Paranoid/Schizoid personality disorders are difficult to treat via insight-oriented therapeutic approaches, mainly because the patient is prone to doubt the motives of the therapist by virtue of the nature of the symptoms of the disease itself: namely, paranoid delusions that convince the patient that the therapist is part of a larger “conspiracy” against the patient (Shapiro 1999).
Narcissistic, histrionic, borderline, and antisocial disorders are treatable via several insight-oriented, one-on-one psychoanalytic psychotherapeutic approaches conducted by specialists in those types of disorders, as are many obsessive-compulsive and avoidant disorders (Gerrig and Zimbardo 2005). Alternatively, obsessive- compulsive, dependant, and especially, avoidant disorders are treatable in group settings as well. Avoidant and dependent personality disorders, in particular, may be best-suited to cognitive behavioral therapeutic approaches where the roots of the patients disorder relates to distorted self-perceptions capable of being addressed directly (Coleman, Butcher and Carson 1994).
Where paranoid or schizophrenic personality disorders are associated with acute psychotic episodes and intense delusions, antipsychotic drugs are used to reduce symptoms sufficiently for the patient to benefit from supportive therapy.
This is less likely to trigger the defensive reaction to the therapist often associated with attempts to treat acute paranoia or schizoid symptoms through insight-oriented psychotherapy (Shapiro 1999).
Antidepressants are often useful in treating histrionic, borderline, and antisocial disorders; antipsychotic agents are helpful at controlling acute paranoid and schizophrenic symptoms. In principle, contemporary approaches to treating personality disorders and the choices of specific treatment is dictated as much by individual factors particular to each patient and to the nature and severity of symptoms as much as by the actual clinical diagnosis of the class of disorder in and of itself (Gerrig and Zimbardo 2005).
Coleman, J., Butcher, J., and Carson, R. (1994). Abnormal Psychology and Human Life. Dallas: Scott, Foresman & Co.
Gerrig, R., Zimbardo, P. (2005).
Psychology and Life 18th Ed..