Schizoid Personality Disorder

What is schizoid personality disorder?

In day-to-day living, a schizoid personality will display a lifelong pattern of social withdrawal. Their lack of vitality, low energy, and the general deficits that appear to be present with regards to spontaneity and expressiveness are noteworthy. A noticeable characteristic is their discomfort with human interactions and their introversion.

Their dress and mannerisms have been described as eccentric, their facial expressions bland and expressionless. They restrict their human interactions remaining isolated and lonely. They often appear aloof, with few friends, absent-minded, and would fit the expression "the silent quiet type" and may be described by neighbors as a recluse.

The prevalence of schizoid personality disorder has been reported to be about seven and a half percent of the general population but is not clearly established. A gender ratio of two to one (male-to-female) has been reported in some studies. Individuals will often find work with night shifts or remote work sites minimizing contact with other people.

The life histories may reflect solitary interests and success at noncompetitive, isolated and lonely jobs that others find difficult to tolerate. Their sexual lives may exist only in fantasy. They are often interested in animals, health fads, philosophical movements, religious cults, and the metaphysical.

How is it diagnosed?

History: In a clinical interview, individuals may appear uneasy with poor eye contact and may be anxious to end the interview. The psychiatric interview and mental status exam are the primary methods utilized by the practitioner. The physician looks for a history of a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions and interpersonal settings, beginning by early adulthood.

The specific symptoms sought in the history, as stated in the DSM-IV, are outlined below:

• Individuals with schizoid personality disorder display 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.
• An individuals will present with 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, interests 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;
  • or shows emotional coldness, detachment, or flattened affectivity.

For the diagnosis to be confirmed, these behavior cannot occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, another psychotic features, another psychotic disorder, or a pervasive developmental disorder, and cannot be due to the direct physiological effects of a general medical condition.

Physical exam is not helpful in diagnosing this disorder. Observation of the individual's orientation, dress, mannerisms, behavior and content of speech provide essential signs to diagnose the illness.

Tests: Psychological testing may be helpful in differentiating this disorder from other similar personality disorders.

How is schizoid personality disorder treated?

Individual and group psychotherapy have been utilized to treat schizoid personality disorder. The treatment approach is similar to the paranoid personality disorder. One of the more important goals of therapy is to have the individual become comfortable in a social setting either one to one with the therapist or in a group setting. Small doses of antipsychotics, antidepressants, and psychostimulants have been effective in some individuals.

Medications

Information

Brand

Generic

Label

Zyban

Bupropion

Zyprexa

Olanzapine

Risperdal

Risperidone

What might complicate it?

A coexisting mood disorder(s) such as major depression, anxiety disorder(s), substance abuse will cause complications. Experiencing changes in certain areas of his or her life, i. e. uncomfortable social setting, living arrangements and/or work environment can complicate this disorder.

Predicted outcome

Many individuals with schizoid personality disorder are able to contribute to society. Although limited, they are usually able to function in a restricted, self-defined environment. Progression to schizophrenia is a possible outcome, usually surfacing as schizophrenia in the second or third decade of the person's life.

Alternatives

The family history and work history of these individuals is important to obtain. A family history of schizophrenia might suggest this is schizophrenia rather than a personality disorder. The two can be distinguished in that schizophrenia exhibits thought disorder and delusional thinking. Similar to schizoid is schizotypical personality disorder; paranoid and avoidant types also have similar traits. Other Axis I disorders that need to be considered are the mood disorders, anxiety disorders, dissociative disorders (depersonalization disorders), schizophreniform and brief reactive psychosis.

Appropriate specialists

Psychiatrist or psychologist.

Last updated 6 April 2018