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:
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Neither desires nor enjoys close relationships, including being part of a family almost always chooses solitary activities.
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Has little, if any, interest in having sexual experiences with another person takes pleasure in few, if any, activities.
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Lacks close friends or confidants other than first-degree relatives appears indifferent to the praise or criticism of others.
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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)."
Associated Features:
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Odd/Eccentric/Suspicious Personality.
Differential Diagnosis
Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.
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Delusional Disorder
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Personality Change Due to a General Medical Condition
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Symptoms that may develop in association with chronic substance use
Cause:
People with schizoid personality disorder do not have schizophrenia; but it is thought that many of the same risk factors in schizophrenia may be factors causing schizoid personality disorder. People with this disorder are able to function in everyday life, but will not develop meaningful relationships with others. Controversially, there is some evidence to indicate that schizoid personality disorder may be the beginning of schizophrenia, or even a very mild form of it.
Treatment:
People with this disorder rarely seek treatment. The treatment can be difficult due to their initial reduced capacity or desire to form a relationship with a health professional.
Counseling and Psychotherapy [ See Therapy Section ]:
Group therapy in people with schizoid personality disorder is another potentially effective form of treatment. Although patients may initially withdraw from the therapy group, they often become more participatory as a comfort level is gradually established. Protected by the therapist who must safeguard schizoids from criticism from other group members, patients have the opportunity to conquer fears of intimacy by engaging in communication and making social contact in a supportive atmosphere.
The social consequences of serious mental disorders—family disruption, loss of employment and housing—can be calamitous. Comprehensive treatment, which includes services that exist outside the formal treatment system, is crucial to ameliorate symptoms, assist recovery, and, to the extent that these efforts are successful, redress stigma. Consumer self-help programs, family self-help, advocacy, and services for housing and vocational assistance complement and supplement the formal treatment system. Consumers, that is, people who use mental health services themselves, operate many of these services. The logic behind their leadership in delivery of these services is that consumers are thought to be capable of engaging others with mental disorders, serving as role models, and increasing the sensitivity of service systems to the needs of people with mental disorders.
Pharmacotherapy [ See Psychopharmacology Section ] :
Medications are not usually recommended as treatment for schizoid personality disorder. However, they are sometimes used for short-term treatment of extreme anxiety states associated with the disorder. Psychotherapy Individual therapy that successfully attains a long-term trust level can be useful in some cases of schizoid personality disorder by providing an outlet for patients to transform their false perceptions of friendships into a genuine relationship. As a therapist-client relationship develops, the patient may begin to reveal imaginary friendships and terrors of dependency. Individual psychotherapy can gradually effect the formation of a true relationship between therapist and patient.
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