Internet Mental Health
 
SCHIZOID PERSONALITY DISORDER
 

Prediction: Lifelong Duration

      Occupational-Economic:
  • Works poorly with others (works best under conditions of social isolation; indifferent to praise or criticism)
      Social:
  • Detachment (social withdrawal; intimacy avoidance; inability to feel pleasure; restricted emotional expression)
      Medical:
  • Normal

SYNOPSIS

Schizoid Personality Disorder F60.1 - ICD10 Description, World Health Organization

Schizoid personality disorder is characterized by withdrawal from affectional, social and other contacts with preference for fantasy, solitary activities, and introspection. There is a limited capacity to express feelings and to experience pleasure.
Schizoid Personality Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with schizoid personality disorder needs to show at least 4 of the following criteria:

  • 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.
Like all personality disorders, schizoid personality disorder is a deeply ingrained and enduring behaviour pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behaviour pattern tends to be stable. It causes subjective distress and problems in social performance.

Core Features

Individuals with schizoid personality disorder grow up being socially and emotionally withdrawn. The core feature of this disorder is detachment (social withdrawal; intimacy avoidance; inability to feel pleasure; restricted emotional expression). This disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. This disorder should not be diagnosed if this social and emotional withdrawal occurs exclusively during the course of a psychotic disorder, autism, or if it is attributable to the physiological effects of another medical condition (e.g., temporal lobe epilepsy).

Lack Of Social Skills And Personality Disorders

There are certain social skills that are essential for healthy social functioning. Individuals with schizoid personality disorder lack the essential social skills of intimacy, sociability, and emotional expressiveness.

    Social Skills That Are Lacking In Schizoid Personality Disorder

    SOCIAL SKILL LOW LEVEL HIGH LEVEL
    Intimacy Intimacy avoidance Wanting close friendships or intimate romantic relationships
    Sociability Social withdrawal Friendly; interested in social contacts and activities
    Emotional Expressiveness Lack of emotional expression Open expression of emotions; full range of emotions

Paranoid, schizoid, and schizotypal personality disorder are so closely related that they are referred to as the "detached" cluster of personality disorders.

    Social Skills That Are Lacking In The "Detached" Cluster Of Personality Disorders

    PERSONALITY DISORDER LACKING LACKING LACKING
    Paranoid Personality Trust (instead has suspiciousness) Forgiveness (instead has bearing grudges) Gratitude (instead has feeling victimized)
    Schizoid Personality Intimacy (instead has intimacy avoidance) Sociability (instead has social withdrawal) Emotional expressiveness (instead has lack of emotional expression)
    Schizotypal Personality Normal Behavior (instead has eccentricity) Normal Beliefs (instead has odd beliefs) Normal Perception (instead has perceptual distortions)

Social Functioning

Individuals with schizoid personality disorder often appear to be socially isolated and almost always choose solitary activities or hobbies. They have little interest in having sex with another person. They seem indifferent to the praise or criticism of others. They often seem socially inept or superficial and self-absorbed.

Schizoid Traits

Individuals with schizoid personality disorder display a restricted range of emotions, and rarely experience strong emotions such as anger or joy. They rarely reciprocate gestures or facial expressions, such nods or smiles. They appear cold and aloof.

Ineffective Therapies

The effectiveness of treatment for schizoid personality disorder is unknown because there are no randomized controlled trials. Individuals with this disorder seldom voluntarily present for treatment. Most therapists believe that this disorder is very difficult to treat. Thus a trusting relationship with primary care physician who accepts the individual's emotional detachment is probably the best therapy.

Which Behavioral Dimension Is Involved?

The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: courage, helping others (service), justice, moderation, and wisdom. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., negative emotions, detachment, antagonism, disinhibition and irrationality).

    Core Dimension: Detachment
    •       Courage vs negative emotions: [n/a]
    •       Helping others vs detachment::
      • social withdrawal; intimacy avoidance; inability to feel pleasure; restricted emotional expression
    •       Justice vs antagonism: [n/a]
    •       Moderation vs disinhibition: [n/a]
    •       Wisdom vs irrationality: [n/a]

Prevalence

The prevalence of schizoid personality disorder is 3.1%-4.9% of the general population. This disorder occurs slightly more commonly in males.

Course

Schizoid personality disorder may be first apparent in childhood and adolescence with solitariness, poor peer relationships, and underachievement in school, which may attract teasing from their peers. The course of this disorder is chronic.

Familial Pattern

Schizoid personality disorder is more common among biological relatives of those with schizophrenia or schizotypal personality disorder.

Complications

The lives of individuals with schizoid personality disorder sometimes seem directionless, and they appear to drift in their goals. These individuals often react passively to adversity and have difficulty responding appropriately to important life events.

Comorbidity

Some other disorders frequently occur with this disorder:

    Non-Personality Disorders:

            Schizophrenia Spectrum and Other Psychotic Disorders:
      • This disorder may be a premorbid antecendent of a psychotic disorder. In response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). If the psychotic episode lasts longer, this disorder may actually develop into delusional disorder or schizophrenia.
            Depressive Disorders:
      • Major depressive disorder.

    Personality Disorders:

            Negative Emotion Cluster:
      • Avoidant personality disorder.
            Detached Cluster:
      • Paranoid, schizotypal personality disorders.
        Note: Paranoid, schizoid, and schizotypal personality disorders are all closely related since they all share the same core feature of detachment. If an individual has one of these detached personality disorders, they are very likely to have another.

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Primate Evolution

There appears to be three different ways in which primates have evolved socially:
  • The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative. Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of the antisocial-narcissistic-borderline-histrionic cluster of personality disorders.

  • In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus bonobo social behavior most closely mirrors the negative emotion (anxious) behavior of the avoidant-dependent cluster of personality disorders.

  • Another separate evolutionary path was followed by the orangutans. They evolved to become solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the paranoid-schizoid-schizotypal cluster of personality disorders.

Core Behaviors Of The Detached Cluster Of Personality Disorders

Religious Hermit

History is filled with thousands of stories of religious hermits who withdrew to a solitary place for a life of religious seclusion.

The core feature of the paranoid-schizoid-schizotypal cluster of personality disorders is detachment. Individuals with these disorders are socially and emotionally withdrawn; thus prefer a solitary life.

    Detachment: The Core Feature Of The Detached Cluster Of Personality Disorders

    • suspiciousness:
      In the past week, did you suspect that people were exploiting, harming, or deceiving you?
    • social withdrawal:
      In the past week, did you mostly prefer to be alone?
    • intimacy avoidance:
      In the past week, did you avoid close friendships (outside of your family) or romantic relationships?
    • inability to feel pleasure:
      In the past week, did few things in life give you pleasure?
    • restricted emotional expression:
      In the past week, did you seldom smile or show much emotion?

Setting Goals In Therapy

    Questions To Ask When Setting Goals

    In The Past Week:
    • WHO: was your problem?
    • EVENT: what did he/she do?
    • RESPONSE: how did you respond to that event?
    • OUTCOME: did your response help?
    • TRIGGER: what did you do that could have triggered this problem?
    • GOAL: what life skill(s) do you have to work on? (from checklist)

    Example Of Setting Goals In Interviewing A Person With Schizoid Personality Disorder

    In The Past Week:
    • WHO: was your problem?
      "My female neighbors."

    • EVENT: what did he/she do?
      "These neighbors always want to talk to me, or sit next to me when I go out for coffee."

    • RESPONSE: how did you respond to that event?
      "I try to avoid these neighbors, but we live in a small apartment where this is almost impossible."

    • OUTCOME: did your response help?
      "No. These women still are very talkative and want to socialize whenever we meet."

    • TRIGGER: what did you do that could have triggered this problem?
      "Ever since I was discharged from hospital, my neighbors have been keeping in closer contact with me. I guess they are trying to help me."

    • GOAL: what life skill(s) do you have to work on? (from checklist)
      "I want to work on: (1) Sociability ("being friendly; interested in social contacts and activities"), and (2) Gratitude ("being thankful for the good things in life; expressing thanks to others")."

Description

Lecture On Schizoid Personality Disorder

Stories

Free Diagnosis Of This Disorder

Rating Scales


Treatment

Research

Other Web Pages
Internet Mental Health © 1995-2011 Phillip W. Long, M.D.