SPD, StPD, avoidant PD, etc., with a little Schizoaffective on the side

Posted by Heidi on March 03, 2001 at 11:15:46:

In Reply to: Excellent question posted by Elizabeth on March 02, 2001 at 16:49:15:

here are some paraphrased descriptions of the disorders in question from the DSM IV:

SPD: reclusive, basically anti-social, perform best while alone, limited emotional range, inclined to daydream a lot, potentially humorless, aloof.

StPD: all of the above plus they have an inclination to relate strange intrapsychic experiences to others, have "odd" reasoning, and are difficult "to get to know."

Avoidant PD: shy, lonely, hypersensitive, low self-esteem, avoids interpersonal contact to allay social disapproval even though they are desperate for social involvement (this is in contrast to those with SPD--they avoid social contact because they have little desire or capacity to form interpersonal connections and don't derive much pleasure from them).

I see SPD and StPD as subtypes of the same category (as you said) with the distinction that StPD is a more "serious" condition. I don't lump Avoidant PD in with those because it is only similar to them on the surface. The motivations behind it contrast with those of the SPD or the StPD. I think an E4 (or 5w4) would probably be more inclined to have Avoidant PD, and a 5w6 or 6w5 is probably more likely to have SPD or StPD.

As I understand it, in a diagnosis there are five different "layers" or axes. Axis I describes the clinical syndrome (eg. Schizophrenia, Schizoaffective disorder, affective disorders like Depression or Bi-polar, anxiety disorders, OCD, etc.) Axis II describes personality disorder(s) that may or may not be present (SPD, StPD, avoidant PD, narcissistic PD, etc). Axis III describes physical disorders that may or may not be present, Axis IV a severity rating of psychosocial stress over the past year on a scale of 1-6. Axis V, the Global Assessment of Functioning scale (GAF) measures current and past levels of functioning.

Apparently, for an official diagnosis, you only need the first three axes. What kind of bothers me about Riso/Hudson's (and others) attempt at correlation between enneagram (etc.) types and psychiatric diagnoses as found in the DSM IV, is that they never explain that, technically, in order to have a personality disorder, you have to have a primary clinical syndrome first. It's not accurate to go around saying someone has XYZ personality disorder as an all-inclusive diagnosis--after all, diagnoses ARE descriptions of characteristics/conditions. Personality disorders are secondary to the Axis I description. Dammit. I'm probably just getting bent about details. Strike that, make it a definitely.

Anyway...it seems to me that schizoaffective disorder would probably be the primary (Axis I) diagnosis for a lot of fives...especially 5w4s (but also 4w5s). That's opening up a bigger subject than I have time to write about now, though.

: StPD has been on my mind a lot lately. Particularly, since I see a connection between StPD and Antisocial PD which I am trying to understand.

: Although the DSM IV separates SPD from StPD, I tend to side with psychologists who think they are subtypes of the same personality. So, the question becomes: What separates SPD from StPD? I think the answer is sex, the part of the id that emerges after self/other differentiation.

: What happens to a child who has an underdeveloped id, possibly trapped in a pre-self/other differentiation stage, when sexual instincts kick in? This libidinal energy may be channeled into introverted creativity or a non-sensual sexuality?

: Obviously, I need to do a lot more thinking on this subject.

Follow Ups:

• A few notes on Personality Disorders and the notorious DSM IV Elizabeth 13:02:56 03/03/01 (1)
  • Re: A few notes on Personality Disorders and the notorious DSM IV Laurence 14:01:28 03/06/01 (0)

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