Schizoid personality disorder

Schizoid personality disorder (SPD) is a cluster A personality disorder characterised by a lack of interest in social relationships, a tendency towards a solitary lifestyle, and emotional coldness. SPD is reasonably rare compared with other personality disorders. Its prevalence is estimated at less than 1% of the general population.

Diagnostic criteria (ICD-10)

According to the ICD-10, schizoid personality disorder is characterised by at least three of the following criteria:

Emotional coldness, detachment or reduced affectivity.
Limited capacity to express either positive or negative emotions towards others.
Consistent preference for solitary activities.
Very few (if any) close friends or relationships, and a lack of desire for such.
Indifference to either praise or criticism.
Taking pleasure in few, if any, activities.
Indifference to social norms and conventions.
Preoccupation with fantasy and introspection.
Lack of desire for sexual experiences with another person.

Diagnostic criteria (DSM-IV-TR)

The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines schizoid personality disorder as:

A. 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

B. 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.

Mnemonic

A mnemonic that can be used to remember the criteria for schizoid personality disorder is SOLITARY.

S – shows emotional coldness
O – omits close relationships
L – lacks close friends or confidants
I – involves in solitary activities
T – takes pleasure in few activities
A – appears indifferent to the praise or criticism
R – restricted interest in sexual experiences
Y – yanks himself or herself from social relationships

Status of SPD as a mental disorder

It is disputed whether SPD should be considered a "disorder" at all, since it does not necessarily involve any suffering either for the affected individual or for others. Many people are critical of society's tendency to pathologise certain personality styles simply because they are unconventional. In their opinion, such a tendency is incompatible with the idea that an individual may choose any lifestyle that he or she desires, as long as it does not disrupt the social order. Others think that, in some cases, strong SPD symptoms may result in an affected person living a dull and unfulfilling life. They think that this is a sufficient argument for maintaining SPD as a personality disorder. Some argue that a strong differentiation should be made between Schizoid Personality Type and Schizoid Personality Disorder, the former being merely a pattern of or trend toward elective solitude, and the latter being a genuine and literal lack of ability to become socially engaged, the degree of which would ordinarily indicate a developmental disorder if the accompanying social skills were also retarded in that way.

Self image

People with SPD are loners who prefer independence, solitude, and detachment. They are also comfortable with the fact that they have an inability for extraversion. Although they experience little anxiety, they can still see the difference between them and the rest of the world. One patient with SPD has commented that he could fully enjoy the life he has because he feels that he is living in a shell. Furthermore, he notes that this distresses his wife. According to Beck and Freeman, patients with schizoid personality disorders consider themselves to be “observers rather than participants in the world around them.”

Relationships with others

People with SPD are seen as aloof, cold and indifferent, which causes some social problems. Most diagnosed with SPD have difficulty establishing personal relationships or expressing their feelings in a meaningful way, and may remain passive in the face of unfavourable situations. Their communication with other people is often at times, indifferent and concise. Because of the lack of communication with other people, those who are diagnosed with SPD are not able to have a reflection of themselves and how well they get along with others. The reflection is important so they can be more aware of themselves and their own actions in social surroundings.

People with SPD are sometimes sexually apathetic, though they do not normally suffer from anorgasmia. Many schizoids have a normal sex drive and prefer to masturbate using pornography rather than deal with the social aspects of finding a sexual partner. Therefore, their need for sex may appear not be as great as it is for non schizoids, instead prefering to remain alone and detached. When having sex, they would feel that their own personal space is being violated and commonly feel that masturbation or abstinence are preferable to the closeness they experience when having sex.

According to Gunderson, people with SPD “feel lost” without the people they are normally around because they need a sense of security and stability. However, when the patients’ personal space is violated, they feel suffocated and feel the need to free themselves and be independent. Those people who have SPD are happiest when they are in a relationship in which their partner demands little or a few emotional or intimate demands.

Other issues

Under stress, some schizoids may rarely experience instances of brief reactive psychosis.

SPD and other disorders

SPD is believed by some to correlate with the INTJ and INTP personality types in the Myers-Briggs Type Indicator (MBTI). SPD is far more common amongst males than females, although this could be due in part to the fact that schizoid symptoms are far less socially acceptable in women.

SPD shares several aspects with depression, avoidant personality disorder and Asperger's Syndrome, and can be difficult to distinguish from these other disorders. However, there are some important differentiating features:

While people who have SPD can also suffer from a clinical depression, this is certainly not always the case. Unlike depressed people, persons with SPD generally do not consider themselves inferior to others, although they will probably recognise that they are different.
Unlike avoidant personality disorder, those affected with SPD do not avoid social interactions due to anxiety or feelings of incompetence, but because they are genuinely indifferent to social relationships; however, in a 1989 study, "schizoid and avoidant personalities were found to display equivalent levels of anxiety, depression, and psychotic tendencies as compared to psychiatric control patients".
Unlike Asperger's Syndrome, SPD does not involve physical symptoms such as hand-flapping or lack of eye-contact. Other symptoms that are typical of Asperger's syndrome, but not of SPD, are an impairment in the use of nonverbal communication, strict adherence to routines or rituals, and a preoccupation with parts of objects. People who are afflicted with Asperger's syndrome often have very intense interests, while people with SPD are typically more indifferent with regard to their activities (however, in a sample of schizoid children, Sula Wolff noticed that "Having special interest patterns differentiated highly between schizoid and control boys".) SPD does not affect the ability to express oneself or communicate effectively with others, and is not believed to be related to any form of autism.

Schizoid personality disorder and schizophrenia

There is also disagreement about the relationship between SPD and schizophrenia. Some argue that the two conditions are entirely unrelated except by the origin of the word (meaning "split", in the case of SPD it is the individual that is "split" from society, rather than the actual mind being damaged), while Kalus believes that schizoids exhibit the negative symptoms that are associated with the schizophrenia, and that SPD may, in rare cases, be an indicator of the onset of the more serious disease. There is a wider consensus to link schizotypal personality disorder with schizophrenia.

Treatment

Treatment is usually not neccesary, and people with this personality type don't really care if they are seen as having a mental disorder, so they generally do not seek psychological treatment, except when they are compelled to enter therapy to solve another problem, such as an addiction. They may benefit from social skills training, although it can be argued that an improvement in social skills does not address the personality disorder itself. Since schizoid traits are very similar to negative schizophrenic symptoms atypical antipsychotics may have efficacy in alleviating them. Those who do seek treatment have the option of medication or therapy. For medication, the schizoid personality disorder seems to have similar negative symptoms of schizophrenia such as anhedonia, little affect, and low energy. The medication that is most recently used to treat the negative symptoms is risperidone. Before this, there was no psychotropic medication that made a impact on the negative symptoms. According to Joseph, low doses of risperdone or olanzapine also work for the social deficits and blunted affect; Wellbutrin for anhedonia. Furthermore, the use of SSRIs, TCAs, MAOIs, low dose benzodiazepines, and beta-blockers may help social anxiety in the SPD. However, social anxiety may not be a main concern for the people who have SPD. In therapy, Zimmerman comes up with a list of questions for the patients with SPD “ Do you have close relationships with friends or family? If yes, with whom? If no, does this bother you? Do you wish you had close relationships with others? Some people prefer to spend time alone, Others prefer to be with people. How would you describe yourself? Do you frequently choose to do things by yourself? Would it bother you to go a long time without a sexual relationship? Does your sex life seem important or could you get along as well without it? What kind of activities do you enjoy? Do you confide in anyone who is not in your immediate family? How do you react when someone criticizes you? How do you react when someone compliments you?

In the assessment process, note if these individuals make eye contact, smile or express affect nonverbally”

According to Beck and Freeman, people with SPD have “defective perceptual scanning which results in missing environmental cues. The defective perceptual scanning is characterized by a tendency to miss differences and to diffuse the varied elements of experience.” The perception of varied events only increases their fear for intimacy and limits them in their interpersonal relationships. Also because of their aloofness, this barrier doesn’t allow them have the social skills and behavior to help them pursue relationships. Therefore, socialization groups may help these people with SPD. They will help them start on a lower interpersonal intensity and will teach social propriety, customs, manners, and comfort. As said by Will, educational strategies also work with people who have SPD by having them identify their positive and negative emotions. They use the identification to learn about their own emotions; the emotions they draw out from others; and the feeling the common emotions with other people who them relate with. This can help people with SPD create empathy with the outside world.

External links

Shizoid Personality Disorder Forum.
Oppressed Group: Schizoid, A Personality, Not a Disorder: An essay defending the position that SPD is not a valid mental disorder.
A comprehensive overview of SPD with many references.
Schizoid (Yahoo!Groups) - A group for people who have schizoid personality disorder or who have some of its traits (welcome message)
Sula Wolff, Beyond Asperger Syndrome Links between SPD, Asperger syndrome and schizophrenia

References

Personality disorders

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