Interpersonal relatedness and paranoid schizophrenia

A 33-year-old man presented with a 10-year history of psychosis and an imaginary companion; he carried a past diagnosis of chronic schizophrenia. He responded quickly to neuroleptic and was noted to be an easily engageable person. It is argued that despite his first-rank Schneiderian symptoms, the patient may not best be conceptualized as having schizophrenia. Specific treatment recommendations are made, predicated on this man's developmental history, his attachment and separation behavior, and his response to a structured social milieu.