Index
Often abbreviated as SPD or SzPD, it is a personality disorder characterized by a lack of interest in social relationships.
As well as a tendency towards a solitary or sheltered lifestyle, secrecy , emotional coldness, detachment and apathy.
Affected individuals may be unable to form intimate bonds with others while simultaneously displaying a rich, elaborate, and exclusively internal fantasy world.
Schizoid personality disorder is not the same as schizophrenia or schizotypal personality disorder
But there is some evidence of links and shared genetic risk between schizoid personality disorder, other group A personality disorders, and schizophrenia.
Therefore, schizoid personality disorder is considered a “schizophrenia-like personality disorder.”
Critics argue that the definition of schizoid personality disorder is flawed due to cultural bias and that it does not constitute a mental disorder but simply an avoidant attachment style that requires more distant emotional proximity.
If that’s true, then many of the more troublesome reactions these people display in social situations can be partly explained by the judgments commonly imposed on people with this style.
However, it is important to note that impairment is mandatory for any behavior to be diagnosed as a personality disorder.
Schizoid personality disorder appears to meet this criterion because it is associated with negative outcomes.
These include a significantly compromised quality of life, lower scores on the Global Assessment of Functioning (GAF) even after 15 years, and one of the lowest levels of ‘success in life’ of all. personality disorders (measured as “status, wealth, and successful relationships”).
Schizoid personality disorder is a poorly studied disorder, and there is little clinical data on schizoid personality disorder, as it is rarely found in clinical settings.
The effectiveness of psychotherapeutic and pharmacological treatments for the disorder has yet to be empirically and systematically investigated.
Signs and symptoms of schizoid disorder
People with schizoid personality disorder are often distant, cold, and indifferent, causing interpersonal difficulty.
Most people diagnosed with schizoid personality disorder have trouble establishing personal relationships or expressing their feelings in a meaningful way.
They can remain passive in the face of unfavorable situations. Your communication with other people can be nonchalant and concise at times.
Due to their lack of meaningful communication with other people, those who are diagnosed with schizoid personality disorder are unable to develop accurate impressions of how well they get along with others.
Schizoid personality types are challenged to achieve self-awareness and the ability to evaluate the impact of their own actions in social situations.
Ronald Laing suggests that when injections of interpersonal reality fail to enrich an individual, their self-image empties and volatilizes, making the individual feel unreal.
When someone violates the personal space of an individual with schizoid personality disorder, they suffocate them and they must free themselves to be independent.
People with schizoid personality disorder tend to be happier when they are in relationships where their partner places few emotional or intimate demands on them.
They are not people who want to avoid, but negative and positive emotions, emotional intimacy, and self-disclosure.
Therefore, it is possible for people with schizoid personality disorder to form relationships with other people through intellectual, physical, family, occupational, or recreational activities, as long as there is no need for emotional intimacy.
Donald Winnicott explains that this is because schizoid individuals “prefer to establish relationships on their own terms and not in terms of other people’s impulses.” Failing to do that, they prefer isolation.
Although there is a belief that people with Schizoid Personality Disorder are complacent and unaware of their feelings, many acknowledge their differences from others.
Some people with schizoid personality disorder who are in treatment say that “life is over them” or feels like living inside a shell; they see themselves as “missing the bus” and complain of observing life from a distance.
Aaron Beck and his colleagues report that people with schizoid personality disorder appear to be comfortable with their distant lifestyle and consider themselves observers, rather than participants, in the world around them.
But they also mention that many of their schizoid patients recognize themselves as socially deviant (or even defective) when faced with the different lives of ordinary people, especially when reading books or watching relationship-focused movies.
Even when schizoid individuals do not long for closeness, they may tire of being “outside, looking in.”
These feelings can lead to depression or depersonalization. If they do, schizoid people often experience feeling “like a robot” or “going through life in a dream.”
It is speculated that schizoid personality disorder may have links to creativity.
Phenomenology
The ‘secret schizoid’
Many schizoid individuals exhibit an attractive and interactive personality that contradicts the observable characteristic emphasized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
And the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) of the schizoid personality.
Klein classifies these people as “secret schizoids,” who behave with socially available, interested, engaged, and involved interaction, but remain emotionally withdrawn and abducted within the safety of the inner world.
Often times, the social functioning of a schizoid individual improves, sometimes dramatically, when the individual knows that he or she is an anonymous participant in a conversation or correspondence, such as in an online chat room or message board.
In fact, it is often the case that the individual’s online correspondent does not report anything wrong with the individual’s commitment and effect.
Withdrawal or detachment from the outside world is a characteristic feature of schizoid pathology, but it can appear “classically” or “secretly.”
When it is classic, it matches the typical description of the schizoid personality offered in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
It is “just as often” a hidden internal state: what meets the objective eye may not coincide with the subjective internal world of the patient.
Klein cautions that the identification of the schizoid person should not be lost because one cannot see the withdrawal of the person through the compensatory and defensive interaction of the patient with external reality.
He suggests that one ask the person what their subjective experience is to detect the presence of the schizoid rejection of emotional intimacy.
Descriptions of the schizoid personality as “hidden” behind an outward appearance of emotional commitment have been recognized since the 1940’s with Fairbairn’s description of “schizoid exhibitionism.”
In which the schizoid individual is able to express a host of feelings and make it appear to be impressive social contacts, but in reality he gives nothing and loses nothing.
Because he or she is “playing a role,” his or her personality is not involved. According to Fairbairn, the person rejects the part he is playing and the schizoid individual seeks to preserve his personality intact and immune to compromise.
Other references to the secret schizoid come from Masud Khan, Jeffrey Seinfeld, and Philip Manfield:
They describe an individual with schizoid personality disorder who “enjoys” speaking in public but experiences great difficulty in breaks when audience members try to get him emotionally involved.
These references expose the problems in relying on observable external behavior to assess the presence of personality disorders in certain individuals.
Schizoid fantasy
The pathological dependence on fantasizing and preoccupation with inner experience is often part of schizoid withdrawal from the world.
Fantasy thus becomes a central component of the self in exile, although fantasizing about schizoid individuals is much more complicated than a means of facilitating withdrawal.
Fantasy is also a relationship with the world and with others by proxy. It is a surrogate relationship, but a relationship nonetheless characterized by idealized, defensive, and compensatory mechanisms.
This is self-contained and free from the dangers and anxieties associated with emotional connection with real people and situations. Klein explains it as:
«An expression of oneself that struggles to connect to objects, although internal objects. Fantasy allows schizoid patients to feel connected, yet still free from imprisonment in relationships. In short, in fantasy you can link (to objects) and still be free. ‘
This aspect of schizoid pathology has been generously elaborated in the works of Laing, Winnicott, and Klein.
Schizoid sexuality
People with schizoid personality disorder are sometimes sexually apathetic, although they do not normally suffer from anorgasmia.
Your preference for being alone and distant can make your need for sex appear less than that of those without schizoid personality disorder.
Sex often makes people with schizoid personality disorder feel like their personal space is being violated, and they commonly feel that masturbation or sexual abstinence is preferable to the emotional closeness they must tolerate when having sex.
Significantly expanding this picture are notable exceptions of individuals with schizoid personality disorder who engage in occasional or even frequent sexual activities with others.
Harry Guntrip describes the “secret sexual relationship” that some married schizoid individuals entered into as an attempt to reduce the amount of emotional intimacy focused on a single relationship.
A sentiment that echoed Karen Horney’s “resigned personality” that can exclude sex such as:
Too intimate for a permanent relationship, instead satisfying her sexual needs with a stranger. On the contrary, it can more or less restrict a relationship to merely sexual contacts and not share other experiences with the partner.
Jeffrey Seinfeld, a professor of social work at New York University, has published a volume on schizoid personality disorder that details examples of “schizoid hunger” that can manifest as sexual promiscuity.
Seinfeld provides an example of a schizoid woman who would secretly go to various bars to meet men for the purpose of impersonal sexual gratification, an act that relieved her feelings of hunger and emptiness.
Salman Akhtar describes this dynamic interplay of overt and covert sexuality and the motivations of some individuals with schizoid personality disorder more precisely.
Rather than following the strict proposition that schizoid individuals are sexual or asexual, Akhtar suggests that these forces may be present in an individual despite their rather contradictory goals.
Therefore, a clinically accurate picture of schizoid sexuality must include the overt signs:
“Asexual, sometimes celibate, free from romantic interests, averse to gossip and sexual innuendo,” as well as possible covert manifestations of “secret voyeuristic and pornographic interests; vulnerable to erotomania “and tendency to perversions”.
Although none of these necessarily apply to everyone with schizoid personality disorder.
Millon subtypes
Theodore Millon restricted the term “schizoid” to those personalities who lack the ability to form social relationships.
He characterizes his thinking as vague and thoughtless and as sometimes having “faulty perceptual scanning.” Because of this, some people with Schizoid Personality Disorder may be prone to overlooking the fine details of life.
For Millon, schizoid personality disorder is distinguished from other personality disorders in that it is “the personality disorder lacking personality.”
He criticizes that this may be due to current diagnostic criteria: they describe schizoid personality disorder only by the absence of certain traits that result in a “deficit syndrome” or “void.”
Instead of delineating the presence of something, they only mention what is missing. Therefore, it is difficult to describe and investigate such a concept.
He identified four subtypes of schizoid personality disorder. Any individual schizoid can exhibit none or one of the following:
Subtype
Languid schizoid (including depressive features).
features
Marked inertia; poor activation level; intrinsically phlegmatic, lethargic, tired, leaden, indolent, exhausted, weakened.
Unable to act spontaneously or seek simpler pleasures, they may experience deep anguish, but lack the vitality to express it forcefully.
Subtype
Remote schizoid (including schizotypal and avoidant features).
features
Distant and removed; inaccessible, lonely, isolated, homeless, disconnected, isolated, aimlessly adrift; peripherally busy.
Seen among people who otherwise would have been able to lead a normal emotional life but who have been subjected to intense hostility, they lost their innate ability to bond.
Some residual anxiety is present. Often seen among the homeless; many depend on public support.
Subtype
Depersonalized schizoid (including schizotypal features).
features
Detached from others and from oneself; the self is a disembodied or distant object; body and mind separated, split, dissociated, separated, eliminated.
They are often seen as simply staring into empty space or being occupied with something substantial while in reality they are occupied with nothing at all.
Subtype
Schizoid without affections (including compulsive characteristics).
features
Without passion, indifferent, little affectionate, cold, indifferent, indifferent, without spirit, mediocre, unquenchable, imperturbable, cold; all emotions subsided.
Combine the preference for the rigid schedule (obsessive-compulsive characteristic) with the coldness of the schizoid.
Akhtar’s profile
Salman Akhtar (a psychiatrist) provided a comprehensive phenomenological profile of schizoid personality disorder in which classical and contemporary descriptive views are synthesized with psychoanalytic observations.
This profile is summarized in the table reproduced below, which lists the clinical features that involve six areas of psychosocial functioning and are organized by “overt” and “covert” manifestations.
“Overt” and “covert” are not thought of as different subtypes but as traits that can be present simultaneously in a single individual.
Dr. Akhtar states that:
“These designations do not imply consciousness or unconsciousness but rather denote apparently contradictory aspects that are phenomenologically more or less easily discernible” and that “this way of organizing symptomatology emphasizes the centrality of division and identity confusion in the schizoid personality.”
In 2013, Akhtar provided a clinical case study of a schizoid man as an illustration of his phenomenological profile.
Clinical Features of Schizoid Personality Disorder
Zone
Selfconcept.
Open Features
- Obedient.
- Stoic.
- Not competitive.
- Self-sufficient.
- No assertiveness.
- Feeling inferior and a stranger in life.
Covert functions
- Cynical.
- Inauthentic.
- Depersonalized.
- Alternatively it feels empty, robot-like, and full of omnipotent and vengeful fantasies.
- Hidden grandeur.
Zone
Relationships.
Open Features
- Retired.
- From distance.
- Have few close friends.
- Impervious to the emotions of others.
- Fear of privacy.
Covert functions
- Exquisitely sensitive.
- Deeply curious about others.
- Hunger for love
- Envy of the spontaneity of others.
- Badly in need of getting involved with others.
- Capable of emotion with carefully selected intimates.
Zone
Social adaptation.
Open Features
- Prefers solitary occupational and recreational activities.
- Marginal or eclectically sociable in groups.
- Vulnerable to esoteric movements due to a strong need to belong.
- They tend to be lazy and indolent.
Covert functions
- Lack of clarity of objectives.
- Weak ethnic affiliation.
- Generally capable of stable work.
- Quite creative and can make unique and original contributions.
- Capable of passionate resistance in certain spheres of interest.
Zone
Love and sexuality.
Open Features
- Asexual, sometimes celibate.
- Free of romantic interests.
- Reluctant to sexual gossip and innuendo.
Covert functions
- Secret voyeuristic interests.
- Vulnerable to erotomania.
- Tendency towards compulsive perversions.
Zone
Ethics, standards and ideals.
Open Features
- Idiosyncratic moral and political beliefs.
- Tendency towards spiritual, mystical and parapsychological interests.
Covert functions
- Moral inequality.
- Occasionally surprisingly amoral and vulnerable to strange crimes, at other times selflessly selfless.
Zone
Cognitive style.
Open Features
- Clueless
- Absorbed in fantasy.
- Vague and forced speech.
- Alternations between eloquence and inarticulation.
Covert functions
- Autistic thinking.
- Fluctuations between acute contact with external reality and hyper-reflection on the self.
- Autocentric use of language.
Causes of schizoid disorder
Some evidence suggests that Group A personality disorders have shared genetic and environmental risk factors, and there is a higher prevalence of schizoid personality disorder in relatives of people with schizophrenia and schizotypal personality disorder.
Twin studies with schizoid personality disorder traits (eg, low sociability and low warmth) suggest that these are inherited.
In addition to this indirect evidence, estimates of direct heritability for schizoid personality disorder range from 50% to 59%.
For Sula Wolff, who conducted extensive research and clinical work with children and adolescents with schizoid symptoms, “the schizoid personality has a constitutional basis, probably genetic.”
The link between schizoid personality disorder and underweight may also indicate the involvement of biological factors.
In general, prenatal caloric malnutrition, premature birth and low birth weight are risk factors for being affected by mental disorders and can also contribute to the development of schizoid personality disorder.
Those who have experienced traumatic brain injury may also be at risk for developing characteristics that reflect schizoid personality disorder.
Other researchers had hypothesized that overly perfectionistic, heartless, or neglectful parenting might play a role.
Diagnosis of schizoid disorder
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
The Diagnostic and Statistical Manual of Mental Disorders is a widely used manual for diagnosing mental disorders.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) still includes schizoid personality disorder with the same criteria as in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning in early adulthood and occurring in a variety of contexts, as indicated by at least four of the following:
- You neither want nor enjoy a close relationship, which includes being part of a family.
- He almost always chooses solitary activities.
- You have little, if any, interest in having sexual experiences with another person.
- He indulges in few activities, if any.
- Lacks close friends or confidants other than first-degree relatives.
- Appears indifferent to praise or criticism from others.
- Shows emotional coldness, detachment, or crushed affectivity.
According to the Diagnostic and Statistical Manual of Mental Disorders, people with schizoid personality disorder can often be incapable or rarely express aggressiveness or hostility, even when directly provoked.
These people may seem lazy or drifting about their goals and their lives may seem without direction. Others see them as indecisive in their actions, self-absorbed, distracted, and cut off from their surroundings (“not with him” or “in a fog”).
Excessive daydreaming is often present. In cases with severe defects in the ability to form social relationships, dating and marriage may not be possible.
Criteria of the International Classification of Statistical Diseases and Related Health Problems, 10th Revision (ICD-10)
The International Statistical Classification of Diseases and Related Health Problems Classification of Mental and Behavioral Disorders, 10th Revision (ICD-10) lists Schizoid Personality Disorder Low (F60.1).
The general criteria for personality disorder (F60) must be met first. Additionally, at least four of the following criteria must be present:
- Few, if any, activities provide pleasure.
- Shows emotional coldness, detachment, or crushed affectivity.
- Limited ability to express warm and tender feelings for others, as well as anger.
- Appears indifferent to praise or criticism from others.
- Little interest in having sexual experiences with another person (considering age).
- He almost always chooses solitary activities.
- Excessive preoccupation with fantasy and introspection.
- You neither want, nor have, close friends or trusted relationships (or just one).
- Marked insensitivity to prevailing social norms and conventions; if they are not followed, this is not intentional.
Guntrip criteria
Ralph Klein, Clinical Director of the Masterson Institute, outlines the following nine characteristics of the schizoid personality described by Harry Guntrip:
Criteria for the schizoid personality
- Introversion.
- Retirement.
- Narcissism.
- Self-sufficiency.
- A sense of superiority.
- Loss of affection.
- Soledad.
- Depersonalization.
- Regression.
Guntrip’s description of the nine characteristics should clarify some differences between the traditional portrait of Schizoid Personality Disorder and the traditional view of object relations.
The nine characteristics are consistent. Most, if not all, must be present to diagnose a schizoid disorder.
More details on each of the characteristics can be found in the article Harry Guntrip (Psychologist).
Controversy
The original concept of the schizoid character developed by Ernst Kretschmer comprised an amalgam of schizoid, schizotypal, and schizoid traits.
It was not until 1980 and the work of Theodore Millon that led to dividing the schizoid character into three personality disorders (now schizoid, schizotypal, and avoidant).
Since then, there has been a debate as to whether that is correct or whether these traits are different expressions of a single personality disorder.
It has also been suggested that two different disorders may better represent schizoid personality disorder:
An affective-constrained disorder (belonging to schizotypal personality disorder) and a seclusive disorder (belonging to avoidant personality disorder).
Some have called for the removal of the category of schizoid personality disorder in future editions of the Diagnostic and Statistical Manual of Mental Disorders and the replacement of this by a dimensional model.
Differential diagnosis
While schizoid personality disorder shares several symptoms with other mental disorders, here are some important differentiating characteristics:
Psychological condition
features
People with schizoid personality disorder can also have clinical depression. However, this is not always the case.
Unlike depressed people, people with schizoid personality disorder generally do not consider themselves inferior to others. They can recognize that they are “different.”
Psychological condition
Avoidant Personality Disorder (AvPD).
features
While people with auditory processing disorder avoid social interactions because of anxiety or feelings of inadequacy, people with schizoid personality disorder do so because they are genuinely indifferent to social relationships.
A 1989 study, however, found that “schizoid and avoidant personalities showed equivalent levels of anxiety, depression, and psychotic tendencies compared to psychiatric control patients.”
There also appears to be some shared genetic risk between schizoid personality disorder and avoidant personality disorder.
Various sources to date have confirmed the synonymy of schizoid personality disorder and avoidant attachment style.
However, a distinction must be made that people with schizoid personality disorder do not seek social interactions simply out of lack of interest.
While those with avoidant attachment style may be interested in interacting with others, but without establishing connections of much depth or duration due to having little tolerance for any type of intimacy.
Psychological condition
Other personality disorders.
features
Schizoid and narcissistic personality disorders may appear similar in some respects (for example, both show identity confusion, may lack warmth and spontaneity, avoid deep relationships with intimacy).
Another coincidence observed by Akhtar is intellectual hypertrophy that leads to a lack of rootedness in bodily existence. There are, however, important differences.
The schizoid hides his need for dependency and is rather fatalistic, passive, cynical, overtly bland, or vaguely mysterious. The narcissist is, on the contrary, ambitious and competitive and exploits others for their dependency needs.
There are also parallels between schizoid personality disorder and obsessive-compulsive personality disorder (OCPD), such as detachment, restricted emotional expression, and rigidity.
However, in obsessive-compulsive personality disorder, the ability to develop intimate relationships is generally intact, but deep contacts can be avoided due to discomfort with emotions and devotion to work.
Psychological condition
Asperger syndrome.
features
There may be considerable difficulty in distinguishing Asperger syndrome (AS), sometimes called “childhood schizoid disorder,” from schizoid personality disorder.
But while Asperger syndrome is an autism spectrum disorder, schizoid personality disorder is classified as a “schizophrenia-like” personality disorder.
There is some overlap as some people with autism also qualify for a diagnosis of schizotypal or schizoid personality disorder.
However, one of the hallmarks of schizoid personality disorder is restricted affect and a limited capacity for emotional expression and experience.
People with Asperger’s syndrome are “hypo-mentalizers,” that is, they do not recognize social cues such as verbal innuendo, body language, and gesticulation.
But people with schizophrenia-like personality disorders tend to be “hypermuralizers,” overinterpreting such signals in a generally suspicious way.
Although they may have been socially isolated from infancy onward, most people with schizoid personality disorder displayed well-adjusted social behavior as children, along with apparently normal emotional function.
Schizoid personality disorder also does not involve disturbances in non-verbal communication, such as lack of eye contact, unusual prosody, or a pattern of restricted interests or repetitive behaviors.
Compared with Asperger’s syndrome, schizoid personality disorder is characterized by prominent conduct disorder, better adult adjustment, less severely impaired social interaction, and a slightly higher risk of schizophrenia.
Psychological condition
Simple type schizophrenia.
features
Both simple schizophrenia and schizoid personality disorder share many negative symptoms such as apathy, poor thinking, and flat affect.
Although they may appear almost identical, what sets them apart is usually gravity. Furthermore, schizoid personality disorder is characterized by an unchanged lifelong pattern while simple schizophrenia represents an impairment.
Comorbidity
Some people with schizoid personality characteristics may occasionally experience brief reactive psychosis when under stress.
The personality disorders that most often coincide with schizoid personality disorder are schizotypy, paranoid, and avoidant personality disorder.
The relationship between alexithymia (the inability to identify and describe emotions) and schizoid personality disorder appears to be strong, but they are not the same condition.
Schizoid individuals frequently operate with substance and alcohol abuse and other addictions that serve as substitutes for human relationships. The substitute for a non-human human object serves as a schizoid defense.
Providing examples of how the schizoid individual creates a personal relationship with drugs, Seinfeld tells of one addict who called heroin his “soothing white pet” and of others who referred to crack as his “bad mother” or “boyfriend.”
He explains that “not all addicts name their drug, but there is often a trace of a personal feeling about the relationship.”
The object relations view emphasizes that drug use and alcoholism reinforce the fantasy of union with an internal object, but allow the addict to be indifferent to the world of external objects. Addiction is therefore a schizoid and symbiotic defense.
Sharon Ekleberry suggests that marijuana “may be the most egoistic drug for people with schizoid personality disorder because it allows a separate state of fantasy and distance from others.
It provides a richer internal experience that these people can normally create and reduces an internal sense of emptiness and lack of participation in life.
Also, alcohol, available and safe to obtain, is another obvious drug of choice for these people. Some will use both marijuana and alcohol and it won’t make much sense to give up either. They are likely to use the effect on internal processes in isolation. ‘
Suicide can also be a recurring theme for schizoid people, although they may not attempt it. They may be depressed and dejected when all possible connections have been cut, but as long as there is some relationship or even hope for one, the risk will be low.
The idea of suicide is a driving force against the person’s schizoid defenses. As Klein says:
“For some schizoid patients, their presence is like a faint and barely discernible background noise, and it rarely reaches a level that bursts into consciousness. For others, he is an ominous presence, an emotional sword of Damocles. It is an underlying fear that everyone experiences.
Treatment of schizoid disorder
People with schizoid personality disorder rarely seek treatment for their condition.
This is a problem found in many personality disorders, which prevents many people affected by these conditions from presenting for treatment:
They tend to view their condition as not in conflict with their self-image and abnormal perceptions and behaviors as rational and appropriate.
There is little data on the effectiveness of various treatments in this personality disorder because it is rarely seen in clinical settings. However, those in treatment have the option of medication and therapy.
Medication
There are no medications indicated to directly treat schizoid personality disorder, but certain medications can reduce the symptoms of schizoid personality disorder and treat co-occurring mental disorders.
The symptoms of schizoid personality disorder mirror the negative symptoms of schizophrenia, such as anhedonia, dullness, and low energy.
And schizoid personality disorder is believed to be part of the “schizophrenic spectrum” of disorders, which also includes schizotypal disorders and paranoid personality disorders, and may benefit from medications prescribed for schizophrenia.
Originally, low doses of atypical antipsychotics such as risperidone or olanzapine were used to alleviate social deficits and blunting of affect. However, a recent review concluded that atypical antipsychotics were not effective in treating personality disorders.
In contrast, bupropion substituted amphetamine can be used to treat anhedonia.
Similarly, modafinil may be effective in treating some of the negative symptoms of schizophrenia, which are reflected in the symptoms of schizoid personality disorder, and therefore may also be helpful.
- Lamotrigine.
- Selective serotonin reuptake inhibitors (SSRIs).
- Tricyclic antidepressants (TCAs).
- Monoamine oxidase inhibitors (MAOI).
- Hydroxyzine.
They can help counteract social anxiety in people with schizoid personality disorder if it is present, although social anxiety may not be a primary concern for people with schizoid personality disorder.
However, it is not general practice to treat schizoid personality disorder with medication, other than for the short-term treatment of concurrent acute Axis I conditions (eg, depression).
Psychotherapy
Supportive psychotherapy is also used in a hospital or outpatient setting by a trained professional who focuses on areas such as coping skills, improving social skills and social interactions, communication, and self-esteem issues.
People with schizoid personality disorder may also have a perceptual tendency to miss out on subtle differences.
That causes an inability to pick up clues from the environment because social cues from others that might normally elicit an emotional response are not perceived.
That in turn limits your own emotional experience. The perception of varied events only increases their fear of intimacy and limits them in their interpersonal relationships.
Your distant attitude can limit your opportunities to refine the social skills and behavior necessary to effectively seek relationships.
In addition to psychodynamic therapy, cognitive behavioral therapy (CBT) can be used.
But because cognitive behavioral therapy generally begins with the identification of automatic thoughts, one must be aware of the potential risks that can occur when working with schizoid patients.
People with schizoid personality disorder seem to distinguish themselves from people with other personality disorders because they often report little or no automatic thinking.
That poverty of thought may have to do with your listless lifestyle. But another possible explanation could be the paucity of emotions shown by many schizoids that would also influence their thought patterns.
Socialization groups can help people with schizoid personality disorder. Educational strategies in which people with schizoid personality disorder identify their positive and negative emotions can also be effective.
Such identification helps them learn about their own emotions and the emotions they draw from others and to feel common emotions with other people with whom they relate. This can help people with schizoid personality disorder build empathy with the outside world.
Short term treatment
The concept of “closest commitment” means that the schizoid patient can be encouraged to experience intermediate positions between the extremes of emotional closeness and permanent exile.
The lack of injections of interpersonal reality causes an impoverishment in which the self-image of the schizoid individual becomes increasingly empty and volatilizes and leads the individual to feel unreal.
To create a more adaptive and enriching interaction with others in which one “feels real,” the patient is encouraged to take risks through greater connection, communication, and sharing of ideas, feelings, and actions.
A closer engagement means that while the patient’s vulnerability to anxieties is not overcome, it is modified and managed in a more adaptive way.
Here the therapist repeatedly conveys to the patient that anxiety is inevitable but manageable, without any illusion that vulnerability to anxiety can be permanently dispensed with.
The limiting factor is the point at which the dangers of intimacy become overwhelming and the patient must withdraw again.
Klein suggests that patients should take responsibility for putting themselves at risk and take the initiative to follow treatment suggestions in their personal lives.
It is emphasized that these are the impressions of the therapist and that he or she does not read the patient’s mind or impose an agenda, but simply affirms a position that is an extension of the patient’s therapeutic desire.
Finally, the therapist directs attention to the need to use these actions outside of the therapeutic setting.
Long-term therapy
Klein suggests that “working through” is the second longest level of psychotherapeutic work with schizoid patients.
Your goals are to fundamentally change old ways of feeling and thinking, and free yourself from vulnerability to those emotions associated with old feelings and thoughts.
A new therapeutic “remembering with feeling” operation is needed that is based on DW Winnicott’s concepts of “false self” and “true self.”
The patient must remember when feeling the emergence of his false self through childhood, and remember the conditions and proscriptions that were placed on the freedom of the individual to experience the self in the company of others.
Recalling with feeling ultimately leads the patient to understand that they did not have the opportunity to choose from a selection of possible ways of experiencing the self and of relating to others, and they had few, if any, options other than developing a schizoid stance towards others.
The false self was simply the best way for the patient to experience the predictable repetitive recognition, affirmation, and approval necessary for emotional survival, while avoiding the effects associated with depression by neglect.
If the goal of short-term treatment is for patients to understand that they are not what they appear to be and that they may act differently, then the long-term goal is for patients to understand who and what they are as human beings, what they really are like. and what they actually contain.
The objective of the work is not achieved by the sudden discovery by the patient of a hidden, fully formed, talented and creative self that lives within, but is a process of slow release from the confinement of depression by abandonment to discover a potential.
It is a process of experimentation with the spontaneous and non-reactive elements that can be experienced in relation to others.
Working through depression by abandonment is a complicated, lengthy, and conflictual process that can be an enormously painful experience in terms of what to remember and what to feel.
It involves mourning and mourning the loss of the illusion that the patient had adequate support for the emergence of the real being. There is also a mourning for the loss of an identity, the false self, that the person built and with whom they have negotiated much of their life.
Dismantling the false self requires giving up the only way the patient has known how to interact with others. This interaction was better than not having a stable and organized experience of the self, no matter how false, defensive, or destructive that identity might be.
Dismantling the false self “leaves the real self with the opportunity to turn its potential and possibilities into reality.”
Work brings unique rewards, of which the most important element is the growing awareness that the individual has a fundamental internal need for relationships that can be expressed in a variety of ways.
“Only schizoid patients,” Klein suggests, “who have worked on the depression of abandonment … will ultimately believe that the capacity for relationship and the desire for relationship are intertwined in the fabric of their selves, that they are really part of who they are. patients are and what they contain as human beings. ‘
“This is the sense that ultimately allows the schizoid patient to feel the most intimate sense of being connected with humanity in general, and with another person more personally.”
“For the schizoid patient, this degree of certainty is the most gratifying revelation and a profound new organizer of the experience of the self.”
Development and course
Schizoid personality disorder may first manifest in childhood and adolescence with loneliness, poor peer relationships, and poor performance in school. This can mark these children as different and make them subject to teasing.
Being a personality disorder, which are generally chronic and long-lasting mental conditions, schizoid personality disorder is not expected to improve over time without treatment; however, much is still unknown because it is rarely found in clinical settings.
epidemiology
Schizoid personality disorder is rare in the clinical setting (approximately 2.2%) and occurs more frequently in males. It is rare compared to other personality disorders, with an estimated prevalence of less than one percent of the general population.
Philip Manfield suggests that the “schizoid condition,” which includes the Diagnostic and Statistical Manual of Schizoid, Avoidant, and Schizotypal Mental Disorders, is represented by “up to 40 percent of all personality disorders.”
Manfield adds: “This large discrepancy (of the 10 percent reported by therapists for the condition) is probably due in large part to someone with a schizoid disorder being less likely to seek treatment than someone with other axis II disorders.”
There is also a very high rate of schizoid personality disorder and other group A personality disorders (up to 92%) among the homeless.
A study from the University of Colorado at Colorado Springs that compared personality disorders and Myers-Briggs Type Indicator types found that the disorder had a significant correlation with Introversion (I) and Thinking (P) preferences.
History
The term “schizoid” was coined in 1908 by Eugen Bleuler to designate a human tendency to direct attention towards one’s own inner life and outside the external world, a concept similar to introversion in the sense that it was not seen in terms of psychopathology. .
Bleuler called the exaggeration of this tendency the “schizoid personality.” He described these personalities as “comfortably boring and at the same time sensitive, people narrowly pursuing vague purposes.”
In 1910, August Hoch introduced a very similar concept called the “closed” personality. The characteristics of this were reluctance, exclusivity, shyness and the preference for living in fantasy worlds, among others.
In 1925, the Russian psychiatrist Grunja Sukhareva described a “schizoid psychopathy” in a group of children, which resembles the current schizoid personality disorder and Asperger’s.
About a decade later, Pyotr Gannushkin also included Schizoids and Dreamers in his detailed typology of personality types.
Studies of the schizoid personality have developed along two different paths.
The tradition of “descriptive psychiatry” focuses on overtly observable, behavioral, and descriptive symptoms, and finds its clearest exposition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
The tradition of dynamic psychiatry includes the exploration of covert or unconscious motivations and the character structure elaborated by classical psychoanalysis and object relations theory.
The descriptive tradition began in 1925 with the description of observable schizoid behaviors by Ernst Kretschmer. He organized them into three groups of characteristics:
- Insociability, quiet, reserve, seriousness, eccentricity.
- Shyness, shyness with feelings, sensitivity, nervousness, excitability, love of nature and books.
- Flexibility, kindness, honesty, indifference, silence, cold emotional attitudes.
These characteristics were the precursors of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III), dividing the schizoid character into three different personality disorders: schizotypal, avoidant, and schizoid.
Kretschmer himself, however, did not conceive of separating these behaviors to the point of radical isolation, but considered them simultaneously present as potential variables in schizoid individuals.
For Kretschmer, most schizoids are neither hypersensitive nor cold, but they are hypersensitive and cold “at the same time” in quite different relative proportions, with a tendency to move along these dimensions from one behavior to another.
The second path, that of dynamic psychiatry, began in 1924 with the observations of Eugen Bleuler, who observed that the schizoid person and the schizoid pathology were not things that should be separated.
Ronald Fairbairn’s seminal work on the schizoid personality, from which most of what is known today about schizoid phenomena is derived, was presented in 1940. Here Fairbairn outlined four central schizoid themes:
- The need to regulate interpersonal distance as a central focus of concern.
- The ability to mobilize self-protective defenses and self-reliance.
- A general tension between the anxiety-laden need for attachment and the defensive need for distance that manifests itself in observable behavior as indifference.
- An overvaluation of the inner world at the expense of the outer world.
Following Fairbairn, the dynamic tradition of psychiatry has continued to produce rich explorations of the schizoid character, especially from writers:
Nannarello (1953), Laing (1965), Winnicott (1965), Guntrip (1969), Khan (1974), Akhtar (1987), Seinfeld (1991), Manfield (1992) y Klein (1995).
