schizoid personality disorder

characterized by…

a lack of and indifference to interpersonal relationships

Schizoids often choose to be by themselves, thus

• Go through life with markedly reduced interpersonal stress

• Immune to the demands that others might put on them

diagnostic criteria

• A pervasive pattern of detachment from social relationships and a restricted range of expression of emotion 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

    • These individuals are not hostile, they are simply indifferent (don’t gaf)

  • 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

Hard to diagnose bc they are largely defined by…

“lack of” certain characteristics

• We all know someone who is an extreme introvert

  • Not an avoidant personality, though

  • We all want to be left alone from time to time…

    • To quiet our own thoughts or think things through

    • To let down the façade of friendliness that is required at a work party or visits from relatives

    • But sooner or later enough is enough

  • Schizoids feel this way the majority of the time

    • Often turn to isolative hobbies like stamp or rock collecting, mechanical gadgetry, mathematics or computer science

Schizoid Personality Disorder versus Delusional Disorder, Schizophrenia and Mood Disorders with Psychotic Features

• In order to give the diagnosis of Schizoid:

  • The personality disorder must have been present before the onset of psychotic symptoms

  • The personality disorder must persist with the psychotic symptoms are in remission

Schizoid personality versus avoidant personality disorder

• Can appear similar upon initial presentation

• Both display

  • Lack of interpersonal relationships

  • Engagement in many solitary activities

  • Difference lies in the desire for relationships

• Avoidant Personality Disorder

  • Avoids relationships due to a fear of rejection

• Schizoid Personality Disorder

  • May also fear such criticism, but will not desire relationships

  • As a result, self-enforced solitude appears less problematic

Schizoid personality versus autism

• Tough…

• Both display severely impaired social interaction and stereotyped behaviors and interests

Interpersonal perspective

• Many clinicians believe it to be a deficit from the very beginning of life

  • Most infants develop one of several types of attachment to caretakers

  • Future schizoid personalities remain weakly attached, if at all

  • Behaviors normally reinforcing caregiving such as coos, smiles, and giggles are infrequent or absent

• Although detached from life, they nevertheless exist in a social world

  • Schizoid patients are likely to: “ignore others’ presence and refuse to speak or respond. He remains totally unresponsive, is constantly lost in his own thoughts, and appears compulsively uncommunicative. He doggedly ignores all social overtures, and resists intrusions into his privacy. Whenever possible, he avoids others and becomes totally reclusive. When around others, he is totally disinterested and relentlessly stays in his own private world. He strikes others as being disengaged, hermetic, and mute.”

  • Schizoids are impressive not for what they do, but for what they fail to do

• Schizoid is probably best described as the reverse of the histrionic personality

  • Histrionic personality

    • Turned radically outward toward the social world

    • Demonstrative, dramatic, spontaneous, and theatrical

    • Hyper-sexualized

    • Cognitively scattered and unable to focus

  • Schizoid personality

    • Radically detached

    • Unanimated, robotic and lacking in energy and vitality

    • Little or no interest in sex

    • Focus intensely and creatively

Cognitive perspective

Doesn’t fit diagnostic criteria

• Early Experience

  • “Square peg in a round hole”

  • Teased and bullied at school

  • “Inept at family activities”

• Core Beliefs

  • “I am different, a loner, an oddity, a misfit, nothing/worthless, boring and dull, half a person, have an ugly personality, not normal”

  • “People are cruel, hostile, out to get me, unfulfilling, don’t like me, pick on weakness”

  • “The World is hostile”

• Conditional Assumptions

  • “If I try and befriend others, they will notice I am different and ridicule me”

  • “If I speak to others, they will notice how dull I am and will reject and taunt me”

  •  “If people don’t fit in, they will not be welcome and cannot have friends”

  • “If I try and talk to others, there will be nothing to say and no point in this communication.” “People should only talk if they have something to say.”

  • “If people see I am anxious, they will consider me weak and pick on me”

  • “If I aggravate people, then they will hurt me”

• Negative Automatic Thoughts

  • “I don’t fit in – there is nothing to say”

  • “Others will taunt me for this”

• Behaviors

  • Avoid all contact/talk with others

  • Look at the ground in social situation

erroneous beliefs

• “I am basically alone”

• “Close relationships with other people are unrewarding and messy”

• “I can do things better if I’m not encumbered by other people”

• “Close relationships are undesirable because they interfere with my freedom of action”

strategy

• To keep their distance from other people, insofar as this is feasible