by step, their own manoeuvres, misconceptions and manipulative use of language within the analytic relationship. The gratifying extension of their self-awareness leads to the introjection of the analyst's alpha-function. This makes possible a more distinct separation of subject and object representations and a transformation to a three-dimensional, oedipally structured world with a strengthened capacity to symbolize. This method of working is grounded in Bion's theory of thinking. A case vignette illustrates a development of this kind.

Growth in personality disorder research has been documented by previous authors up to 1995. The aim of the present study was to extend this by examining publications rates for individual DSM personality disorders over the period 1971–2005, and making projections to 2015 based on these data. It was found that personality disorder research has grown in absolute terms, and as a proportion of overall psychopathology research. Research output is dominated by borderline personality disorder, with strong publication rates in other conditions such as antisocial and schizotypal personality disorders. In contrast, several personality disorders such as schizoid and paranoid personality disorder have failed to attract research interest. Based on current projections, there is expected to be no research output in 2015 for schizoid personality disorder. It was found that the rate of publications for personality disorders was not influenced by the publication of the last three revisions of the DSM diagnostic cri...

The relationship between Asperger syndrome (AS) and schizophrenia is still unclear. An unanswered question is, do hallucinations or delusions per se justify a diagnosis of schizophrenia when these symptoms appear in subjects with AS? The aims of the present study were: (1) to review the characteristics of thought disorder in AS and schizophrenia; (2) to describe the clinical features of six adult patients with AS who presented psychotic symptoms without mood symptoms; (3) to observe their clinical course and response to therapy in order to speculate possible relations between AS and schizophrenia. In the presence of its specific symptoms, it seems inappropriate to omit the diagnosis of AS because the DSM-IV-TR criteria for schizophrenia are also met, whether delusions and hallucinations appear early or late in the course of the disease. Recognizing and emphasizing the diagnosis of AS is not only important for clinicians to tailor the therapeutic strategy to the features of patients, but also for the patients and their relatives.

This paper submits passages from four papers--'Notes on some schizoid mechanisms' (Klein); 'On identification' (Klein); 'Analysis of a schizophrenic state with depersonalization' (Rosenfeld); and 'Remarks on the relation of male homosexuality to paranoia, paranoid anxiety and narcissism' (Rosenfeld)-to a critical reading, enabling the theoretical premises which have produced the current, differing views on projective identification to be traced. These views revolve both around the role assigned to identification in the process and around the meaning of the expression 'to identify oneself with' which in 'On identification' goes from 'to feel similar to, or identical to the other' to 'to take another person as a model'. This legitimizes the inclusion of very different phenomena into the concept of projective identification. The author describes some uses of the term 'projective identification' and proposes the hypothesis that the process constitutes a way for managing otherness and the separateness of the object (be it external or internal, real or imaginary) that can compromise its reality to a greater or lesser degree. Covering a large set of phenomena, the author poses the question of whether it is useful to retain the term 'projective identification'. She proposes an answer in the last part of the paper.

This article studies recalled parental bonding, adult attachment style, and personality disorders in child molesters and reports on the findings of two separate studies. The first study examines differences between a group of 84 child molesters and 80 matched normal control subjects. This study found that the antisocial and the schizoid personality disorders are typical for the molester group, and that at an interpersonal level this group can be typified by recollections of an uncaring father and mother, recollections of an elevated level of autonomy emanating from the father, and insecure current attachment patterns. The second study compares a subgroup of personality-disordered child molesters to a subgroup without personality disorders. This study revealed that recollections of the role of the father in parenting are decisive. The personality-disordered group reports that the father was both more uncaring and granted more autonomy. Regarding current adult attachment style, an avoidant and anxious-ambiv...

serotonin transporter (5-HTT) gene allelic variants were shown to be associated with Neuroticism and Harm Avoidance but the results were not replicated in other studies. The current investigation was undertaken in a further attempt to study the relationship between 5-HTT polymorphism and personality traits.to evaluate a spectrum of personality traits, MMPI was administered to a sample including patients with affective disorders (n=114), patients with schizophrenia spectrum illnesses (n=110) and psychiatrically well controls (n=124). All groups were genotyped for VNTR-17 and functional insertion-deletion (5-HTTLPR) polymorphisms.an association was found between 5-HTTLPR polymorphism and scores on three MMPI scales: Psychopathic deviance, Paranoia and Schizophrenia in patients with affective disorders and S chizophrenia in normal subjects. Both affected and control individuals with 'ss' genotype exhibited lower scores on these scales.we demonstrated that functional deletion/insertion allelic variation associated with decreased expression of serotonin transporter ('s' allele or 'ss' genotype) may restrict expression of schizoid traits in normal subjects and patients with affective disorders.

This paper examines the interplay among schizoid personality traits, chronicity of homelessness, and engagement in treatment in a homeless mentally ill population. Both qualitative and quantitative information will be provided about a sample of 125 homeless mentally ill individuals receiving psychiatric treatment in a comprehensive services drop-in clinic. Naturalistic observations and a case vignette suggested that schizoid traits were prevalent and may have been playing a role in treatment engagement and chronicity of homelessness. This hypothesis was tested using quantitative research methods. The results showed that schizoid personality disorder and schizoid personality traits were prevalent in the sample. The presence of schizoid traits was positively correlated with chronicity of homelessness. Further, two schizoid traits (being content without sexual involvement with others, and lacking close friends or confidants) were positively correlated with remaining in treatment at 3 months. Implications of these findings for future research and treatment design will be discussed.

Our study investigated the convergent and discriminant validity of five of Chapman's Schizotypia Scales (i.e., Physical Anhedonia, Revised Social Anhedonia, Perceptual Aberration, Magical Ideation, and Impulsive Nonconformity; L.J. Chapman, J.P. Chapman,Raulin 1976, 1978; EckbladL.J. Chapman, 1983) and Meehl's Schizoidia Scale (Meehl, 1964) within a sample of 50 personality disordered subjects, many of whom possessed schizotypic traits. It was hypothesized in part that all five of the Chapman scales and the Schizoidia Scale would correlate with the schizotypal personality disorder; the Physical Anhedonia and Revised Social Anhedonia Scales would correlate with the schizoid personality disorder, whereas the Magical Ideation and Perceptual Aberration Scales would not; the Physical and Revised Social Anhedonia Scales would not correlate with the avoidant personality disorder; and the Impulsive Nonconformity Scale would correlate with the borderline and antisocial personality disorders. Only the hypotheses concerning the avoidant personality disorder and the Schizoidia Scale were not supported. The findings remained even when the effects of state anxiety and state depression were controlled. Implications of the findings with respect to the validity of the Chapman and Schizoidia Scales and the personality disorders are discussed.

This report presents an extremely rare and unusual case of voyeurism in a 26-year-old female with a diagnosis of schizoid personality disorder. A detailed case description is presented and some of the unique aspects of this dual diagnosis are discussed.

Brvnjolfsson J, Petursson H, Gurling H, Sherrington R. Diagnostic issues in the study of schizophrenia genetics.As a result of a series of collaborative studies, we have reported preliminary evidence of linkage between a locus on chromosome 5 and schizophrenia in Icelandic and British families. The purpose of this article is to describe the part of our work carried out in Iceland, in particular the population background, as well as the methods of selection, diagnostic assessment, interview schedules, and clinical aspects. The project group chose to study high-density pedigrees with schizophrenia in at least three generations. Extensive pedigree tracing work aimed at selecting families without manic depression (bipolar disorder) and in which there was only one possible source for a schizophrenia allele segregating into the kindred. Diagnosis included schizophrenia, schizophreniform disorder, unspecified functional psychosis, schizoid personality disorder with and without schizotypal features, and other psy...

The choice of good leaders is a major task for all organizations. Inforamtion regarding the prospective administrator's personality should complement questions regarding his previous experience, his general conceptual skills, his technical knowledge, and the specific skills in the area for which he is being selected. The growing psychoanalytic knowledge about the crucial importance of internal, in contrast to external, object relations, and about the mutual relationships of regression in individuals and in groups, constitutes an important practical tool for the selection of leaders.

Patients with a personality disorder exhibit fixed, lifelong patterns of behavior that normal persons exhibit to a lesser extent. Ability to identify such exaggerated behavior patterns can help the physician to manage more skillfully difficult physician-patient relationships.

(1976). Two Patterns of Adaptation in Late Adolescent Borderline Personalities. Psychiatry: Vol. 39, No. 1, pp. 41-50.

The importance of differential diagnosis in using Masterson's (1976, 1981, 1985) techniques to treat patients with borderline personality is stressed because patients with certain other personality...