Schizoid Personality Disorder

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For instance, they make excellent night watchmen and security guards. They have little emotional range, they daydream excessively, and appear to be humorless and aloof. (Grinspoon, 1982).

Clinical Presentation

The Schizoid Personality Disorder is characterized by the following behavior and interpersonal styles, thinking or cognitive styles, and emotional or affective styles.

• The behavioral pattern of schizoids can be described as lethargic, inattentive, and occasionally eccentric. They exhibit slow and monotone speech and are generally non-spontaneous in both their behavior and speech.
• Interpersonally, they appear to be content to remain socially aloof and alone. These individuals prefer to engage in solitary pursuits, they are reserved and appear to others as “cold fish.” They do not involve themselves in group or team activity. In short, they appear inept and awkward in social situations.
• Their thinking style can be characterized as cognitively distracted. That is, their thinking and communication can easily become derailed through internal or external distraction. This is noted in clinical interviews, when these patients have difficulty organizing their thoughts; they often wander into irrelevance such as the shoes certain people prefer (Milton, 2011). They appear to have little ability for instrospection, nor ability to articulate important aspects of interpersonal relationships. Their goals are vague and appear to be indecisive.

• Their emotional style is characterized as being humorless, cold, aloof, and unemotional. They appear to be indifferent to praise and criticism, and they lack spontaneity. Not surprisingly, their rapport and ability to empathize with others is poor. In short, they have a constricted range of affective response.

DSM-5 Characterization

Individuals with this personality disorder are characterized by an unremitting pattern of detachment from others and restricted emotional expression.

Not surprisingly, they seem indifferent to the feedback, including criticism, of others. They experience little, if any, pleasure in most activities. Instead, they exhibit emotional coldness, detachment, or flat affect (American Psychiatric Association, 2013).

Biopsychosocial – Adlerian Conceptualization

The following biopsychosocial formulation may be helpful in understanding how the schizoid personality develops. Biologically, the schizoid personality was likely to have had a passive and anhedonicOpens in new window infantile pattern and temperament. Millon (2011) suggested that this pattern results, in part, from increased dopaminergic postsynaptic limbic and frontal lobe receptor activity. Constitutionally, the schizoid is likely to be characterized by an ecomorphic body type (fragile and delicate) (Sheldon, Dupertius, & McDermott, 1954).

Psychologically, schizoids view themselves, others, the world, and life’s purpose in terms of the following themes. They view themselves by some variant of the theme: “I’m a misfit from life, so I don’t need anybody. I am indifferent to everything.”

For schizoid personalities, the world and others are viewed by some variant of the theme: “Life is a difficult place and relating to people can be harmful.” As such, they are likely to conclude, “Therefore, trust nothing and keep a distance from others and you won’t get hurt.”

Alexandra Adler (1956) further describes these life-style dynamics. The most common defense mechanism utilized by them is intellectualization.

Socially, predictable patterns of parenting and environmental factors can be noted for schizoids.

• Parenting styles is usually characterized by indifference and impoverishment. It is as if the parental injunction was: “You’re a misfit,” or, “Who are you, what do you want?”
• Their family pattern is characterized by fragmented communications and rigid, unemotional responsiveness. Because of these conditions, schizoids are grossly under-socialized and develop few if any interpersonal relating and coping skills.

This schizoid pattern is confirmed, reinforced, and perpetuated by the following individual and systems factors: Believing themselves to be misfits, they shun social activity. This plus social insensivity leads to reinforcement of social isolation and further confirmation of the schizoid style.

Treatment Considerations

Included in the differential diagnosis of the Schizoid Personality Disorder are the following personality disorders: the Avoidant Personality DisorderOpens in new window, Schizotypal Personality DisorderOpens in new window, and the Dependent Personality DisorderOpens in new window.

The most common symptom disorders associated with the Schizoid Personality Disorder are: Depersonalization DisorderOpens in new window, the Bipolar and Unipolar DisordersOpens in new window, Obsessive-Compulsive DisorderOpens in new window, HypochondriasisOpens in new window, SchizophreniformOpens in new window, Disorganized SchizophreniaOpens in new window and Catatonic SchizophreniaOpens in new window.

Schizoid personalities rarely volunteer for treatment unless decompensation is present. However, they may accept treatment if someone, like a family member, demands it.

Treatment goals are focused on symptom alleviation rather than on restructuring of personality. Treatment strategy involves a crisis and supportive approach, as well as providing a consistent and supportive therapeutic interaction. Medications, particularly the neuroleptics, do not appear to be useful with schizoid personality unless some psychotic decompensation has been noted (Reid, 1989).