I will start by saying that it is NOT clearly demarcated from BPD. In most cases there is co-morbidity with another disorder. STs suffer from anxiety, depression and other dysphoric mood states. A very typical feature is strange convictions and sometimes reactive psychoses. Most STs believe in the supernatural, confess to magical thinking and are very superstitious (in the sense that superstition dictates their behaviors to the point of making it "dysfunctional"). STs construct their sentences idiosyncratically and communication with them might be stilted and difficult.

STPD seems to have some genetic component. There are many first and second degree schizophrenic relatives in the families of STPDs.

The treatment includes both antipsychotic medicines when required plus VERY tactful exploration of the eccentric belief systems of the STPD in talk therapy.

Of course the determination of eccentricity and idiosyncrasy is rather dependent on the predominant cultural and societal values, lore, and narratives of the time.

The DSM IV has this to say:

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 beginning by early adulthood and present in a variety of contexts as indicated by five (or more) of the following:

• Ideas of reference (excluding delusions of reference)
• Odd beliefs or magical thinking that influences behaviour and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations)
• Unusual perceptual experiences, including bodily illusions
• Odd thinking and speech (e.g., vague, circumstantial, metaphorical, over-elaborate, or stereotyped)
• Suspiciousness or paranoid ideation
• Inappropriate and constricted affect
• Behaviour, 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 judgements about self.

Does not occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, another psychotic disorder, or a pervasive developmental disorder.

3. Inverted Narcissism

The DSM IV defines the NPD using nine criteria. It is sufficient to possess five of them to "qualify". Thus, theoretically, it is possible to be NPD WITHOUT having grandiosity. Many researchers (Alexander Lowen, Jeffrey Satinover, Theodore Millon) suggested a "taxonomy" of pathological narcissism. They divided narcissists to sub-groups (very much as I did with my somatic versus cerebral narcissist dichotomy). Lowen, for instance, talks about the "phallic" narcissist versus others. Satinover makes a very important distinction between narcissists who were raised by abusive parents - and those who were raised by doting mothers or domineering mothers. I expanded upon the Satinover classification in FAQ 64.

I wrote "Malignant Self Love" exactly five years ago (1996). I corresponded with thousands (including dozens of mental health professionals) since then. It is clear to me from this correspondence that there is, indeed, a type of narcissist, hitherto rather neglected and obscure. It is the "self-effacing" or "introverted" narcissist. I call it the "Inverted Narcissist" and others on this list preferred to use "Mirror Narcissist", "NMagnet", or "NCodependent (NCo for short)". Alice Ratzlaff compiled an excellent "DSM" type "list of criteria".

Methodologically she erroneously insisted upon calling it a narcissist in the classical sense but finally we compromised on "Inverted Narcissist".

This is a narcissist who, in many respects, is the mirror image of the "classical" narcissist. The psychodynamics of such a narcissist are not clear, nor are his developmental roots. Perhaps he is the product of a doting or domineering primary object/caregiver. Perhaps excessive abuse leads to the repression of the narcissistic and other defence mechanisms themselves. I mean to say that perhaps the parents suppressed every manifestation of grandiosity (very common in early childhood) and of narcissism - so that the defence mechanism that narcissism is was "inverted" and internalized in this unusual form.

These narcissists are self-effacing, sensitive, emotionally fragile, sometimes socially phobic. They import all their self-esteem and sense of self-worth from the outside (others), are pathologically envious (a transformation of aggression), are likely to intermittently engage in aggressive/violent behaviours, are more emotionally labile that the classic narcissist, etc.