Diagnosing Ignatius: Schizotypal Personality Disorder

1. Diagnosing Ignatius:Schizotypal Personality Disorder The Schizies (Team 4): Becky Guiler, Misty Mahan, Renee Pittman, & Keima Thomas

2. Schizotypal Personality Disorder (301.22) • According to the DSM-IV-TR, is a “pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior.” • begins by early adulthood • present in variety of contexts • occurs in approximately 3% of population • may be slightly more common in males

3. DSM-IV-TR Diagnostic Criteria for Schizotypal Personality Disorder Must have five (or more) of the following: • Ideas of reference – i.e., incorrect interpretations of casual incidents and external events as having a particular and unusual meaning specifically for the person (excluding delusions of reference – when the beliefs are held with delusional conviction) • Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations)

4. DSM-IV-TR Diagnostic Criteria for Schizotypal Personality Disorder • Unusual perceptual experiences, including bodily illusions • Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) • Suspicious or paranoid ideation (e.g., believing that their colleagues at work are intent on undermining their reputation with the boss) • Inappropriate or constricted affect (usually not able to negotiate the full range of affects and interpersonal cuing required for successful relationships and therefore interact in an inappropriate, stiff, or constricted fashion)

5. DSM-IV-TR Diagnostic Criteria for Schizotypal Personality Disorder • Behavior or appearance that is odd, eccentric, or peculiar • Lack of close friends or confidants other than first-degree relatives • Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

6. DSM-IV-TR Diagnostic Criteria for Schizotypal Personality Disorder • These symptoms can not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder. • If criteria met before onset of Schizophrenia, then “Premorbid” would be added to the diagnosis.

7. Does Ignatius Meet The Criteria??

8. Examples of:Ideas of Reference Mrs. Reilly sold her hat to a man at the bar Ignatius was upset and didn’t understand why she sold the hat and she did not ask him if he wanted her to sell it or not. He claimed he was very attached to that hat. Mrs. Reilly enters Ignatius’ room and Ignatius believes that she has disturbed his sanctuary: “…why you have this sudden compulsion to invade my sanctuary. I doubt whether it will ever be the same after the trauma of this intrusion by an alien spirit.”

9. “You can’t go bowling. This is the most absurd thing you have ever done.”( pg. 79) • When Ignatius fell on the floor from a stool screams, “Oh my God! I think I have broken my back!” (pg. 84) Then later, “ Good grief! The bones in my hand are crushed. I’ll never be able to use it again.” (pg. 85) • “…it was my interest in civil rights which led to my becoming a crippled vendor of franks. I lost a particularly successful position because of my stand on the racial question.” (pg. 306)

10. As a group of tourists walked along the street they saw Ignatius, they thought he was a drunk, but he thought they admired him… “they begged me to pose for a photograph. For minutes they snapped away as I obliged them with several artful poses.” (pg. 231)

11. Examples of:Odd Beliefs or Magical Thinking “ Everyone has a valve! Mine is simply more developed. I am trying to open a passage which you have succeeded in blocking. It may be permanently closed now, for all I know.” (pg. 48) Ignatius also believed that his valve can disable him on days. “ I have a valve which is subject to vicissitudes which may force me to lie abed on certain days.” (pg. 69)

12. “Hroswitha could have predicted this long ago… A sibyl of a medieval nun. She has guided my life.” (p. 259) • “I am the avenging sword of taste and decency.” (p. 260)

13. Examples of:Unusual Perceptual Experiences • Ignatius is constantly talking about is valve and the people around him don’t need to upset him or they would bother his valve. “Oh, my valve! It’s closing!” and “Are you satisfied now that you have ruined me for the rest of the evening?” • After Dorian grabbed Ignatius hoop earring in his ear he cried, “I will probably spend several years at the Eye, Ear, Nose, and Throat Hospital having this attended to,” (pg. 249)

14. Even though it is clear Ignatius is very over- weight he believes he have a great body. “I seriously doubt whether my substantial and well-formed physique…” (pg. 227)

15. Examples of:Odd Thinking or Speech When Ignatius and Mrs. Reilly were kicked out of the bar Ignatius said, “Hurry along, Mother. This woman looks like a Nazi commandant. She may strike us.” (pg. 23) On page 42 Ignatius continues talking about the program and says this, “..is that supposed to be an exemplum to the youth of our nation. I would like very much to know what the Founding Fathers would say if they could see these children being debauched to further the cause of Clearasil.”

16. Ignatius is trying to get Dorian to help him organize a political rally. “The apocalypse is near at hand.” (pg. 254) • “I had a rather apocalyptic battle with a starving prostitute…Had it not been for my superior brawn, she would have sacked my wagon.” (pg. 213) • “Can you name one good, practicing transvestite on the Senate? No! These people have been without representation long enough.” (pg. 281)

17. Examples of:Suspicious or Paranoid Ideation “ Employers sense in me a denial of their values. They fear me. I suspect that they can see that I am forced to function in a century which I loathe.” (pg. 51) Ignatius got all the factory workers to rally up and go to “battle” with Mr. Gonzalez. He made them collect different weapons to attack him. Mr. Gonzalez has done nothing to Ignatius, but Ignatius was very suspicious of him.

18. “I know that Clyde was really trying to kill me. He would have the perfect excuse: self-defense.” (pg. 229) • “Every soldier and sailor that we see could simply be some mad decadent in disguise. My God! We may all be trapped in some horrible conspiracy. I knew that something like this was going to happen. The United States is probably totally defenseless!” (p. 262)

19. “She is undermining our civilization. She is a Chinese Communist agent sent over to destroy us.” (pg. 303)

20. Examples of:Inappropriate or Constricted Affect Overall, Ignatius acts inappropriately with others, which prevents him from establishing successful interpersonal relationships. When the bartender was trying to interact with Ignatius and be polite, Ignatius responded, “Will you kindly tend the bar properly.” Ignatius asked furiously, “It is your duty to silently serve when we call upon you. If we had wished to include you in our conversation, we would have indicated it by now. As a matter of fact, we are discussing rather urgent personal matters.” (pg. 13)

21. In an attempt to attract business during a ladies art show Ignatius created a sign saying, “TWELVE INCHES (12) OF PARADISE.” (pg. 243) (Does he not realize why this is offensive to others, or does he just not care?)

22. Examples of:Behavior or Appearance that is Odd, Eccentric, or Peculiar Ignatius wore his green hunting cap wherever he would go. The type of weather outside did not matter, but he found it practical because it kept him from getting head colds. When Mrs. Reilly tells Ignatius that her elbow needs to be massaged because of her arthritis, Ignatius replies with, “I hope you don’t want me to do that. You know how I feel about touching other people.” (pg. 10)

23. Mrs. Reilly mentions that Ignatius would not miss a particular television program for anything, but he hates it and he says this about the CHILDREN in the program, “ The children on that program should all be gassed.” (pg. 41)

24. Other people’s reactions to him: • “He belched violently during the silence that followed. The ladies pretended to study the sky and the little garden behind the cathedral.” (pg. 255) • “He’s mad.” (pg.256) • “You really are insane aren’t you?” (pg. 258) • “They sure got some funny people at matinees…Just take a look at him.” (pg. 302)

25. Examples of:Lack of Close Friends or Confidants Throughout the book, Ignatius really only has one friend that he keeps in touch with (Myrna), and their relationship is often hostile and competitive. •Ignatius makes reference to his lack of friends/peers: “I have no peers, I mingle with no one.”

26. Examples of:Excessive Social Anxiety • The police officer asked Ignatius what the string hanging out of his bag was and Ignatius’s response was, “Is it the part of the police department to harass me when this city is a flagrant vice capital of the civilized world? This city is famous for its gamblers, prostitutes, exhibitionists, Antichrists, alcoholics, sodmites, drug addicts, fetishists, onanists, pornographers, frauds, jades, litterbugs, and lesbians, all of whom are only too well protected by graft.” (pg. 3)

27. “I myself was a vagrant in happier, better days. If only I were in your shoes. I would stir from my room only once a month to fumble for my relief check in the mailbox.” (pg. 309)

28. To Sum It Up: • “Suspicious, odd/inappropriate affect, social withdrawal, peculiar ways of thinking and perceiving things, loose associations” (Davis, J. M., 2008) • “Seen as odd, eccentric, socially isolated, few friends” (Davis, J. M., 2008) • Additional Info That Possibly Relates to Ignatius: • Oddities reinforced when shunned by peers, increases social anxiety and suspicion (Davis, J. M., 2008) • Caregivers modeled unusual versions of reality (Davis, J. M., 2008) • Needs were met but without emotional warmth & intimacy, development then marked by punitive criticism, inconsistent communication, humiliation by peers (Davis, J. M., 2008)

29. Some Video Clips……. • http://www.youtube.com/watch?v=DZstNPQTJfQ&feature=related • http://www.youtube.com/watch?v=UGrQXi5eQ4g&feature=related

30. Does the diagnosis fit??What do you think?

31. References • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association. • Dr. Davis (lecture) • Toole, J. (1980). A confederacy of dunces. New York: Grove Press. • Video Clips from YouTube