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Yıl:2007; Cilt: 3; Sayı: 12>> Özet
Türkiye Klinikleri Dahili Tıp Bilimleri Dergisi Psikiyatri; 2007;3(12):24-29
Şizoid Kişilik Bozukluğu
C Göker, Ö Öner, H Özsan
Ankara Üniversitesi Tıp Fakültesi Psikiyatri ABD
Şizoid kişilik bozukluğu tanısı ömür boyu sosyal ilişki kurmaktan kaçınan ve yalnızlığı tercih eden kişilere konur. Bu kişiler kendi aile fertleriyle bile sosyal ilişki kurmaktan pek hoşlanmazlar. Yakın arkadaş­ları yoktur. Televizyon seyretmek gibi tek başına yapılan etkinliklerden hoşlanırlar. Duygusal tepki göstermezler, konuşurken jest ve mimiklerle karşılık vermezler. Diğer insanlar tarafından soğuk ve tuhaf bulunurlar. Strese tepki olarak çok kısa psikotik dönemler yaşayabilirler. Eşlik eden depresyon, anksiyete ve madde kullanımı benzeri bir durum olmadıkça psikiyatriste pek başvurmadıkları için kliniklerde sık görülmezler. Prevelans tam bilinmemekle birlikte genel toplumun %7,5 kadarının etkilendiği düşünülmektedir. Erkeklerde iki kat daha fazla görüldüğünü belirten çalışmalar vardır. Şizofreni veya şizotipal kişilik bozukluğu olanların akrabalarında şizoid kişilik bozukluğu prevelansı daha yüksek olabilir. Psikanalitik literatüre göre şizoid kişiliğin özellikleri şunlardır: (1) ağır ve devam eden preödipal travma, (2) tamamlanmamış aynşma-bireyleşme süreci ve dolayısıyla nesne sürekliliğinde eksiklik, (3) bölme, projektif identifikasyon ve ilkel idealizasyon gibi savunma mekanizma­larının sebat etmesi, (4) preödipal ve ödipal çatışmaların yol açtığı sadomazoşist eğilim ve cinsel sapma, (5) kimlik difüzyonu ve (6) ger­çekçi olmayan bir ego ideali. Sannsal bozukluk, şizofreni, psikotik özellikleri olan duygudurum bozukluğu gibi psikotik bozukluklardan, otistik bozukluğun hafif formlarından, Asperger sendromundan, çekin­gen kişilik bozukluğu, şizotipal kişilik bozukluğu ve paranoid kişilik bozukluğundan ayırdedilmesi gerekir. Bu hastalar ancak hayatlarını zorlaştıran bir kriz durumunda tedavi için başvururlar. Ego güçleri sınırlı olduğu için tedavi zordur. Destekleyici psikoterapi ve farmakoterapi uygulanabilir.
Bu makalede deskriptif çalışmalar ve dinamik görüşler özetlen­dikten sonra şizoid kişilik bozukluğu tanımlanacak ve klinik özellik­ler, ayırıcı tanı, gidiş, prognoz ve tedavi üzerinde durulacaktır.
Schizoid Personality Disorder
Schizoid personality disorder is diagnosed in patients who dis­play lifelong pattern of social withdrawal. Schizoid persons don't enjoy close relationships, icluding being part of a family. They enjoy solitary activities. They don't show their emotions and use gestures. They are seen by others as cold and eccentric. They can have short psychotic episodes as a reaction to stress. Since they don't seek psychiatric help unless they have depression and anxiety, they aren't seen often in hospitals. The prevalence isn't clear but it may affect 7.5 percent of the general population. Some studies report 2 to 1 male to female ratio. Its prevalence is higher among the relatives of patients with schizophrenia and schizotypal disorder. Psychoanalitic literature characterizes the schizoid personality as displaying (1) severe and sustained preoedipal trauma, (2) aborted seperation-individuation process and therefore a lack of self and object constancy, (3) persis­tence of splitting, projective identification and primitive idealization mechanisms, (4) condensation of preoedipal-oedipal conflicts with a sadomasochistic tinge and tendency towards perverse formations, (5) identity diffusion, (6) unrealistic ego ideal. It should be distinguished from the psychotic disorders, autistic disorder, Asperger's syndrome, avoident, schizotypal and paranoid personality disorders. These patients seek out treatment generally because some crisis disrupt their lifes. They are difficult to treat because their ego resources are lim­ited. Supportive psychotherapy and pharmacotherapy can be applied. In this article after descriptive studies and dynamic views are summa­rized, clinical features, differential diagnosis, course, prognosis and treatment of schizoid personality disorder will be mentioned.

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