Monthly Archives: September 2018

Sense of Self

Talking to a few others with schizotypal disorder during a group session, I found a curious trait most of us seemed to share. And that was a lacking, or poor sense of self. It was somewhat described as feeling “hollow” or not having a core of identity by one and it’s a feeling I find I can recognize: The sense of being a different person depending on who I’m talking to. I’ve on occasion thought of myself as a mirror, merely reflecting others’ own image back at them. Sometimes I’ve felt like a poor facsimile of a human being, other times just as if I’m missing something crucial that’s supposed to make me a person. Sometimes, when alone, I’d feel like a puppet, with her strings cut, or a toy others might pull out and play with for a while, but then put back in the toy box and forget about until the next play-time.

Identity is a complex thing I’m sure we all struggle with at one point or another. Teenage years and mid-life crises come to mind. Questions like: Who am I? What do I want? Like? What do I think about this or that or how does one thing or other make me feel? But I imagine most people have a sense of being, something inside they can point to and say: That’s me. They might not know who they are or what they’re really like, but there’s something. A constant that’s always there. A certainty that there’s something that’s you and you do exist.

This doesn’t seem necessarily the case if you suffer from Schizotypal disorder. I don’t know if it’s a trait in every case or how severe or mild it can be for each person. For me, I do usually have a sense of self. I’m the source of my thoughts. Trouble is, I can’t always tell if it’s really a me, or stray fragments of thoughts and opinions picked up from other people and tangled up together to fill an empty void.

The worst part of it is, I think, that whenever I try to talk about what I think/feel or how I see myself, I can’t always tell if I’m even telling the truth or not. I often struggle to find the right words to describe them and I am endlessly worrying about whether or not the words I use actually mean what I think they mean. I worry constantly that I’m being misunderstood and that I in turn don’t understand others at all. Makes for interesting social interaction. Not to mention sitting down and writing a blog like this one. Sometimes it just all feels like a massive waste of time, but anxiety and depression are a topics for another day.

So, what do I do to try and lessen the feeling of emptiness, the lack of identity? I treat it like an empty canvas and paint something on it. I sit down and think about what kind of person I want to be: Honest, compassionate, loyal, kind, intelligent, confident… and then I strive to live by the values I make for myself. Of course it’s not easy and I don’t always live up to my ideals, but then no one actually does. I think of it like this: Who I am doesn’t matter nearly as much as what I do. Then all I have to think about is what do to do to create the image I want for myself. But I realize it might ring a little hollow to some. It just ends up feeling like another role to play. A lie.

Another thing I do is, I spend a lot of time pondering my interests, my talents, consider what I like to do, take the time to really think about my likes and dislikes, try to examine my feelings and emotions and how I react to one thing or another. I imagine Cognitive Behavior Therapy (CBT) also might provide a good way to challenge the feeling of emptiness/hollowness and negative thoughts such as “I’m nobody”, “I don’t have a personality” and the like. Often times, when you sit down and really think about it, there’s usually always some kind of evidence that there really is a person inside.

I try not to compare myself to other people too much. Down that road lies all kinds of misery.

I mentioned playing a role earlier and incidentally, one of my big interests is roleplaying. I recommend it for anyone who struggles with identity problems. Or hell, I’d recommend it to anyone just ’cause it’s super fun! The gist of it is, you construct a fictional character complete with a backstory and personality and then act them out in a series of scenarios together with other players. Basically making a game out of playing pretend. There are many ways you can roleplay: Live action roleplay, a great variety of desktop games like Dungeons & Dragons, Warhammer and Shadowrun, as well as text-based roleplaying fora all around internet. There are also roleplaying communities in the various Massively Multiplayer Roleplaying Games like World of Warcraft and the like. Roleplaying gives a great opportunity to explore roles, personalities and even sexuality without actually putting yourself out there. I had a guy in my roleplaying group once, who played a gay character before he officially came out as gay. I don’t know if the roleplaying ever actually had any effect on his decision when he did decide to come out of the closet. I never asked. But I like to think it helped just a little.

 

A poor sense of self can be an incredibly painful, confusing thing to live with. But perhaps there can be upsides to it too and it certainly doesn’t have to be all pain always.

Symptom: Unusual Perceptual Experiences

This is perhaps one of the more insane-sounding symptoms, but also one of the hardest for me to correctly understand and identify. In fact, it took me many years to realize what they were.

Sometimes, when I’m really stressed, I see shadows, either flickering out of the corner of my eye or appearing and disappearing from one blink of an eye to the next. They were always so brief they weren’t really worth paying much attention to. Easy to ignore and forget. At most, they might weird me out a little, but I got over them quick enough.

Whenever I stare at a blank wall, more often than not it will begin to waiver, wriggle and squirm as if it were alive. This happens so often it hardly registers as unusual. I know the wall is completely inanimate and that it’s just my eyes creating the illusion, so I can just ignore it.

Sometimes I’d hear my mom calling my name in this really annoying voice, even when she wasn’t. But I haven’t heard her calling my name since I moved away from home.

Phantom noise or cries is fairly common and not necessarily a sign of insanity. Parents to infants might experience hearing their baby crying even when it’s not, or perhaps they’ll hear a random noise, like a bird call or the like, and it’d sound like their baby crying. I suppose the stress of too little sleep and too much awful noise can get to anyone. But knowing this, I never really thought of my ‘hearing’ things as anything unusual or a cause for concern. In the end, it was easily ignored and soon became little more than background noise.

I’ve had problems with neighbors playing too loud music because the walls are stupid-thin, but sometimes I felt as if I was just hearing things. As soon as I left my room to complain to my neighbor, I wouldn’t be able to hear anything at all. Usually, there’d be a window or door open and that’s what made the sound carry. Other times the music would be loud enough to hear from outside as well. To this day, I don’t know if some of the noise was created solely in my head just out of the stress created by the actual noise. But that period of about two years was the one period I felt the most insane in all my life.

The worst case of seeing something that wasn’t there, that I can remember was when I was still living at home. One evening I saw a girl sitting in the corner of my room. But it wasn’t exactly how I’d thought seeing things was like. I could see the empty corner clearly with my eyes and knew she wasn’t there. But at the same time, I had the feeling she was there and I could see her clearly in my mind’s eye. Even though I knew she wasn’t actually there, I just couldn’t get her out of my mind. I had to leave the room and go sit in the living room for a while. I was obviously upset and worried my mother, but I couldn’t explain why or what happened to me. How do you explain seeing something, but not really? I never saw it as “seeing things”. Because it wasn’t exactly at the level of A Beautiful Mind, now was it?

When I was first questioned by a doctor on whether I heard or saw things that weren’t there, I said no. Because the squirmy walls, the shadows, the strange girl, the phantom noises, those weren’t “seeing” or “hearing” things, they were just a trick of my over-active imagination. They weren’t the signs of a mental illness. I was depressed, not insane.

It wan’t until much later, when I attended a lecture by a woman suffering from Schizophrenia and she described hearing voices as very similar to having a song stuck in your head, that my view of my own experiences began to change. As she said, most people have experienced a catchy song continuously playing in their head. She said that the voices were like that, but talking instead of playing music. And a lot more oppressive, upsetting and disruptive.

She described how she learned to cope with the voices, identifying when they grew worse, which was usually when she was especially tired or stressed out. They weren’t just always there. Knowing when and why they appeared helped her overcome the negative voices. Then, instead of being a torment, they became a reminder to take better care of herself.

Hers is the best advice I’ve found to cope with unusual perceptual experiences. The shadows and phantom cries aren’t the first warning sign that I’m starting to get overwhelmed and stressed out, but they’re probably the most obvious and easily identified.
These days, shadows hardly appear in the corner of my eyes, but when they do, I try to pay more attention to what I’m doing and how I’m feeling.

Occasionally, when I’m really tired, I’ve also started to ‘hear’ a whole crowded restaurant in my head, full of broken pieces of conversations, fragments of sentences that make little sense. It makes thinking or focusing on things really hard. Luckily, it doesn’t last very long and it’s not something that actually keeps me from sleep.

The unusual perceptual experiences I’ve described here may not sound very severe and in most cases are fairly easy to ignore. But when they start to chase you out of a room, keep you from going out the door or drive you so much to distraction you don’t have any attention left for the things you need or actually want to do, they can become very debilitating indeed. Like a hundred little streams that become a large river.

In summary: Unusual perceptual experiences can be small, almost trivial and little more than a distraction. But if that distraction is actually really upsetting or disruptive, it may be worth it to pay more attention to the situations in which they arise. The nature and experience of the unusual perceptual experiences can vary greatly from person to person. Some may not be able to distinguish them from reality, which is upsetting enough all on its own, whereas others may experience them as a figment of an over-active and out of control imagination. The point is, it’s not something you can control.
Reducing stress can reduce the impact of unusual perceptual experiences significantly.

Symptoms: Odd Thinking

I figured, rather than just copying the many pages describing schizotypal disorder, I’d take my time going through each symptom and just give my own perspective on them.

So let me start with the one that might be the most obvious when reading this blog: Odd thinking and speech (or in this case, writing).

The Encyclopedia of Mental Disorders I found here writes this: “People with schizotypal personality disorder may have speech patterns that appear strange in their structure and phrasing. Their ideas are often loosely associated, prone to tangents, or vague in description. Some may verbalize responses by being overly concrete or abstract and insert words that serve to confuse rather than clarify a particular situation, yet make sense to them.”

It’s a bit iffy and looking from the outside, it might be a bit hard to put your finger on exactly what it is that makes the speech or writing sound weird exactly.

Seen from the inside, I’m not actually sure myself that my thinking or speech really is that odd compared to anyone else’s. I make perfect sense to my own ears. The only clue I have is the way other people react to the things I say and do, which don’t always make any sense to me. As if they heard something completely different from what I said. Although it’s pretty rare.

In conversation and writing, I think I tend to turn to metaphors and allegories a lot when trying to explain things and depending on how complex the topic is, I might never actually manage to get to the true core of the matter. But it’s not something I’ve ever registered as a problem myself. I can imagine how it might become a little tedious for some.

Sometimes in conversation, I’ll taste test words, trying to gauge whether it fits the thought or feeling I’m trying to describe. If I’m writing, Thesaurus can be a big help finding just the right word. In speech, I’m stuck with my own memory and gut feeling.

Whether in speech or writing, it takes me a lot of time to organize my thoughts. The harder the topic, the longer it takes. On top of that, when I get nervous or insecure, my speech becomes very slow and halting. I’m sure you can imagine how that might make conversation a bit tedious and uncomfortable for everyone.

Most times, this symptom is really more of an annoyance than an actual problem for me, but it can get in the way of communication and thus personal relationships. It does tend to build up over time and the negative experiences stick out more in my memory than the positive experiences.

The little misunderstandings sometimes makes me hesitant to talk. Especially when I’m already in a mood or tired. Then it’s easier not to say anything at all rather than risk talking myself into a mess and waste time and resources I don’t have.

The misunderstandings unfortunately aren’t only one way. Sometimes, people have this annoying habit of not saying what they actually mean. Like for instance, someone might say: “It’s really hot in here.” And apparently that’s supposed to translate to: “Can we open a window?” Except sometimes, it’s really just an observation, not a request, and how on earth is anyone supposed to tell the difference?!

It takes me a while to realize when someone wants me to do something when they don’t tell me outright what they want and more often than not, it’ll be much too late when I finally realize what they actually meant.

Flirting and banter is perhaps the most difficult for me to deal with, because I get confused easily and end up doubting my understanding of the other person. Then, what’s supposed to be fun and lighthearted becomes a scary minefield at the flip of a coin.

The better I know a person and the longer I’ve known them, the easier it is to understand them and make myself understood. I have pretty good, close relationships with my immediate family and I have two very close friends whom I’ve known for ages. But I haven’t really managed to form a decent friendship with anyone since 7th grade, maybe barring a single internet friend. Even though the relationships I do have are generally good, misunderstandings can still make problems sometimes. The good thing about the old, close relationships is they don’t break so easily.

The problems with misunderstandings has made me very concerned with word choice and whether or not they mean the same to others as they mean to me. I’ll often agonize over word-choice and end up not saying what I wanted to say, because I’m afraid of hurting others’ feelings. In my most hopeless moments, I’m convinced that words really don’t mean the same to others as they do to me and that I’ve no hope at all for properly communicating my thoughts and feelings to anyone, ever.

My point is, communication becomes a whole lot more complicated and anxiety-inducing than it needs to be. It’s exhausting and so it’s so much simpler and easier to just – not.

The problem with this symptom isn’t that my brain’s a little funky in the way it works. When it comes right down to it, it’s not as if it’s all that alien. Everyone differs in their thinking one way or another. The problem is the isolating effect it has on my life.

It’s easy to imagine that my thinking and writing style might turn out to be a problem for what I’m trying to do with this blog. I try to keep on point and my posts are pretty heavily edited before I publish them. But things do slip. Sometimes, a digression doesn’t register to me as such. So I’d appreciate any loose threads pointed out to me, or if something comes out unclear. I do want my writing to be both legible and if not at all entertaining, at least useful in some way.

 

Disorder or Personality Disorder?

When searching “schizotypal” around the net, you may have seen it referred to either as a personality disorder or simply a disorder.

Why is that, and what’s the difference?

I’ve dug through a few internet pages including APA’s (American Psychiatric Association) homepage and various danish sites on psychiatry and mental health information pages.

Far as I can tell, the main difference lies simply in the diagnostics system. There are two distinct, primary diagnostics systems used in psychiatry largely depending on where you live in the world: ICD (International Classification of Disease) and DSM (Diagnostic and Statistical Manual of Mental Disorders).

ICD is developed by WHO (World Health Organization). It is primarily used in Europe and various countries connected to WHO. It is the official diagnostics system used in Denmark, where I live. The newest iteration and currently used version is ICD-10. In this system, schizotypal is listed as a disorder. Here, it is loosely grouped with psychotic disorders such as Schizophrenia, paranoid delusions and acute or passing psychoses. This, I believe is due to the relationship and similarity to schizophrenia.

DSM is published by APA and is primarily used in USA, Canada and Australia. If memory serves correctly, it is also the system most commonly used in research papers. The newest iteration and current version in use is DSM-5. In this system, schizotypal is listed as a personality disorder. It is classed as a cluster A personality disorder, which is known as the “eccentric personality disorders” along with schizoid and paranoid personality disorders.

There are a total of 3 clusters of personality disorders in DSM-5.
B is the dramatic, emotional, irratic cluster, which consists of antisocial, histrionic, narcissistic and borderline personality disorders. cluster C is the fearful, anxious cluster and consists of avoidant, dependant and obsessive compulsive personality disorders.
So, what is a personality disorder? It is a type of disorder so deeply ingrained in a person’s behavior and way of thinking that it could be considered a distinct part of their personality. Roughly speaking. Symptoms typically become apparent during adolescence and cause long-term difficulties in personal relationships and function in society.

Essentially, Schizotypal Disorder and Schizotypal Personality Disorder are the same disorder, only classified differently, with slight variations. Symptoms are essentially the same. In DSM-5, the symptoms have to appear even without outside stressors, whereas ICD-10 is slightly more lenient in this. In practice, there’s hardly any difference that I could detect.

I might remember this wrong, but I believe the difference in classification comes from the structure of the diagnostics system. In ICD-10, disorders are largely classified on a spectrum or several, like autism spectrum disorders, whereas in DSM-5, they are largely categorical.

By calling it a personality disorder, DSM-5 focuses on the distinct pattern of thought and behavior in people with schizotypal personality disorder, which deviates from what is considered normal in society. Personality disorders affect the way one thinks of oneself, relates to other people, responds emotionally and controls one’s behavior. These problematic behaviors and thinking patterns persist over very long periods of time and treating a personality disorder can be a lengthy endeavor both with psychotherapy and if needed, medication. The fact that psychotic symptoms such as delusions and hallucinations are very limited or entirely non-existent probably also plays a role in this classification.

ICD-10 on the other hand seems to primarily consider the similarity of shizotypal disorder to schizophrenia. Research has shown a fairly strong familial relationship between schizophrenia and schizotypal disorder where families with cases of schizophrenia are more likely to also have cases of schizotypal disorder. Another reason for this classification might be the hierarchical nature of ICD-10, where disorders are ranked by numbers where the lower numbers take priority over lower numbers. So if someone has symptoms fitting into several different disorders, it is the disorder listed first in the system that takes priority. That way if I have enough symptoms to be diagnosed with both schizotypal disorder and bipolar disorder, depression or anxiety, it is the schizotypal disorder that is diagnosed first while any symptoms of the other disorders are treated as part of my schizotypal disorder. I’d guess this is to prevent over-long, messy diagnoses.

I am slightly more familiar with ICD-10, but I am by no means an expert in either diagnostics system, so there’s a good chance I got some things wrong. If you spot any mistakes, please correct me in the comments.

In this blog I use the term schizotypal disorder, because that is the term I am most familiar with.

TL;DR version: DSM-5 is American and calls it a personality disorder, ICD-10 is European and calls it a disorder related to schizophrenia.