Schizoid personality disorder
Schizoid personality disorder is characterized by a persistent withdrawal from social relationships and lack of emotional responsiveness in most situations. It is sometimes referred to as a "pleasure deficiency" because of the seeming inability of the person affected to experience joyful or pleasurable responses to life situations.
A person with schizoid personality disorder has little or no interest in developing close interpersonal relation ships. They appear aloof, introverted and prefer being alone. Those who know them often label them as shy or a "loner." They turn inward in an effort to shut out social relationships. It is common for a person with schizoid personality disorder to avoid groups of people or appear disinterested in social situations even when they involve family. They are often perceived by others as socially inept.
A closely related trait is the absence of emotional expression. This apparent void of emotion is routinely interpreted by others as disinterested, lacking concern and insensitive to the needs of others. The person with schizoid personality disorder has particular difficulty expressing anger or hostility. In the absence of any recognizable emotion, the person portrays a dull demeanor and is easily overlooked by others. The typical person with schizoid personality disorder prefers to be viewed as "invisible" since it aids their quest to avoid social contact with others.
The person with schizoid personality disorder may be able to hold a job and meet the expectations of an employer if the responsibilities do not require more than minimal interpersonal involvement. People with this disorder may be married, but do not develop close intimate relationships with their spouse and typically show no interest in sexual relations. Their speech is typically slow and monotonous with a lethargic demeanor. Because their tendency is to turn inward, they can easily become preoccupied with their own thoughts to the exclusion of what is happening in their environment. Attempts to communicate may drift into tangents or confusing associations. They are also prone to being absent minded.
Causes and symptoms
The schizoid personality disorder has its roots in the family of the affected person. These families are typically emotionally reserved, have a high degree of formality, and have a communication style that is aloof and impersonal. Parents usually express inadequate amounts of affection to the child and provide insufficient amounts of emotional stimulus. This lack of stimulus during the first year of life is thought to be largely responsible for the person's disinterest in forming close, meaningful relationships later in life.
People with schizoid personality disorder have learned to imitate the style of interpersonal relationships modeled in their families. In this environment, affected people fail to learn basic communication skills that would enable them to develop relationships and interact effectively with others. Their communication is often vague and fragmented, which others find confusing. Many individuals with schizoid personality disorder feel misunderstood by others.
DSM-IV-TR specifies seven diagnostic criteria for schizoid personality disorder:
- Avoids close relationships: People with this disorder show no interest or enjoyment in developing interpersonal relationships; this may also include family members. They perceive themselves as social misfits and believe they can function best when not dependent on anyone except themselves. They rarely date, often do not marry, and have few, if any, friends.
- Prefers solitude: They prefer and choose activities that they can do by themselves without dependence upon or involvement by others. Examples of activities they might choose include mechanical or abstract tasks such as computer or mathematical games.
- Avoids sex: There is typically little or no interest in having a sexual experience with another person. This would include a spouse if the affected person is married.
- Lacks pleasure: There is an absence of pleasure in most activities. A person with schizoid personality disorder seems unable to experience the full range of emotion accessible to most people.
- Lacks close friends: People affected with this disorder typically do not have the social skills necessary to develop meaningful interpersonal relationships. This results in few ongoing social relationships outside of immediate family members.
- Indifferent to praise or criticism: Neither positive nor negative comments made by others elicit an emotionally expressive reaction. They don't appear concerned about what others might think of them. Despite their tendency to turn inward to escape social contact, they practice little introspection.
- Emotional detachment: Their emotional style is aloof and perceived by others as distant or "cold." They seem unable or uninterested in expressing empathy and concern for others. Emotions are significantly restricted and most social contacts would describe their personality as very bland, dull or humorless. The person with schizoid personality disorder rarely picks up on or reciprocates normal communicational cues such as facial expressions, head nods, or smiles.
Of all personality disorders , schizoid personality disorder is the least commonly diagnosed personality disorder in the general population. The prevalence is approximately one percent. It is diagnosed slightly more often in males.
The symptoms of schizoid personality disorder may begin in childhood or adolescence showing as poor peer relationships, a tendency toward self-isolation, and underachievement in school. Children with these tendencies appear socially out-of-step with peers and often become the object of malicious teasing by their peers, which increases the feelings of isolation and social ineptness they feel.
For a diagnosis of schizoid personality disorder to be accurately made, there must be an ongoing avoidance of social relationships and a restricted range of emotion in interpersonal relationships that begin by early adulthood. There must also be the presence of at least four of the above-mentioned symptoms.
A common difficulty in diagnosing schizoid personality disorder is distinguishing it from Autistic Disorder and Asperger's Disorder , which are characterized by more severe deficits in social skills. Other individuals who would display social habits that might be viewed as "isolating" should not be given the diagnosis of schizoid personality disorder unless the personality traits are inflexible and cause significant obstacles to adequate functioning.
The diagnosis is based on a clinical interview to assess symptomatic behavior. Other assessment tools helpful in diagnosing schizoid personality disorder include:
- Minnesota Multiphasic Personality Inventory (MMPI-2)
- Millon Clinical Multiaxial Inventory (MCMI-II)
- Rorschach Psychodiagnostic Test
- Thematic Apperception Test (TAT)
A major goal of treating a patient diagnosed with schizoid personality disorder is to combat the tendencies toward social withdrawal. Strategies should focus on enhancing self-awareness and sensitivity to their relational contacts and environment.
Psychodynamically oriented therapies
A psychodynamic approach would typically not be the first choice of treatment due to the patient's poor ability to explore his or her thoughts, emotions, and behavior. When this treatment is used, it usually centers around building a therapeutic relationship with the patient that can act as a model for use in other relationships.
Attempting to cognitively restructure the patient's thoughts can enhance self-insight. Constructive ways of accomplishing this would include concrete assignments such as keeping daily records of problematic behaviors or thoughts. Another helpful method can be teaching social skills through role-playing. This might enable individuals to become more conscious of communication cues given by others and sensitize them to others' needs.
Group therapy may provide the patient with a socializing experience that exposes them to feedback from others in a safe, controlled environment. It can also provide a means of learning and practicing social skills in which they are deficient. Since the patient usually avoids social contact, timing of group therapy is of particular importance. It is best to develop first a therapeutic relationship between therapist and patient before starting a group therapy treatment.
Family and marital therapy
It is unlikely that a person with schizoid personality disorder will seek family therapy or marital therapy. If pursued, it is usually on the initiative of the spouse or other family member. Many people with this disorder do not marry and end up living with and are dependent upon first-degree family members. In this case, therapy may be recommended for family members to educate them on aspects of change or ways to facilitate communication. Marital therapy (also called couples therapy ) may focus on helping the couple to become more involved in each other's lives or improve communication patterns.
Some patients with this disorder show signs of anxiety and depression which may prompt the use of medication to counteract these symptoms. In general, there is to date no definitive medication that is used to treat schizoid symptoms.
Since a person with schizoid personality disorder seeks to be isolated from others, which includes those who might provide treatment, there is only a slight chance that most patients will seek help on their own initiative. Those who do may stop treatment prematurely because of their difficulty maintaining a relationship with the professional or their lack of motivation for change.
If the degree of social impairment is mild, treatment might succeed if its focus is on maintenance of relationships related to the patient's employment. The patient's need to support him- or herself financially can act as a higher incentive for pursuit of treatment outcomes.
Once treatment ends, it is highly likely the patient will relapse into a lifestyle of social isolation similar to that before treatment.
Since schizoid personality disorder originates in the patient's family of origin, the only known preventative measure is a nurturing, emotionally stimulating and expressive caretaking environment.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC:American Psychiatric Association, 2000.
Beers, Mark H., M.D., and Robert Berkow, M.D., eds. The Merck Manual of Diagnosis and Therapy. 17th edition. Whitehouse Station, NJ: Merck Research Laboratories,1999.
Millon, Theodore, Ph.D., D.Sc. Disorders of Personality: DSM IV and Beyond. New York: John Wiley and Sons, Inc., 1996.
Sperry, Len, M.D., Ph.D. Handbook of Diagnosis and Treatment of DSM-IV Personality Disorders. New York: Brunner/Mazel, Inc., 1995.
American Psychiatric Association. 1400 K Street NW, Washington D.C. 20005 <http://www.psych.org> .
Gary Gilles, M.A.