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