Edit concept Create issue ticket

Schizoid Personality Disorder

Schizoid personality disorder is a personality disorder characterized by emotional coldness, reduced affect, limited capacity to express emotions and indifference to praise and criticism.


Presentation

Clinical manifestations of schizoid personality disorder are diverse and can change over a period of time. [7] The most characteristic aspect of this disorder which is very prominent is that the affected individuals appear detached and are loners. People suffering from this condition are prone to:

  1. Longstanding emotional detachment from social relation and refrain from emotional intimacy. Enjoy spending time alone and indulge in activities which do not require other people.
  2. Be alone and are unable to express themselves emotionally.
  3. Have few or no friendships, avoid marriage or dating.
  4. Appear indifferent and cold towards others.
  5. Unable to respond or react in social situations.

Most of these personality disorders begin in early adulthood and become noticeable during personal or social situations. Schizoid personality disorder is a part of the schizophrenic spectrum which includes schizophrenia and schizotypal personality disorder. Schizoid personality disorder is almost similar in its presentation to the other two, but varies in two main aspects. Firstly, schizoid personality disorder patients are in touch with reality and speak in a reasonable way. Hallucinations and delusions are common in the other two disorders but not in this condition.

Dutch
  • The risk of schizoid personality disorder, as defined by ICD-6 to ICD-9, in men at age 18 years was compared in birth cohorts that were conceived at the height of the Dutch Hunger Winter famine and in unexposed birth cohorts of 1944-1946 in the famine[ncbi.nlm.nih.gov]
Weight Gain
  • Schizoid disorder drugs like risperidone cause several side effects including high blood pressure, muscle pain, tremors, weight gain, constipation, and stuffy nose.[newsmax.com]
Social Isolation
  • Several scales are described for measuring aspects of eccentricity and social isolation; in particular, for assessing schizoid and schizotypal personality and for rating abnormal non-verbal expression.[ncbi.nlm.nih.gov]
  • This can cause an indifference to people and social isolation. While the symptoms are similar to those of schizophrenia, they are generally more mild and do not include hallucinations or a complete disconnection from reality.[gomentor.com]
  • The social isolation that characterizes schizoid personality disorder also makes it difficult to find support and assistance.[psychology.about.com]
  • Schizoid personality disorder is a mental condition in which a person has a lifelong pattern of indifference to others and social isolation. Cause of this disorder is unknown.[medlineplus.gov]
  • Definition Schizoid personality disorder is a mental condition in which a person has a lifelong pattern of indifference to others and social isolation. Alternative Names Personality disorder - schizoid Causes Cause of this disorder is unknown.[m.ufhealth.org]
Anger
  • […] interaction with others in order to enjoy experiences or live their lives Almost always choose solitary activities Even-tempered, dispassionate, calm, unflappable, and rarely sentimental Rarely, if ever, claim or appear to experience strong emotions, such as anger[psychpage.com]
  • Symptoms of Schizoid Personality Disorder: Weak interpersonal skills Difficulty expressing anger, even when provoked "Loner" mentality; avoidance of social situations Appear to others as remote, aloof, and unengaged Low sexual desire Unresponsive to praise[4degreez.com]
  • Schizoid Personality Disorder Personality disorder characterized by at least 3 of the following: few, if any, activities, provide pleasure; emotional coldness, detachment or flattened affectivity; limited capacity to express either warm, tender feelings or anger[mhreference.org]
  • The person affected by this disorder usually displays a persistent behavior of isolation, is depressed, unable to express anger, and seems unaffected by life’s events. Patients display very few emotions and seem to be involved in themselves.[newsmax.com]
  • Their social skills are limited, and they have a difficult time expressing anger, even if provoked.[schizophrenic.com]
Withdrawn
  • Learn about this topic in these articles: personality disorders In personality disorder Persons with schizoid personality disorder appear aloof, withdrawn, unresponsive, humourless, and dull and are solitary to an abnormal degree.[britannica.com]
  • Those who suffer from this disorder are often described as distant or withdrawn. This type of personality disorder is believed to be relatively rare and tends to affect more men than women.[psychology.about.com]
  • They lead an isolated life and are socially withdrawn. They rarely show any emotions and appear aloof and cold towards other individuals.[symptoma.com]
  • […] relationships with others, reclusiveness, and a cold, detached affect. schizoid personality disorder a personality disorder (DSM-IV) characterized by a defect in the ability to form interpersonal relationships, as shown by emotional coldness and aloofness, withdrawn[medical-dictionary.thefreedictionary.com]
Flat Affect
  • In people with SPD, the flat affect varies from failure to show emotion even when it is present, and an actual lack of emotional affectivity in certain situations.[humanologyproject.org]
  • SPD overlaps with the negative symptoms of schizophrenia: flat affect, lack of motivation, and social withdrawal.[scielo.isciii.es]
  • Both simple schizophrenia and STPD may share negative symptoms like avolition , impoverished thinking and flat affect. Although they can look very similar, the severity usually dinstinguishes them.[en.wikipedia.org]
Hunger
  • The risk of schizoid personality disorder, as defined by ICD-6 to ICD-9, in men at age 18 years was compared in birth cohorts that were conceived at the height of the Dutch Hunger Winter famine and in unexposed birth cohorts of 1944-1946 in the famine[ncbi.nlm.nih.gov]
  • The child copes with this situation by splitting the self; the person is left with a deep and painful intimacy-hunger, dread, and isolation 16 .[scielo.isciii.es]
  • Seinfeld provides an example of a schizoid woman who would covertly attend various bars to meet men for the purpose of gaining impersonal sexual gratification, an act which alleviated her feelings of hunger and emptiness.[en.wikipedia.org]

Workup

A complete psychological assessment is involved, which also includes a complete physical examination and a review of personal and medical history. Sometimes reference to a psychiatrist will be required. Childhood history also needs to be analyzed [8]. To diagnose an individual with schizoid personality disorder, at least four of the following criteria from the Diagnostic & Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association should be met. These are:

  1. Patients distance themselves from close relationships including their own family members. They do not marry or date other people and feel they are functionally best when they are alone.
  2. Desire solitude and prefer to do activities alone without depending on anyone. They will enjoy playing games alone on the computer or some mathematical calculation games which does not require any other person.
  3. Have no interest in the opposite sex and have no sexual desires.
  4. Be unable to enjoy any emotions which people normally do on a daily basis. They experience no pleasure in any activity and appear dull or lifeless.
  5. Lack close friends or a good social circle. Very bad in interpersonal relationships.
  6. Apathetic towards positive or negative comments. Praise or criticism makes no difference to them and they show no response or reaction to either. They are indifferent to what other people think about them.
  7. Emotional detachment is one of the most prominent symptoms wherein they are unable to express themselves emotionally. Due to this they appear bland, dull and are considered social misfits. They are unable to reciprocate communication gestures either by a smile or a nod. Emotional expression is severely restricted in these individuals.

These are the important diagnostic criteria to judge and evaluate such cases. Elimination of other medical conditions with similar symptoms should be done.

Treatment

The most important aspect of treatment is the acknowledgement of the condition by the patient. Often treatment is discontinued by the patient due to failure to maintain a relationship with the therapist. Treatment options are variable and the outcome is also varied due to the complexity of patient's nature. Different therapies include:

  • Psychotherapy (individual therapy)- Patients on their own will never come for such sessions unless under the pressure of a family member. Short term therapies should be designed to solve immediate problems of the patient. The therapist should understand the patient's limitations in maintaining a social distance and that he/she is most likely to terminate this therapy. Therapist should bear this in mind while treating such patients. Simple cognitive behavioral therapy in the form of cognitive exercises to improve social behavior and to remove certain irrational and illogical thoughts. Everything possible should be done to let the patient speak, including the implementation of social skills training and psychosocial rehabilitation programs [9].
  • Group therapy- After sessions of individual therapy, the patient can begin group therapy. This therapy should not be the initial choice of treatment as the patient can terminate it abruptly. Thus, after acquiring certain social confidence and skills from individual therapy, they may tolerate such therapy better. Patience should be shown with the patients and they should not be forced into participation.
  • Medications- They are often the last option. Long-term medications should be avoided and given only for acute symptom relief. There is no particular single drug for schizoid personality disorder, but if the patient shows symptoms of depression a selective serotonin reputable inhibitor may be given. Antipsychotics are not routinely given except in certain cases.[10]

Prognosis

Most of the cases are considered untreatable and each case can follow various patterns and can have variable outcomes .The psychosocial environment appears important in the prognosis. Since this disorder is chronic, the life of the affected individuals appears lifeless or directionless which generally does not become better with time. Due to lack of insight, patients deny they are ill and refrain from seeking help and support. This probably is the most difficult aspect of schizoid personality disorder to treat.
Due to inability to maintain social relationships, these patients may abruptly stop taking medications. Cases with mild level of social impairment can improve with treatment and therapy, if we try to focus the treatment on maintaining relationships pertaining to patient's employment.
A relapse of social isolation is very possible even though treatment ends. Since this is a prolonged disorder, patients can go into depression very easily.

Etiology

No single cause has been identified to date. A number of possible causes have been implicated and are the subject of research. Many hypotheses [2] and theories have been formulated regarding this condition, and numerous studies have underlined the influence of both genetic and environmental factors. The roots of this disease seem to originate from the childhood of the affected individual, in circumstances such as the influence of unemotional parents, family ruptures, neglected upbringing or living in families socially withdrawn. Child abuse can also significantly contribute to this condition.

There is a lack of emotional stimuli from childhood as well as lack of attention, love and care which seems to trigger this condition. Due to lack of communication and stimuli these children do not understand the importance of interpersonal relationships and interaction with others. Many studies show a higher prevalence of this condition in relatives of people with schizophrenia. There are certain risk factors which increases the chances of developing this condition such as:

  • The presence of family member is affected by schizoid personality disorder or schizophrenia [3].
  • Having unemotional and detached parents.
  • Hypersensitive since childhood and being neglected or avoided since then.
  • Suffering any kind of child abuse

Thus, there is no single cause of this condition, but a rather complex play of various factors which tends to be passed on from one generation to another.

Epidemiology

Amongst personality disorders, schizoid personality disorder is quite uncommon in clinical settings. There is very limited information on the epidemiology [4] of this condition as many cases go undiagnosed. According to certain studies, schizoid personality disorder may be more common than other mental conditions , but due to its presentation, it may go unnoticed and not reported. There is no genetic variation in the incidence of this condition [5]. Schizoid personality disorder affects less than about 3-4% of the general population and tends to affect males more than females.

Schizoid personality disorder is mainly detected in young adults, as we cannot diagnose this condition in adolescents when the personality has not fully formed yet [6]. The condition has a familiar pattern and tends to affect biological relatives of those suffering from either schizophrenia or schizoid personality disorder.
Environmental or developmental factors may account for the variability in the onset of the condition. Patients with the disorder are more likely to be unmarried or single and have no or low sex drive. This is due to lack of interest in emotional intimacy.

Sex distribution
Age distribution

Pathophysiology

Recent work has emphasized the importance of the interaction of both genetic and non-genetic factors in the disease expression. Individuals may carry a genetic predisposition, but this vulnerability is not manifested unless others factors intervene.

  • Genetics- many single gene or polygenic theories have been proposed in the pathophysiology of schizoid personality disorder.
  • Neuroanatomy- several neuroanatomical abnormalities have been reported in this condition. They can be detected in the frontal, temporal and parietal lobes. These can occur due to injury or trauma; thus, it is also known as a neurodevelopmental disorder resulting from neuronal injury occurring early in life that interferes with normal brain maturation. Encephalitis can also produce these abnormalities.
  • Neurochemistry-the most widely accepted theory for the pathophysiology of this personality disorder was a functional hyperactivity in the amine system. Reduced levels of monoamine oxidase (MAO) and serotonin levels are also observed in this condition. Recent hypothesis also include the role of other neurotransmitter systems in the pathophysiology of schizoid personality disorder.

Prevention

Emphasis should be given to early identification of high risk individuals who can develop these personality disorders. Since the cause of this condition is obscure, there are no definite preventive methods. Certain services should be made available for determining and identifying children from broken families, or vulnerable parents and counseling and rehabilitation should be provided.
This personality disorder can be prevented by education of the masses of the importance of love, care and attention amongst parents and children. People need to be first educated about such cases in order to detect them.

Summary

Schizoid personality disorder is one of the lesser known and lesser common mental health conditions, wherein the affected individuals tend to have an emotional detachment and indifference towards others. They lead an isolated life and are socially withdrawn. They rarely show any emotions and appear aloof and cold towards other individuals. This mental disorder mainly manifests itself as an abnormal behavioral pattern [1] and these individuals cannot adapt or change their behavior under personal or social situations. This condition is often confused with schizophrenia, but they are different mental conditions, although both show many similarities. The cause of this condition is not clearly understood and there seems to be a role of both genetic as well as environmental factors. It tends to affect males more than females and may be seen in families with schizophrenia. Even though the affected individuals are lonely, it is difficult for them to acknowledge this fact and still prefer solitude. Interpersonal relationships are difficult for them and they even prefer to work alone. They shun crowds and sometimes appear invisible and enjoy being in their own thoughts and world. Therapy in the form of counseling and family support may seem to help. In certain cases medications are also given.

Patient Information

Schizoid personality disorder is a type of mental disorder in which an affected individual will refrain from social contact and avoid any close relationships. They appear as loners who do not like personal interactions. This disorder has no known cause and is believed to originate from a combination of genetic as well as environmental factors .Environmental factors mainly include any history of family ruptures, neglected upbringing, abuse or any kind of mental trauma. This tends to start in early adulthood and affects men more than women. The most common presentation of this condition is emotional detachment, failure to interact socially, no interest in sex or marriage and preference for solitude.
These cases go unnoticed due to the fact that the affected individuals refuse to acknowledge their condition or confide in no one or seek help from no one. It is important that such conditions be detected early so that appropriate therapy can be implemented. It is important for family members to help such patients take timely treatment and provide ample moral support.
Treatment is mainly psychotherapy which includes group therapy as well. Medications are normally given as a last option. Relapses are quite common.
There is no known prevention other than early detection, education and counseling.

References

Article

  1. Shedler J, Westen D. Refining personality disorder diagnosis: integrating science and practice. Am J Psychiatry. 2004 Aug;161(8):1350-65.
  2. Akhtar, S. Schizoid Personality Disorder: A Synthesis of Developmental, Dynamic, and Descriptive Features. Am J Psychother. 1987 OCt; 41(4):499–518.
  3. Gask L, Evans M, Kessler D; Personality disorder. BMJ. 2013 Sep 10;347:f5276.
  4. Kirkbride J, Coid JW, Morgan C, et al. Translating the epidemiology of psychosis into public mental health: evidence, challenges and future prospects. J Public Ment Health. 2010 Jun;9(2):4-14.
  5. Weissmann, M. M. The epidemiology of personality disorders. A 1990 update. Journal of Personality Disorders (Spring issue, Suppl.): 1993;44–62.
  6. R.L. Jenkins, S. Glickman. The Schizoid Child. American Journal of Orthopsychiatry. 1946 Apr;16 (2): 255–61.
  7. J. J. Nannarello, Schizoid. Journal of Nervous and Mental Disease, 1953;118, p. 237-249.
  8. Stein DJ. Borderline personality disorder: toward integration. CNS Spectr. 2009 Jul;14(7):352-6.
  9. J. Seinfeld- The Empty Core: An Object Relations Approach to Psychotherapy of the Schizoid Personality. Jason Aronson. 1991. p. 101.
  10. Soloff PH. Psychopharmacology of borderline personality disorder. Psychiatr Clin North Am. 2000 Mar;23(1):169-92.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-21 19:42