3. Schizoid personality disorder

Schizoid Personality Disorder is characterized by a long-standing pattern of detachment from social relationships. A person with schizoid personality disorder often has difficulty expression 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.”

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.

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Symptoms of Schizoid Personality Disorder

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 affect (emotion)

Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.

Schizoid personality disorder is more prevalent in males than females. Its prevalence in the general population is between 3.1 and 4.9 percent.

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 schizoid personality disorder.

Many people with 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 for  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.

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.

Treatment of Schizoid Personality Disorder

Treatment of schizoid personality disorder  typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please seeschizoid personality disorder treatment.

Schizoid Personality Disorder

What Are Personality Disorders?

People with personality disorders have long-standing patterns of thinking and acting that differ from what society considers usual or normal. The inflexibility of their personality can cause great distress, and can interfere with many areas of life, including social and work functioning. People with personality disorders generally also have poor coping skills and difficulty forming healthy relationships.

Unlike people with anxiety disorders, who know they have a problem but are unable to control it, people with personality disorders generally are not aware that they have a problem and do not believe they have anything to control. Because they often do not believe they have a disorder, people with personality disorders often do not seek treatment.

What Is Schizoid Personality Disorder?

Schizoid personality disorder is one of a group of conditions called "Cluster 'A' " or eccentric personality disorders. People with these disorders often appear odd or peculiar. People with schizoid personality disorder also tend to be distant, detached, and indifferent to social relationships. They generally are loners who prefer solitary activities and rarely express strong emotion. Although their names sound alike and they might have some similar symptoms, schizoid personality disorder is not the same thing as schizophrenia. Many people with schizoid personality disorder are able to function fairly well, although they tend to choose jobs that allow them to work alone, such as night security officers, library, or lab workers.

What Are the Symptoms of Schizoid Personality Disorder?

People with schizoid personality disorder often are reclusive, organizing their lives to avoid contact with other people. Many never marry or may continue to live with their parents as adults. Other common traits of people with this disorder include the following:

• They do not desire or enjoy close relationships, even with family members.
• They choose solitary jobs and activities.
• They take pleasure in few activities, including sex.
• They have no close friends, except first-degree relatives.
• They have difficulty relating to others.
• They are indifferent to praise or criticism.
• They are aloof and show little emotion.
• They might daydream and/or create vivid fantasies of complex inner lives.

How Common Is Schizoid Personality Disorder?

It is difficult to accurately assess the prevalence of this disorder, because people with schizoid personality disorder rarely seek treatment. Schizoid personality disorder affects men more often than women, and is more common in people who have close relatives withschizophrenia.

Schizoid personality disorder usually begins in late adolescence or early adulthood.

What Causes Schizoid Personality Disorder?

Little is known about the cause of schizoid personality disorder, but both genetics and environment are suspected to play a role. Somemental health professionals speculate that a bleak childhood where warmth and emotion were absent contributes to the development of the disorder. The higher risk for schizoid personality disorder in families of schizophrenics suggests that a genetic susceptibility for the disorder might be inherited.

How Is Schizoid Personality Disorder Diagnosed?

If symptoms of this personality disorder are present, the doctor will begin an evaluation by performing a complete medical history and possible physical exam. Although there are no lab tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder.

How Is Schizoid Personality Disorder Treated?

People with this personality disorder rarely seek treatment, because their thoughts and behavior generally do not cause them distress. When treatment is sought, psychotherapy -- a form of counseling -- is the form of treatment most often used. Treatment likely will focus on increasing general coping skills, as well as on improving social interaction, communication, and self-esteem. Because trust is an important component of therapy, treatment can be challenging for the therapist, because people with schizoid personality disorder have difficulty forming relationships with others.

Medication is generally not used to treat schizoid personality disorder itself. Drugs might, however, be prescribed if the person also suffers from an associated psychological problem, such as depression.

What Are the Complications of Schizoid Personality Disorder?

A lack of social interaction is the main complication of schizoid personality disorder. People with this personality disorder are rarely violent, as they prefer not to interact with people.

What Is the Outlook for People With Schizoid Personality Disorder?

Although some of their behaviors might be odd, people with schizoid personality disorder are generally able to function in everyday life. However, they might not form any meaningful relationships or have families of their own.

Can Schizoid Personality Disorder Be Prevented?

There is no known way to prevent schizoid personality disorder.

Schizoid Personality Disorder

In-depth look at Schizoid Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.

Schizoid personality disorder (SZPD) is one of a group of conditions called eccentric personality disorders. People with these disorders often appear odd or peculiar. People with schizoid personality disorder also tend to be distant, detached, and indifferent to social or close relationships. They generally are loners who prefer solitary activities and rarely express strong emotion. This person's life is marked by little pleasure in activities. People with this disorder appear indifferent to the praise or criticism of others and often seem cold or aloof. People with schizoid personality disorder are rarely violent, as they prefer not to interact with people.

Although the names sound alike and they might have some similar symptoms, schizoid personality disorder is not the same thing as schizophrenia. Many people with schizoid personality disorder can function fairly well. They tend to choose jobs that allow them to work alone, such as night security officers and library or laboratory workers.

It is difficult to accurately assess the prevalence of this disorder because people with schizoid personality disorder rarely seek treatment. Schizoid personality disorder affects men more often than women and is more common in people who have close relatives with schizophrenia. Schizoid personality disorder usually begins in early adulthood.

What are the signs and symptoms of Schizoid Personality Disorder?

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People with schizoid personality disorder often are reclusive, organizing their lives to avoid contact with other people. Many never marry and continue to live with their parents as adults. They talk little, are given to daydreaming, and prefer theoretical speculation to practical action. Fantasizing is a common coping (defense) mechanism. The following are additional traits of people with this disorder

• They do not desire or enjoy close relationships, even with family members.
• They choose solitary jobs and activities.
• They take pleasure in few activities, including sex.
• They have no close friends, except first-degree relatives.
• They have difficulty relating to others.
• They are indifferent to praise or criticism.
• They are aloof and show little emotion.
• They might daydream and/or create vivid fantasies of complex inner lives.

DSM IV Criteria for Schizoid Personality Disorder

A pervasive 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

Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition. Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizoid Personality Disorder (Premorbid)."

What causes someone to develop Schizoid Personality Disorder?

Little is known about the cause of schizoid personality disorder, but both genetics and environment are suspected to play a role. Some mental health professionals speculate that a bleak childhood where warmth and emotion were absent contributes to the development of the disorder. The higher risk for schizoid personality disorder in families of schizophrenics suggests that a genetic susceptibility for the disorder might be inherited.

What are the risk factors linked to Schizoid Personality Disorder?

It is likely that a sustained history of isolation during infancy and childhood with encouragement and modeling of interpersonal withdrawal, indifference, and detachment by parental figures contributes to the development of schizoid personality traits.

How is Schizoid Personality Disorder diagnosed?

There are no laboratory tests for schizoid personality disorder, and diagnosis usually comes after a thorough clinical interview. During this interview, the doctor will ask questions about symptoms and mental well-being, and take a medical, psychiatric and social history. A physical examination can help rule out other conditions, and a mental health professional will likely be consulted for further evaluation.

In order for someone to receive a diagnosis of schizoid personality disorder, he or she must meet at least four 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 sexual experiences with another person
• Takes pleasure in few, if any, activities and rarely experiences strong emotions
• Lacks close friends or confidantes other than first-degree relatives
• Appears indifferent to praise or criticism
• Shows emotional coldness, detachment or flattened emotions

In addition, the symptoms must not occur exclusively during a bout of schizophrenia, a mood disorder with psychotic features, another psychotic disorder or a pervasive developmental disorder (such as autism or Asperger's syndrome). Also, a diagnosis of schizoid personality disorder may not be

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appropriate should symptoms be due to the direct physiological effects of a general medical condition.

Further complicating a diagnosis is that the symptoms of schizoid personality may resemble autism or Asperger's syndrome.

How is Schizoid Personality Disorder treated?

Persons with Schizoid Personality Disorder (SZPD) rarely present for treatment, whether it is for their schizoid traits or a co-existing Axis I disorder. They feel little need for treatment, as their isolation is often ego-syntonic (compatible with their ego). Their social isolation is of more concern to their relatives, colleagues, or friends than to themselves.

If persons with SZPD are seen for treatment for a concomitant Axis I disorder (e.g., a sexual arousal disorder or a substance dependence), it is advisable to work within the confines and limitations of the schizoid personality traits.

It is also important not to presume that persons with SZPD are simply inhibited, shy, or insecure. Such persons are more appropriately diagnosed with Avoidant Personality Disorder.

When they do come into treatment, a person with schizoid personality disorder can have trouble communicating with a therapist and react in a bland, detached manner. However, when a doctor shows respect for their personal space and private thoughts, people with a schizoid personality can respond effectively to treatment.

Schizoid personality disorder is generally treated with psychotherapy. Types of psychotherapy vary, ranging from psychodynamic therapy to group therapy. Since personality disorders cause distorted thought patterns, cognitive-behavioral therapy is often particularly effective in helping individuals adjust their thinking and behavior patterns.

One may not be able to increase the desire for social involvements but one can increase the ability to relate to, communicate with, and get along with others. Persons with SZPD may not want to develop intimate relationships but they often want to interact and relate more effectively and comfortably with others. Role-playing and videotaped interactions can at times be useful in this respect. Group therapy is often useful as a setting in which patients can gradually develop self-disclosure, experience the interest of others, and practice social interactions with immediate and supportive feedback.

There's no specific drug treatment for schizoid personality. Medications are sometimes utilized in combination with psychotherapy. Drugs such as antidepressants, anti-psychotics, and anti-anxiety medications are commonly used to alleviate the associated symptoms of depression and anxiety. For example, the psychological inability to experience pleasure can be treated withbupropion (Wellbutrin). Risperidone (Risperidal) or Olanzapine (Zyprexa) can help with flattened emotions and social problems.

Medications are best used in combination with some form of psychotherapy and are not recommended as a sole treatment for personality disorders.

Sources:

• American Psychiatric Association pamphlet on Personality Disorders
• American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC.
• NIMH
• Wikipedia: Schizoid Personality Disorder

Schizoid personality disorder

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Schizoid personality disorder is a mental health condition in which a person has a lifelong pattern of indifference to others and social isolation.

Causes

Cause of schizoid personality disorder is unknown. This disorder may be related to schizophrenia and shares many of the same risk factors.

Schizoid personality disorder is generally not as disabling as schizophrenia. It does not cause the disconnection from reality (in the form of hallucinations or delusions) that occurs in untreated (or treatment-resistant) schizophrenia.

Symptoms

A person with schizoid personality disorder often:

• Appears aloof and detached
• Avoids social activities that involve emotional intimacy with other people
• Does not want or enjoy close relationships, even with family members

Exams and Tests

Schizoid personality disorder is diagnosed based on a psychological evaluation that assesses the history and severity of the symptoms.

Treatment

People with this disorder rarely seek treatment, thus little is known about which treatments work. Talk therapy may not be effective because persons with schizoid personality disorder may have great difficulty forming an effective working relationship with a therapist.

One approach that appears to help is to put fewer demands for emotional closeness or intimacy on the person with this condition.

People with schizoid personality disorder often do well in relationships that do not focus on emotional closeness. They tend to be better at handling relationships that focus on work or intellectual activities and expectations.

Outlook (Prognosis)

Schizoid personality disorder is a long-term (chronic) illness that usually does not improve much over time. Social isolation often prevents the person from seeking the help or support that might improve the condition.

Limiting expectations of emotional intimacy may help people with this condition make and keep connections with other people.

Alternative Names

Personality disorder - schizoid

References

Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psyhchiatry. 1st ed. Philadelphia, PA: Elsevier Mosby; 2008:chap 39.

Update Date: 11/10/2012

Updated by: David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

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