Schizotypal Disorder: An Inside Look
Habré has already been written about various disorders, but somehow it turns out that the topic of schizotypal disorder remains unresolved. Yes, and the network is difficult to find information for a wide range of people on this topic. Often you can find texts copied by copywriters with many inaccuracies and frank myths, and even more often - the exact opposite, abstruse texts written by doctors for doctors. Thus, according to the DSM, a schizotypal disorder is the patient’s demonstration of a pervasive model of social and interpersonal deficit, marked by acute discomfort and reduced ability to form close relationships, experiencing cognitive and perceptual distortion, as well as showing eccentricity in behavior starting from early adolescence and represented different contexts. If you do not understand a word of this - welcome under cat. Today we will see how it all looks from the inside.
For a start it is worth making a small digression. As far as self-examination is concerned, everything will be biased. I am not a doctor. It should be understood that not all things are perceived adequately and an attempt to describe their condition may not quite correspond to what the doctor will see or even worse a psychologist. Many statements will be given without evidence, simply because "I see this." This article is more likely for those who are interested in just looking at everything "from the first person".
Who am I?
I believe that the article will fall into a new audience for me and I need to introduce myself. My name is Ivan and ... I will not go into details, I will try to briefly tell about myself. Before, everything was fine with me. He studied at the art school and physics department, participated in various competitions and contests. He was engaged in programming, wrote in different languages, became interested in analyzing the security of computer systems, entered the corresponding specialty. Parallel developed as a musician. But gradually I covered, I abandoned both my studies, and my hobby, and I increasingly fell out of my life ...
So. Schizotypal disorder. If several independent psychiatrists pointed to the same thing - it is unlikely that they were all wrong in one direction. So it is. It crept unnoticed and the last few years does not let go. And, apparently, never let go. In the past in our country it was called sluggish schizophrenia. Currently, the name has changed, but the essence remains. In general, the classification of disorders with a prefix is schizo-quite spreading and it is rather difficult to draw boundaries between many of them. I do not know how the doctors do it. Wikipedia says that schizotypal disorder occurs in 3% of the population, but in general it is difficult to assess. Many people with similar illnesses fall out of public life and they are “not visible”. And given the living conditions in our country, where in places almost everyone looks sullen and depressed,
There is an opinion that schizotypal disorder is, in contrast to schizophrenia, not a disabling diagnosis, but the practice of communicating with doctors in the IPA shows that disability is given is simply not for everyone. With a strong social maladjustment and loss of performance can put 2 group.
There are a lot of myths around the schizophrenic spectrum disorders. For example, that all such patients are violent psychopaths who are ready to cut everyone, or that permanent hallucinations and delirium must necessarily occur, or that a person's reproduction occurs or something else like that. In fact, many patients are quite calm people, maybe even frighteningly calm, and the presence of pronounced positive symptoms is not mandatory. One negative and so lacks a head. In this regard, schizotypal disorder is close to the simple form of schizophrenia, it is just not so strongly pronounced, certain criticism to its condition persists. Although when they say “not very pronounced” - this, of course, doctors say, and not patients.
Psychiatrists in the network often use the concept of apathetic-abulic syndrome. In practice, I have never heard that such words were spoken to patients, but they constantly imply something like that. These are mainly those moments from which complaints begin when talking to a doctor and something that is more or less clearly described. Apathy, fatigue, fatigue, drowsiness - this is what hurts performance in the first place. From conversations with doctors in the hospital, I came to the conclusion that disability is often put to patients with similar disorders precisely because of these problems. They just can't work.
Some people think that people with this disorder are just very lazy and therefore they can do nothing for hours. But it is not so. Rather, there is a complete lack of desires, aspirations, which is complemented by fatigue. If a lazy person is too lazy to do some useful things, but in general he is not against walking, eating something tasty, watching movies, playing toys, then even there is no desire to turn on the movie. And if you turn it on, by the middle of the film you can understand that you didn’t even watch it, you don’t remember what happened there. Or even tired of looking. This also happens. At the same time you didn’t do anything else, just been in your thoughts.
It often happens that there are no thoughts in my head at all. The head "does not think." It is very difficult to collect thoughts and do something, even simple daily tasks take a very long time. You can lie, not think about anything and do nothing for a very long time. You don't even want to throw a pebble against the wall (you know, this is when it bounces off the wall and returns back to the hand). On Habré, they already wrote about how in different disorders people have a stream of thoughts that they cannot control, but here the situation is completely opposite - there are too few thoughts and they flow very slowly.
You can often hear that this all comes from lack of will. Allegedly, you need to force yourself to do something, work on yourself and not be a "weakling." This is of course great, but in my opinion the main problem is not this, but in the absence of emotions and the opportunity to have fun. And when you can’t have fun, it’s very hard to do something to force yourself. The final goal is not clear, and the process itself does not bring pleasant feelings. The only real motivation that came up with is the desire to leave something behind.
Lack of emotion
Judging by the photos before, I had emotions. Now I do not remember when it was. And how it was. A few years ago, everything began to change. It looked like this: at first, positive emotions disappear, the ability to get pleasure goes, only anxiety, fear, anger remain, but then they leave. All this happens slowly, gradually, you only after the fact begin to understand that everything has changed, that the feelings have disappeared. And it remains ... And it is not clear what remains. When a psychiatrist asks "how could you characterize your mood," the most appropriate answer is no. It is none. Neither good nor bad. It is simply missing. For a long time I tried to find some ways to change it, but as a result I just got tired of looking.
The only thing that changes is internal stress under stress. And that's all. Sometimes the tension is so strong that it just breaks from the inside. Doctors for some reason call it anxiety. Although perhaps this word may come up - vague experiences ... Yes, perhaps it can be called that, but these emotions do not carry the emotional coloring. This internal stress is more physiological in nature. Pulse, breathing becomes frequent, pressure rises, dizziness or “hammers in the head” can begin if everything is very bad, nothing more. Perhaps this is the very “splitting” when completely opposite emotions arise at the same time and as a result they quench each other and a strong tension is obtained without coloring.
The reaction to good and bad events is no different. As a result, any event passes only through the prism of logic and a positive or negative evaluation is made only on the basis of practical conclusions. Delicious food - good. If it were not tasty it would be worse. The sun is shining and in general the weather is normal - well, in the rain you can get wet. Slipped on the ice - bad, and so you can get hurt. The car drove through a puddle and splashed my pants - bad, you have to wash it. No emotion
At the same time, the instinct of self-preservation is dulled. From the point of view of a healthy person, this most likely looks like an attempt to harm oneself. But such a thought may not be, it is rather the loss of the border beyond which the probability of harming oneself greatly increases. Under stress, internal stress interferes with the work of the logical part of the brain, and there are no feelings that can hedge at this moment.
Here it is worth saying that having lost a landmark in the form of feelings, you begin to treat many things differently. Lost fear of many phenomena. Combined with impaired thinking, this leads to frightening reactions to external stimuli. That same incompatibility with cultural norms originates somewhere here. For example, if in a healthy person the series “Hannibal” (a show not for the faint of heart, where everyone constantly goes beyond the boundaries of socially acceptable behavior) causes a whole storm of various emotions, in my case this is complete indifference. Rather, the plot itself is of interest, the dialogues, some minor details, beautiful shots, and the heroes of the series (especially Will Graham) seem closer in spirit than the people around them.
It is very difficult to empathize fully with another person when you have no emotions that he feels. But the prism of logic can help in this situation. I did not accidentally gave an example with the character of the series. He and I really are somewhat alike. And the gift of empathy that he has is familiar to me. Where ordinary people only feel, we think and match the details that everyone usually does not notice for emotions. And we see everything. All the falsity, all the manipulations, all the tricks. Indeed, you can see the point of view of another person, or at least it seems that you can see it. Psychiatrists call this “magical thinking”; they say that patients think that they “read minds”. This, of course, is not so, just the attention is not directed where everyone usually turns it on, and such an effect is obtained. Often, their conclusions are difficult to explain.
Accompanying this process of avoiding eye contact is such a way to remove some of the secondary information and focus. You see too much and at the same time too little - this is a very accurate description of eye contact. A broken capillary, eye color, cat hair on the cap - the brain begins to engage in minor details and is distracted from the main thing. It is very difficult to face and think at the same time. And if you do not think, then nothing will remain.
Since there is nothing special to show, then people like me may seem cold and detached. His mimicry is scant, his voice is also poorly modulated, almost always monotonous, uniform. In combination with a certain appearance and clothing can be formed the image of a monk.
Sometimes there are smiles, or better even call it grimaces. Involuntary reactions that have nothing to do with emotions. For others, they can cause a feeling of fear and abnormality, because they often do not match the environment. It's like horror stories with clowns - breaks the brain and causes mixed feelings. Not all people know that these antics are not a manifestation of good nature or good mood, and this sometimes in the process of talking with someone leads to the thought “no one cares about me”. Indeed, the appearance of others is not always interpreted correctly and it is not at all clear what can be done with this. Strange as it may sound, dogs understand me better than people.
Impaired memory and thinking
After passing the battery of tests from the psychologist and the subsequent acquaintance with the conclusion, which she wrote, I was somewhat puzzled. There was a whole paragraph about the thinking disorders that I have. This is a really interesting point - the intelligence in terms of "intelligent" is well preserved, but thinking as a whole is disturbed. Perception, attentional switching, memory and associations - everything is working incorrectly.
By “intelligent” I mean intelligence in the usual sense of the word. That, for example, is determined using the Raven matrices. I have not seen them for a long time, but this test was recently given here and it turned out to be 130 points. I am usually skeptical about such tests, but the result obtained at least says that there are definitely no strong problems with this part.
Sometimes there is a feeling that I am very forgetful. I even have to write down what I have to buy from products for example. Or you can get out of the subway with a clear understanding that you forgot how I arrived somewhere. That is, I understand where I arrived, but the process itself falls out of memory. Thoughts about this cause a lot of stress. It seems that you are going crazy, that for some period of time you were not yourself and not sure that all this time was happening ...
At the same time, according to tests, it turns out that everything is fine with memory. Well, or not very bad at least. The last time was the curve of memorizing words - 5-7-9-10-9. Postponed - 6. Memorizing words with drawing pictures - 11 out of 13 is true and one more thing - close in meaning. And failures in memory are not due to problems with the memory itself, but due to the fact that the brain is not so busy. He is busy with philosophical reflections, obsessions or some details that are not related to the main activity. Attention is emphasized somewhere completely wrong. According to the results of the implementation of some not very complicated matter, you may not remember at all how he did it. You can't trust yourself. There are various doubts that do not let go and do not get out of my head, and associative chains can lead very far. This is one example of obsessive thinking,
Associations work in an interesting way and, as far as I understand, are associated with all the same slippage on minor details of objects. This is exactly what others are often mistaken for “creative” abilities. But it's not about the work, just a chain of thoughts periodically slides onto some insignificant, inconspicuous detail, and it continues on as if nothing had happened. It helps to do various weird things, yes. It helps to look for patterns where no one sees them, yes. But at the same time, it is not always possible to conduct purposeful activities. The brain constantly jumps off somewhere. You have to look after yourself and constantly return to the original train of thought. But not always it turns out, of course. It is especially difficult to find the right words. If you have forgotten a word, then you will remember a lot of things, but not the word you need.
Accentuation of attention to details and constant slippage are clearly seen in the tests for the generalization of pictures - there I immediately generalize to some completely unimportant criteria, and only then, and even then not always, can I correct the decision to more "conventional". Washed away the criteria of importance and unimportance. At the same time, it is difficult to diagnose this myself, I would not even think that I have such problems if the psychologist did not tell me about them.
Oh yeah, about the details it is worth adding that the freezing chains of coincidences periodically begin, which the brain itself isolates from everyday life. For example, when you start to see patterns in all digital clocks around you. Doubles like 11:11 or the same number of minutes, for example 13. And now you unknowingly notice it day after day and it seems that the roof is going. It’s as if you only look at your watch when it's 13 minutes there.
Thinking is an interesting topic. The disease creates the very “blind spots” and it is very difficult to understand for oneself what exactly is happening and whether it is happening at all. If everything is clear with apathy, you can find it at yourself and make sure that yes, it is, then with thinking it’s not so simple. And here an interesting question arises: is it necessary to try to correct these problems, as some psychologists try to do if they help to create, conduct some research or solve nontrivial problems? But this is more a rhetorical question. Completely solve problems with thinking, no one has yet learned.
Very often, I draw conclusions based on my observations, on many small details, and the people around me (even some doctors) consider my findings to be manifestations of anxiety and paranoia. At the same time, they themselves are busy with emotions and, in my opinion, are blind. Sometimes you even have to search for documentary evidence of your statements in order to prove something to them. And they are often found. So, people: just because you think that someone has paranoia does not mean that you are not being followed. And given the long period of information security, about many things I know not only what can be done, but also about how it can be done. So the edge of madness here is very thin, it is not necessary to customize everyone for it.
People often misunderstand me. Due to the lack of emotions, I often look just calm. And everyone around may suddenly decide that I am sad and start doing something to cheer me up. But I'm not sad, they came up with it all. And communication with psychologists is generally a beauty. They immediately begin to manipulate and I see all this and ... I think the best way to describe this state is this: imagine that you know how to show some kind of trick with maps. Know how it works. And here you sit and watch how someone else shows him. And how to be surprised, but you can not - you know how everything works and you can not bring yourself to see all this. And as a result, the psychologist thinks one thing, you something else, and as a result there is a precipitate in the form of “something the psychologist has invented for himself.” I have often had this and I stopped classes after the first visit. Not because I was "running away from my problems," as the psychologist saw it, but because I "almost fell asleep on this boring view."
Fencing and masks
In general, I do not need communication. In any case, the constant is definitely not needed. It is good for me to be alone, my inner world is big enough so that there is no need to plug holes in it with the help of other people. Intellectual, professional communication is generally perceived as normal, it does not affect emotions. But with everyday it is more difficult and it is not always possible to avoid it.
In order not to get out of the environment, you have to pull on the mask of emotions, which were formed not by internal processes, but by long-term observation of others. They are not always appropriate or natural, and I think this is noticeable. Everyone in some situation is smiling - you should smile too, everyone is sad - you should also be sad. It looks like this. Only this very quickly tires and you need a lot of rest. It's like being an actor - hard work. You have to pull on yourself the image of another person who is alien to you. That's not you. Perhaps it is this behavior that leads to the myth that schizophrenia is a split personality. But it is not. This is one person under the mask and without it.
Derealization and illusions
The surrounding space loses perspective, the sounds are muffled, the color saturation decreases, time slows down ... As if you are asleep and you see a dream. Understanding perfectly what is happening around, you lose the "sense of reality." All kind of wrong. This is one of the most severe manifestations of the disease. Such a "coming" can happen anywhere, this state is not provoked by anything, it comes on its own. It does not last long, but due to the wrong sense of time it seems that it will never end.
Some people think that with the implementation of de-realization, the shapes of objects are distorted, the colors change to the opposite or some other garbage occurs that is difficult to imagine for a healthy person. But actually it is not. The main pressure is rather the very feeling that everything is somehow not so. I would describe it as a feeling that you are sleeping and you cannot wake up. But at the same time you are awake. It is very hard to bear.
Illusions are less frightening, but nonetheless very entertaining phenomena of perception. Unlike hallucinations, illusions are based on lack of information. The idea is that we own only a part of the information and the brain itself completes the missing part. As a result, you can see a person in a column among the bushes, in a package flying across the road - a cat, in the sounds of the printer behind the wall you can hear individual words, etc.
Sometimes there are flavoring and olfactory illusions. Or hallucinations, I somehow do not really understand where the border lies here. This is generally a very strange thing. You can just smell the salad with crab sticks, when there is nothing like that in the apartment, or in the process of eating a meat dish to get a taste of lemonade in the language. This is a short-term manifestation, but it makes you look for some kind of trick. It seems to me that this is due to the fact that the brain somehow decomposes complex smells and tastes into components and at some point one of the components begins to dominate and such effects are obtained. Although it is likely that here I am mistaken.
Treatment in PND
At some point, it became clear that medical treatment is indispensable. The choice was not very rich and I turned to the IPA at the place of residence. Further treatment took place first in the main branch of the clinic, then transferred to another one, based at the city clinic, but in general they were similar. Perhaps someone will be interested to learn about what is happening within the walls of this institution, so I will tell you a little.
There are two parts to the dispensary. This is a general ward where district psychiatrists and psychologists take on, and there is a day hospital. The general department is more like a clinic - a lot of very different people, long lines, noisy, everyone runs and nothing is clear. The registry is the same as in the usual clinic. Cards are constantly losing. No procedures are carried out here, they simply communicate with patients, send them to a psychologist for diagnosis, collect consultations of doctors, make diagnoses, write out prescriptions and certificates.
Day hospital is located on another floor. In the new department, he looks more like a psychological assistance center than a hospital. Quiet, clean, there are some plants. People are mostly very calm, apparently due to the medications taken. In the old section there is some oppressive feeling, but it is rather because of the old building. There are narrow dark corridors and small cabinets. Interestingly, in both cases there are no mirrors in hospitals. They are nowhere to be found, neither in the corridors, nor in the toilets, nor in the offices.
Day hospital does not imply permanent presence in it. Formally, you can be in it all the first half of the day - they are fed there with breakfast and lunch, you can go to different classes. Now there are lectures on the psycho-education of patients and relatives, various trainings and consultations. It is even a bit strange that in our country they are trying to do something normally. But visiting all of this is voluntary.
It is imperative to visit only two rooms. This is the office of the attending psychiatrist, who prescribes medications, and the office where there are safes and these same medications issue. That is, he came to the doctor, received a form for issuing pills, got them and you can go home. In the beginning you need to come every day, then - every other day. As soon as the dosages of drugs are selected, they can be released for a week.
To date, there is no clear understanding of the causes of the development of disorders of this spectrum and the treatment is symptomatic. In my situation, apathy and depressions prevail because I cannot do anything. Atypical antipsychotics and antidepressants help to cope with this a little, but of course there is no talk of a full recovery. Actually, these drugs in the clinic are issued free of charge. Well, that is, it is an insurance case that is covered by the OMS policy.
There are a couple of cabinets. This is a procedural, where they take blood on admission and make injections to some patients, and a room with beds, where they make droppers. I have never been there, just passing by.
This is how it looks. In general, nothing terrible happens at the dispensary. Unlike the hospital, which once brought me through the draft board. The psychiatric hospital has greatly frightened its atmosphere. You can say a few words about it. Actually, we are talking about the first Alekseev hospital, it is Kashchenko, to whom the “vouchers” are written, as some radishes affectionately call them, asserting that there is nothing to fear there. A deserted park with old buildings, ambulances, militia that forcibly hospitalizes people, some of the doors are gone, others are locked, windows on the windows are just left to go, search at the entrance, patients are taken away, and the doctors look even more insane, than patients they appear to be pumping up to their ears. The department to which they tried to send me created the impression of a mixture of a prison and a communal apartment. He took advantage of his sanity and refused to be examined there. And I do not advise anyone in their right mind to go to such a place. In an ordinary dispensary, the conditions are much better, but the pills are the same everywhere.
What else do I do with my condition?
I had to look for some lessons that would distract from bad thoughts and gradually return from complete impotence and inaction to a more or less working state. In this regard, cooking was a good occupation. Not a very long action at a time — you can force yourself, and this is an activity that you can focus on. It is important. It is necessary to carefully cut everything, keep track of time, collect a bunch of different ingredients, then another serving - also something else. And at the end - a bonus in the form of a beautiful snack. She will not bring joy, but anything is better than macaroni from the store. If you prepare something new every day, then you can discipline and shake yourself a little. It really helps with apathy.
Over time, the development was added to cooking. Back to information security after a thorough knockout of this topic was difficult. Yes, and tolerances in different places get standing on the account is problematic. He began to explore a new area for himself - the layout, the development of non-standard sites. Of course, there was no talk about any study for 8-10 hours a day. He started with sessions for half an hour, then for an hour a day. So I studied. Appeared underworking. For a couple of years I dived very well, I started doing things that many people are surprised at. Before I began to describe all this in the articles, people simply did not believe me that I myself had made my portfolio.
In the course of treatment, a small tremor of hands from neuroleptics also appeared. It helps to play musical instruments - guitar and piano. I do not quite understand how this works, but the effect is noticeable. If a couple of days do not play - the tremor increases. Also added an hour a day music lessons. In small steps he wrote a book - a manual on flamenco guitar. I started writing etudes. First small, then longer. If someone is suddenly interested, you can listen to the synthesized recordings . It’s impossible to record everything live yet. But the collections in print published.
This is all to the fact that even with serious problems, you can achieve something. Being engaged in an hour a day, you can slowly but surely come to something. I am surprised when perfectly healthy people say that they cannot achieve anything. All of you can.
I do not know what conclusions can be drawn here. I hope that it was interesting for someone to read about how their condition seems to be with such a disorder. Perhaps this will give someone hope that they can at least partially rehabilitate themselves. In general, draw your own conclusions.