Schizophrenic, Dissociative, or Personality Disorders?
As a licensed marriage and family therapist, based on these demonstrated behaviors, I have come to understand the UMC as a dysfunctional family system that exhibits schizophrenic tendencies and behaviors, but other diagnoses may fit or may need to be ruled out. The denomination may be demonstrating a schizoid personality disorder or a borderline personality disorder or even a dissociative identity disorder.
Before making any conclusions, it is important to explore the various disorders.
Schizophrenia?
Definition/symptoms: In general, schizophrenia is a group of disorders distinguished by severe impairment of cognitive processes, personality disintegration, affective disturbances, and social withdrawal (Sue, David; Sue, Derald; and Sue, Stanley, Understanding Abnormal Behavior, Third Edition, 1990).
Schizophrenic disorders are primarily characterized by impaired or disordered thinking. The most common symptom is lack of insight.
Webster’s Third New International Dictionary (1981) states that schizophrenia is characterized by a disturbance in thinking that involves a distortion of the usual logical relations between ideas, a separation between the intellect and emotion, and a reduced tolerance for the stress of interpersonal relations.
Schizophrenic symptoms can include the following (Sue, Sue, and Sue, 1990; Diagnostic and Statistical Manual, IV (1994):
• Impaired cognition: impairment of the processes of thinking, perceiving, judging, and recognizing
• Thought disturbances such as delusional thinking or false beliefs that are firmly and consistently held despite evidence to the contrary. Delusions (false intellectual perceptions) are firmly held but the strength varies from person to person and even within a single person.
• Problems with verbal communication
-- loosening of associations, or cognitive slippage: the continual shifting of thoughts from topic to topic without any apparent logical or meaningful connection among topics.
-- over-generalizing or vague or overly concrete language
-- tangential thoughts: answering questions indirectly through a series of asides rather than answering directly and specifically
• Problems with attention
• Perceptual distortion: hallucinations, or false sensory perceptions
• Motor disturbances: extreme activity levels, unusual body movements and gestures
• Affective symptoms: usually seen as inappropriate emotions or lack of emotion; ambivalent feelings, rapid changes of mood for no apparent reason; suspicion and reacting with anger or rage
Application/Diagnosis: In my evaluation of the UMC, I find the schizophrenic symptoms of impaired cognition, thought disturbances, including delusional thinking, problems with communication, and affective symptoms. Symptoms not present or not prominent include motor disturbances, problems with attention, and perceptual distortions. Given these findings, the UMC demonstrates schizophrenic behaviors, even though there are not enough symptoms present to firmly say that the denomination is schizophrenic.
A Personality Disorder?
The UMC may also be exhibiting symptoms of a personality disorder. Personality disorders
Personality disorders commonly reflect enduring personality traits that define those who possess them and are characterized by behavioral patterns that are inflexible and maladaptive. Frequently those with personality disorders do not seek mental health treatment for their personality disorders because they do not recognize those traits as problems. Instead, they seek treatment for other disorders that give them problems, such as depression or anxiety; the personality disorder becomes evident during the intake or in the course of treatment. Symptoms include temperamental deficiencies or aberrations, rigidity in dealing with problems, and defective perceptions of self and others, symptoms considered normal (and not maladaptive) by those who have them. The two personality disorders I would consider applying to the UMC are borderline personality disorder and schizoid personality disorder.
Borderline personality disorder
Definition/symptoms: A borderline personality disorder is most often characterized by impulsiveness and by intense fluctuations in mood, self-image, and interpersonal relationships. Those diagnosed with borderline personality disorder may be friendly one day and hostile the next. They demonstrate object splitting, at different times perceiving others as all good or all bad, which results in emotional fluctuations toward others (Sue, Sue, and Sue, 1990). The DSM-IV defines the borderline personality disorder as "a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts" (p. 654).
The DSM-IV lists 9 diagnostic criteria for this disorder, and five of the nine must be present for diagnosis.
• frantic efforts to avoid real or imagined abandonment;
• a pattern of unstable and intense relationships that alternate between extremes;
• identity disturbance; a marked and persistent unstable self-image;
• impulsivity in at least two areas that are potentially self-damaging;
• recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior;
• affective instability due to a marked reactivity of mood
• chronic feelings of emptiness;
• inappropriate, intense anger or difficulty controlling anger;
* transient, stress-related paranoid ideation or severe dissociative symptoms.
Application/Diagnosis: From my professional observation, behaviors and actions taken by the UMC with regard to homosexuality demonstrate at least four of the symptoms of borderline personality disorder, just one too few to definitively diagnose borderline personality disorder. However, because four out of five symptoms are present, I cannot fully rule out this diagnosis at this time. More observation is required.
Schizoid Personality Disorder
A schizoid personality disorder might also be considered for the UMC.
Definition/Symptoms: A schizoid personality disorder is characterized by social isolation, impairment in social functioning, and emotional coldness (Sue, Sue, and Sue, 1990). According to the DSM-IV, those with this diagnosis seem to lack a desire for intimacy, appear to not develop close relationships, and do not seem to get satisfaction from being part of a family or other social group. They often solitary activities that do not include interaction with others, such as mechanical or abstract tasks. Persons with this disorder may relate to others at work and other places, but such relationships are superficial and can be awkward. They often seem indifferent to the approval or criticism of others and do not appear to be bothered by what others may think of them.
Application/diagnosis: There do not appear to be enough behaviors or symptoms demonstrated by the UMC to allow for this diagnosis.
Dissociative Identity Disorder?
Definition/Symptoms: According to the DSM-IV, the primary feature of this disorder is the presence of two or more distinct identities or personality states that recurrently take control of behavior. This disorder reflects a failure to integrate various aspects of identity, or dissociation. Alternate identities take control, one at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. There may be loss of memory for recurrent periods of time. Transitions among/between identities are often triggered by psychosocial stress. The dissociation may be between the emotional and rational parts of the personality.
Application/diagnosis: Although the primary features of this diagnosis are present, one diagnostic criterion (the inability to recall important information that is too extensive to be explained by ordinary forgetfulness) may not be clearly identifiable. In that case, it may not be possible to fully diagnose the UMC with a dissociative identity disorder at this time. Again, more observation is needed in order to rule out or diagnose this disorder.
Possible Diagnoses