Schizoid Personality Disorder

Schizoid personality disorder is a pattern of indifference to social relationships, with a limited range of emotional expression and experience. People with schizoid personality disorder rarely feel there is anything wrong with them. The disorder manifests itself by early adulthood through social and emotional detachments that prevent people from having close relationships. People with it are able to function in everyday life, but will not develop meaningful relationships with others. They are typically loners and may be prone to excessive daydreaming as well as forming attachments to animals. They may do well at solitary jobs others would find intolerable. There is evidence indicating the disorder shares an underlying genetic architecture with schizophrenia, and social withdrawal is a characteristic of both disorders. Crucially, people with schizoid personality disorder are in touch with reality, unlike those with schizophrenia or schizoaffective disorder. 

Symptoms

According to the DSM-5, symptoms of schizoid personality disorder include the following:  

  • Does not desire or enjoy close relationships
  • Appears aloof and detached
  • Avoids social activities that involve significant contact with other people
  • Almost always chooses solitary activities
  • Little or no interest in sexual experiences with another person
  • Lacks close relationships other than with immediate relatives
  • Indifferent to praise or criticism
  • Shows emotional coldness, detachment, or flattened affect
  • Exhibits little observable change in mood
  • Takes pleasure in few if any activities

Causes

The cause of personality disorders isn't known, but a higher risk for schizoid personality disorder in families of those with illnesses on the schizophrenia spectrum suggests that there is genetic susceptibility to developing this disorder.  

Treatment

Little research has been done on the treatment of schizoid personality disorder. This is partly because people with this diagnosis typically do not experience loneliness or compete with or envy people who enjoy close relationships. 

Medications are not usually recommended for schizoid personality disorder. However, they are sometimes used for short-term treatment of extreme anxiety states associated with the disorder. The presence of anxiety, usually caused by fear of other people, may mean that a diagnosis of the related schizotypal personality disorder is more appropriate. 

Individual therapy that successfully attains a long-term level of trust may be useful, as it helps people with the disorder to establish authentic relationships, in cases where this is desired. Individual psychotherapy can gradually affect the formation of a true relationship between the patient and therapist.

Long-term psychotherapy should not be pursued because this disorder is difficult to ameliorate. Instead, therapy should focus on simple treatment goals to alleviate current pressing concerns or stressors within the individual's life. Cognitive-restructuring may be proper to address certain types of clear, irrational thoughts that are negatively influencing the patient's behaviors. This therapeutic plan should be clearly defined at the onset of treatment.   

References

  •  Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition  
  • Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735-743.
  • Mayo Clinic

Last reviewed 02/07/2019