Schizoid Personality Disorder

Schizoid Personality Disorder is characterized by a long-standing pattern of detachment from social relationships. A person with a schizoid personality disorder often has difficulty expressing emotions and does so typically in very restricted range, especially when communicating with others.

A person with this disorder may appear to lack a desire for intimacy and will avoid close relationships with others. They may often prefer to spend time with themselves rather than socialize or be in a group of people. In laypeople terms, a person with schizoid personality disorder might be thought of as the typical “loner.”

Schizoid Personality Disorder
Schizoid Personality Disorder

Individuals with Schizoid Personality Disorder may have particular difficulty expressing anger, even in response to direct provocation, which contributes to the impression that they lack emotion. Their lives sometimes seem directionless, and they may appear to “drift” in their goals. Such individuals often react passively to adverse circumstances and have difficulty responding appropriately to important life events. Because of their lack of social skills and lack of desire for sexual experiences, individuals with this disorder have few friendships, date infrequently, and often do not marry. Employment or work functioning may be impaired, particularly if interpersonal involvement is required, but individuals with this disorder may do well when they work under conditions of social isolation.

Symptoms of Schizoid Personality Disorder

The schizoid personality disorder is characterized by a pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  • Neither desires nor enjoys close relationships, including being part of a family
  • Almost always chooses solitary activities
  • Has little, if any, interest in having sexual experiences with another person
  • Takes pleasure in few, if any, activities
  • Lacks close friends or confidants other than first-degree relatives
  • Appears indifferent to the praise or criticism of others
  • Shows emotional coldness, detachment, or flattened affectivity
Schizoid Personality Disorder
Schizoid Personality Disorder

As with all personality disorders, the person must be at least 18 years old before they can be diagnosed with it.

The schizoid personality disorder is more prevalent in males than females. Its prevalence in the general population is not known.

Like most personality disorders, schizoid personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

How is Schizoid Personality Disorder Diagnosed?

Personality disorders such as schizoid personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose a schizoid personality disorder.

Many people with the schizoid personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis of schizoid personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Schizoid Personality Disorder
Schizoid Personality Disorder

Diagnosis of schizoid personality disorder is typically based on:

  • Thorough discussion of your symptoms
  • Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
  • Your medical and personal history

Diagnostic Criteria for the schizoid personality

  • Introversion
  • Withdrawnness
  • Narcissism
  • Self-sufficiency
  • A sense of superiority
  • Loss of effect
  • Loneliness
  • Depersonalization
  • regression

ICD-10 criteria for Schizoid Personality Disorder

Schizoid Personality Disorder is characterized by at least four of the following criteria:

  • Emotional coldness, detachment or reduced effect.
  • Limited capacity to express either positive or negative emotion towards others.
  • Consistent preference for solitary activities.
  • Very few, if any, close friends or personal relationship, and a lack of desire for such.
  • Indifference to either praise or criticism.
  • Little interest in having sexual experiences with another person (taking age into account).
  • Taking pleasure in few, if any, activities.
  • Indifference to social norms and conventions.
  • Preoccupation with fantasy and introspection.

Causes of Schizoid Personality Disorder

Researchers today don’t know what causes schizoid personality disorder. There are many theories, however, about the possible causes of schizoid personality disorder. Most professionals subscribe to a biopsychosocial model of causation – that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.

Schizoid Personality Disorder
Schizoid Personality Disorder

Risk factors for Schizoid Personality Disorder

Factors that increase your risk of developing schizoid personality disorder include:

  • Having a parent or other relative who has schizoid personality disorder, schizotypal personality disorder or schizophrenia
  • Having a parent who was cold, neglectful or unresponsive to emotional needs

Complications of Schizoid Personality Disorder

People with schizoid personality disorder are at an increased risk of:

  • Developing schizotypal personality disorder, schizophrenia or another delusional disorder
  • Other personality disorders
  • Major depression
  • Anxiety disorders

Millon’s subtypes of Schizoid Personality Disorder

  • Languid schizoid (including depressive features)
  • Remote schizoid (including avoidant, schizotypal features)
  • Depersonalized schizoid (including schizotypal features)
  • Affectless schizoid (including compulsive features)

Differential diagnosis of Schizoid Personality Disorder

While Schizoid Personality Disorder shares several symptoms with other mental disorders, here are some important differentiating features:

Schizoid Personality Disorder
Schizoid Personality Disorder
  • Depression
  • Avoidant personality disorder (AvPD)
  • Narcissistic personality disorder
  • Asperger syndrome
  • Simple-type Schizophrenia

Clinical Features of Schizoid Personality Disorder

Clinical features of schizoid personality disorder include 6 different zones they are specified below :

Self-concept (Expressional Clinical Features)

  • compliant
  • stoic
  • noncompetitive
  • self-sufficient
  • lacking assertiveness
  • feeling inferior and an outsider in life

Self-concept (Hidden or Secret Clinical Features)

  • cynical
  • inauthentic
  • depersonalized
  • alternately feeling empty, robot-like, and full of omnipotent, vengeful fantasies
  • hidden grandiosity

Interpersonal relations (Expressional Clinical Features)

  • withdrawn
  • aloof
  • have few close friends
  • impervious to others’ emotions
  • afraid of intimacy

Interpersonal relations (Hidden or Secret Clinical Features)

  • exquisitely sensitive
  • deeply curious about others
  • hungry for love
  • envious of others’ spontaneity
  • intensely needy of involvement with others
  • capable of excitement with carefully selected intimates

Social adaptation (Expressional Clinical Features)

  • prefer solitary occupational and recreational activities
  • marginal or eclectically sociable in groups
  • vulnerable to esoteric movements owing to a strong need to belong
  • tend to be lazy and indolent

Social adaptation (Hidden or Secret Clinical Features)

  • lack clarity of goals
  • weak ethnic affiliation
  • usually capable of steady work
  • quite creative and may make unique and original contributions
  • capable of passionate endurance in certain spheres of interest

Love and sexuality (Expressional Clinical Features)

  • asexual, sometimes celibate
  • free of romantic interests
  • averse to sexual gossip and innuendo

Love and sexuality (Hidden or Secret Clinical Features)

  • secret voyeuristic interests
  • vulnerable to erotomania
  • the tendency towards compulsive perversions

Ethics, standards, and ideals (Expressional Clinical Features)

  • idiosyncratic moral and political beliefs
  • the tendency towards spiritual, mystical and para-psychological interests

Ethics, standards, and ideals (Hidden or Secret Clinical Features)

  • the moral unevenness
  • occasionally strikingly amoral and vulnerable to odd crimes, at other times altruistically self-sacrificing

Cognitive style (Expressional Clinical Features)

  • absent-minded
  • engrossed in fantasy
  • vague and stilted speech
  • alternations between eloquence and inarticulateness

Cognitive style (Hidden or Secret Clinical Features)

  • autistic thinking
  • fluctuations between sharp contact with external reality and hyper-reflectiveness about the self
  • auto-centric use of language

How to Treat Schizoid Personality Disorder

If you have the schizoid personality disorder, you may prefer to go your own way and avoid interacting with others, including doctors. You may be so used to a life without emotional closeness that you’re not sure you want to change — or that you can.

Schizoid Personality Disorder
Schizoid Personality Disorder

Medication Treatment of Schizoid Personality Disorder

No medications are indicated for directly treating schizoid personality disorder, but certain medications may reduce the symptoms of SPD as well as treat co-occurring mental disorders. The symptoms of SPD mirror the negative symptoms of schizophrenia, such as anhedonia, blunted affect and low energy, and SPD is thought to be part of the “schizophrenic spectrum” of disorders, which also includes the schizotypal and paranoid personality disorders, and may benefit from the medications indicated for schizophrenia.Originally, low doses of atypical antipsychotics like risperidone or olanzapine were used to alleviate social deficits and blunted affect. However, a recent review concluded that atypical antipsychotics were ineffective for treating personality disorders. In contrast, the substituted amphetamine, Bupropion may be used to treat anhedonia. Likewise, Modafinil may be effective in treating some of the negative symptoms of schizophrenia, which are reflected in the symptomatology of SPD and therefore may help as well.

  • Lamotrigine
  • SSRIs
  • TCAs
  • MAOIs
  • Hydroxyzine may help counter social anxiety in people with SPD if present, through social anxiety may not be the main concern for the people who have SPD.

However, it is not general practice to treat SPD with medications, other than for the short-term treatment of acute co-occurring Axis I conditions (e.g. depression).

  • Talk therapy (psychotherapy). Psychotherapy can be helpful. If you’d like to develop closer relationships, a modified form of cognitive behavioral therapy may help you change the beliefs and behaviors that are problems. A therapist understands your need for personal space and how difficult it is for you to open up about your inner life. He or she can listen to and help guide you without pushing too hard.
  • Group therapy. A goal of individual treatment may be a group setting in which you can interact with others who are also practicing new interpersonal skills. In time, group therapy may also provide a support structure and improve your social skills.
  • Medications. Although there’s no specific drug to treat schizoid personality disorder, certain drugs can help with issues such as anxiety or depression.

Psychotherapy.

Supportive psychotherapy is also used in an inpatient or outpatient setting by a trained professional that focuses on areas such as coping skills, improvement of social skills and social interactions, communication, and self-esteem issues. People with SPD may also have a perceptual tendency to miss subtle differences. That causes an inability to pick up hints from the environment because social cues from others that might normally provoke an emotional response are not perceived. That, in turn, limits their own emotional experience. The perception of varied events only increases their fear for intimacy and limits them in their interpersonal relationships. Their aloofness may limit their opportunities to refine the social skills and behavior necessary to effectively pursue relationships.

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