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Schizoid Personality Disorder

Reviewed by Psychology Today Staff

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 this personality disorder are able to function in everyday life, but don’t 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 difficult, such as night security watchmen or librarians.

There is evidence indicating the disorder shares an underlying genetic architecture with schizophrenia, and social withdrawal is a characteristic of both disorders. Most important, people with schizoid personality disorder are in touch with reality, unlike those with schizophrenia or schizoaffective disorder. Prevalence of this disorder is around 3.1 to 4.9 percent of the population, with an even frequency in men and women.

Schizoid personality disorder is classified under the Diagnostic and Statistical Manual of Mental Disorders-5 as a Cluster A condition; it is described as odd and eccentric. The other two Cluster A personality disorders are schizotypal personality disorder and paranoid personality disorder. Social awkwardness and withdrawal are hallmarks of this cluster.

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
  • Has trouble with self-expression

  • Exhibits little observable change in mood

  • Takes pleasure in few if any activities
  • Little motivation or life goals

Are schizoid personality disorder and schizophrenia the same?

No. Like all personality disorders, schizoid personality disorder is a lifelong pattern of behavior, and does not lead to subjective distress in the afflicted individual. Schizophrenia, by contrast, has a typical onset in early adulthood and is results in great distress in the individual.  The disorders share some characteristics, such as the inability to connect with others, and the inability to express themselves emotionally.  But people with schizoid personality disorder do not hallucinate or feel paranoid, nor do they have distorted thinking or speech.

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Causes

The causes of personality disorders are not known, but there is a higher risk for schizoid personality disorder in families of those with illnesses on the schizophrenia spectrum; this suggests that there is a genetic susceptibility to developing this disorder, with some studies placing the rate of heritability at approximately 30 percent.

Treatment

People who have the disorder rarely seek treatment, they do not think there is anything wrong. 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 depression and or extreme states of anxiety 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 is more difficult to pursue because this disorder is hard to ameliorate. Instead, therapy should focus on simple treatment goals to alleviate current pressing concerns or stressors in the individual's life. Cognitive therapy may be used 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. The therapist should be aware of cultural differences, which can masquerade as personality disorders.

Why do most people with schizoid personality disorder decline to seek treatment?

This disorder is not experienced as ego-dystonic, or subjectively distressing, to the individual. While people with schizoid personality disorder recognize that they differ from others, especially in their lack of interest in close relationships, this does not lead to concern or loneliness. Those who seek treatment often do so because a family member or professional contact has suggested that they obtain counseling or coaching

What is the best course of action for those who do seek treatment?

Therapy should focus on simple treatment goals to alleviate current pressing concerns or stressors in the individual's life, rather than attempting to "cure" the individual. Cognitive therapy may be used 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. The therapist should be aware of cultural differences, which can masquerade as personality disorders.

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 updated: 07/22/2021