Schizoid personality disorder

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Schizoid personality disorder
Classification & external resources

ICD-10	F601.
ICD-9	301.20

Schizoid personality disorder (SPD) is a cluster A personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, and emotional coldness. SPD is reasonably rare compared with other personality disorders. Its prevalence is estimated at less than 1% of the general population.^[1]

Contents 1 Diagnostic criteria (ICD-10) 2 Diagnostic criteria (DSM-IV-TR) 2.1 Mnemonic 3 Self image 4 Relationships with others 5 Other issues 6 SPD and other disorders 6.1 Schizoid personality disorder and schizophrenia 7 Treatment 8 See also 9 External links 10 References

[edit] Diagnostic criteria (ICD-10)

According to the ICD-10, schizoid personality disorder is characterized by at least four or more of the following criteria:

• Emotional coldness, detachment or reduced affection.
• Limited capacity to express either positive or negative emotions towards others.
• Consistent preference for solitary activities.
• Very few (if any) close friends or relationships, and a lack of desire for such.
• Indifference to either praise or criticism.
• Taking pleasure in few, if any, activities.
• Indifference to social norms and conventions.
• Preoccupation with fantasy and introspection.
• Lack of desire for sexual experiences with another person.

Case example: A 48-year-old man presents to a primary care physician because of a one-week history of symptoms consistent with pneumonia. Since this is the patient's first visit to the clinic, the physician gathers a full history for a new patient assessment. The patient has no significant past medical, surgical, or psychiatric history. Family history is significant for a brother and an uncle with paranoid schizophrenia.

Social history reveals that the patient lives alone, has minimal contact with family, and describes no real social activities or friends. When questioned about this, he states, "I've never been much interested in my family or being around people." He has worked delivering newspapers for the past 15 years. He has not dated since having one girlfriend in the 11th grade. During interview, though he seems emotionally detached, he denies depressive symptoms or psychotic symptoms.

[edit] Diagnostic criteria (DSM-IV-TR)

The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines schizoid personality disorder as:

A. 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:

1. neither desires nor enjoys close relationships, including being part of a family
2. almost always chooses solitary activities
3. has little, if any, interest in having sexual experiences with another person
4. takes pleasure in few, if any, activities
5. lacks close friends or confidants other than first-degree relatives
6. appears indifferent to the praise or criticism of others
7. shows emotional coldness, detachment, or flattened affectivity

B. 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.

DSM-IV, which is an earlier version of DSM-IV-TR, does say that a person with Schizoid Personality Disorder may feel sensitive to the opinions of others and may even feel lonely but can not do anything about the loneliness due to the schizoid.

[edit] Mnemonic

A mnemonic that can be used to remember the criteria for schizoid personality disorder is SOLITARY.

• S – shows emotional coldness
• O – omits close relationships
• L – lacks close friends or confidants
• I – involved in solitary activities
• T – takes pleasure in few activities
• A – appears indifferent to praise or criticism
• R – restricted interest in sexual experiences
• Y – yanks himself from social relationships

[edit] Self image

People with SPD prefer independence, solitude, and detachment. They are also comfortable with the fact that they have an inability for extraversion. Although they experience little anxiety, they can still see the difference between them and the rest of the world. One patient with SPD commented that he could not fully enjoy the life he has because he feels that he is living in a shell. Furthermore, he noted that his inability distressed his wife.^[2] According to Beck and Freeman,^[3] patients with schizoid personality disorders consider themselves to be “observers rather than participants in the world around them.”

[edit] Relationships with others

According to Gunderson,^[4] people with SPD “feel lost” without the people they are normally around because they need a sense of security and stability. However, when the patient’s personal space is violated, they feel suffocated and feel the need to free themselves and be independent. Those people who have SPD are happiest when they are in a relationship in which the partner places few emotional or intimate demands on the individual with this disorder.

People with SPD are seen as aloof, cold and indifferent, which causes some social problems. Most individuals diagnosed with SPD have difficulty establishing personal relationships or expressing their feelings in a meaningful way, and may remain passive in the face of unfavourable situations. Their communication with other people at times may be indifferent and concise. Because of their lack of communication with other people, those who are diagnosed with SPD are not able to have a reflection of themselves and how well they get along with others. The reflection is important so they can be more aware of themselves and their own actions in social surroundings.^{[citation needed]}

People with SPD are sometimes sexually apathetic, though they do not normally suffer from anorgasmia. Many schizoids have a normal sex drive and prefer to masturbate rather than deal with the social aspects of finding a sexual partner. Therefore, their need for sex may appear less than for those who do not have SPD, as the individuals with SPD prefer remaining alone and detached. When having sex, individuals with SPD often feel that their personal space is being violated, and they commonly feel that masturbation or sexual abstinence is preferable to the closeness they must tolerate when having sex. ^{[verification needed]}

[edit] Other issues

Under stress, some schizoids may occasionally experience instances of brief reactive psychosis.

[edit] SPD and other disorders

SPD is believed by some to correlate with the INTJ and INTP personality types in the Myers-Briggs Type Indicator (MBTI). SPD is far more common among males than among females, although this could be due in part to the fact that schizoid symptoms are far less socially acceptable in women.

SPD shares several aspects with depression, avoidant personality disorder and Asperger's Syndrome, and can be difficult to distinguish from these other disorders. However, there are some important differentiating features:

• While people who have SPD can also suffer from clinical depression, this is certainly not always the case. Unlike depressed people, persons with SPD generally do not consider themselves inferior to others, although they will probably recognise that they are different.
• Unlike avoidant personality disorder, those affected with SPD do not avoid social interactions due to anxiety or feelings of incompetence, but because they are genuinely indifferent to social relationships; however, in a 1989 study,^[5] "schizoid and avoidant personalities were found to display equivalent levels of anxiety, depression, and psychotic tendencies as compared to psychiatric control patients".
• Unlike Asperger's Syndrome, SPD does not involve an impairment in nonverbal communication (e.g., lack of eye-contact or unusual prosody) or a pattern of restricted interests or repetitive behaviors (e.g., a strict adherence to routines or rituals, or an unusually intense interest in a single topic). Instead people with SPD are typically more indifferent with regard to their activities (however, in a sample of schizoid children, Sula Wolff noticed that "Having special interest patterns differentiated highly between schizoid and control boys".) SPD does not affect the ability to express oneself or communicate effectively with others, and is not believed to be related to any form of autism.

[edit] Schizoid personality disorder and schizophrenia

There is also disagreement about the relationship between SPD and schizophrenia. Some argue that the two conditions are entirely unrelated except by the origin of the word meaning "split", in the case of SPD it is the individual that can behave in two different ways, but because other personality disorders have the same split behaviour, the word 'schizoid' should be changed according to some psychiatrists. while Kalus^[6] believes that schizoids exhibit the negative symptoms that are associated with the schizophrenia, and that SPD may, in rare cases, be an indicator of the onset of the more serious disease. There is a wider consensus to link schizotypal personality disorder with schizophrenia.

[edit] Treatment

Treatment is usually not necessary, and people with this personality type don't really care if they are seen as having a mental disorder, so they generally do not seek psychological treatment, except when they are compelled to enter therapy to solve another problem, such as an addiction. They may benefit from social skills training, although it can be argued that an improvement in social skills does not address the personality disorder itself. Since schizoid traits are very similar to negative schizophrenic symptoms atypical antipsychotics may have efficacy in alleviating them. Those who do seek treatment have the option of medication or therapy. For medication, the schizoid personality disorder seems to have similar negative symptoms of schizophrenia such as anhedonia, little affect, and low energy. The medication that is most recently used to treat the negative symptoms is risperidone. Before this, there was no psychotropic medication that made an impact on the negative symptoms. According to Joseph,^[7] low doses of risperdone or olanzapine also work for the social deficits and blunted affect; Wellbutrin for anhedonia. Furthermore, the use of SSRIs, TCAs, MAOIs, low dose benzodiazepines, and beta-blockers may help social anxiety in the SPD. However, social anxiety may not be a main concern for the people who have SPD. Mark Zimmerman suggested the following questions for evaluation of patients with SPD:

Do you have close relationships with friends or family? If yes, with whom? If no, does this bother you?
Do you wish you had close relationships with others?
Some people prefer to spend time alone, Others prefer to be with people. How would you describe yourself?
Do you frequently choose to do things by yourself?
Would it bother you to go a long time without a sexual relationship? Does your sex life seem important or could you get along as well without it?
What kind of activities do you enjoy?
Do you confide in anyone who is not in your immediate family?
How do you react when someone criticizes you?
How do you react when someone compliments you?

In the assessment process, note if these individuals make eye contact, smile or express affect nonverbally. ^[8]

According to Beck and Freeman,^[3] people with SPD have “defective perceptual scanning which results in missing environmental cues. The defective perceptual scanning is characterized by a tendency to miss differences and to diffuse the varied elements of experience.” The perception of varied events only increases their fear for intimacy and limits them in their interpersonal relationships. Also because of their aloofness, this barrier doesn’t allow them have the social skills and behavior to help them pursue relationships. Therefore, socialization groups may help these people with SPD. They will help them start on a lower interpersonal intensity and will teach social propriety, customs, manners, and comfort. As said by Will, educational strategies also work with people who have SPD by having them identify their positive and negative emotions. They use the identification to learn about their own emotions; the emotions they draw out from others; and the feeling the common emotions with other people who they relate with. This can help people with SPD create empathy with the outside world.

[edit] See also

• Asperger's syndrome
• Avoidant personality disorder
• Schizotypal personality disorder

[edit] External links

• Schizoid Personality Disorder Forum.
• Oppressed Group: Schizoid, A Personality, Not a Disorder: An essay defending the position that SPD is not a valid mental disorder.
• Schizoid (Yahoo!Groups) - A group for people who have schizoid personality disorder or who have some of its traits (welcome message)
• Sula Wolff, Beyond Asperger Syndrome Links between SPD, Asperger syndrome and schizophrenia
• NY Times article "Like a Fish Needs a Bicycle: For Some People, Intimacy Is Toxic"

[edit] References

1. ^ Weismann, M. M. (1993). "The epidemiology of personality disorders. A 1990 update.". Journal of Personality Disorders (Spring issue, Suppl.): 44-62. 
2. ^ Magnavita, Jeffrey J. (1997). Restructuring Personality Disorders: A Short-Term Dynamic Approach. New York: The Guilford Press. 
3. ^ ^{a b} Beck, Aaron T., M.D., Freeman, Arthur, Ed.D. (1990). Cognitive Therapy of Personality Disorders. New York: The Guilford Press. 
4. ^ Gunderson, John G., Zanarini, Mary C., Kisiel, Cassandra L. (1995). "Borderline Personality Disorder", in Livesley, W. John (ed.): The DSM-IV Personality Disorders. New York: The Guilford Press. 
5. ^ Overholser, JC (November 1989). "Differentiation between schizoid and avoidant personalities: an empirical test". Canadian Journal of Psychiatry 34 (8): 785-90. 
6. ^ Kalus, Oren, Bernstein, David P., and Siever, Larry J. (1995). "Schizoid Personality Disorder", in Livesley, W. John (ed.): The DSM-IV Personality Disorders. New York: The Guilford Press. 
7. ^ Joseph, S., M.D., Ph.D., MPH (1997). Personality Disorders: New Symptom-Focused Drug Therapy. New York: The Haworth Medical Press. 
8. ^ Zimmerman, Mark, M.D. (1994). Interview Guide for Evaluating DSM-IV Psychiatric Disorders and the Mental Status Examination. East Greenwich, RI: Psych Products Press.