Learning Objectives
- Describe the characteristics and diagnosis of schizoid personality disorder
We’ve learned about paranoid personality disorder, now let’s take a look at another Cluster A disorder: schizoid personality disorder. Persons with schizoid personality disorder are considered classic loners.
| DSM-5 Personality Disorder | Description | Cluster |
|---|---|---|
| Paranoid | harbors a pervasive and unjustifiable suspiciousness and mistrust of others; reluctant to confide in or become close to others; reads hidden demeaning or threatening meaning into benign remarks or events; takes offense easily and bears grudges; not due to schizophrenia or other psychotic disorders | A |
| Schizoid | lacks interest and desire to form relationships with others; aloof and shows emotional coldness and detachment; indifferent to approval or criticism of others; lacks close friends or confidants; not due to schizophrenia or other psychotic disorders, not an autism spectrum disorder | A |
| Schizotypal | exhibits eccentricities in thought, perception, emotion, speech, and behavior; shows suspiciousness or paranoia; has unusual perceptual experiences; speech is often idiosyncratic; displays inappropriate emotions; lacks friends or confidants; not due to schizophrenia or other psychotic disorder, or to autism spectrum disorder | A |
Schizoid Personality Disorder
Figure 1. Schizoid personality disorder is characterized by a solitary lifestyle and detachment from others.
Schizoid personality disorder (often abbreviated as SPD or SzPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy. Affected individuals may be unable to form intimate attachments to others and simultaneously possess a rich and elaborate but exclusively internal fantasy world. Other associated features include stilted speech, a lack of deriving enjoyment from most activities, feeling as though one is an observer rather than a participant in life, an inability to tolerate emotional expectations of others, apparent indifference when praised or criticized, a degree of asexuality, and idiosyncratic moral or political beliefs. Symptoms typically start in late childhood or adolescence.
Schizoid personality disorder (SPD) is described as 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 at least four of the following:
- neither desires nor enjoys close relationships, including being part of a family
- almost always chooses solitary activities
- has little, if any, interest in having sexual experiences with another person
- takes pleasure in few, if any, activities
- lacks close friends or confidants other than first-degree relatives
- appears indifferent to the praise or criticism of others
- shows emotional coldness, detachment, or flattened affect
Those with schizoid personality disorder (SPD) may often be unable to, or will rarely, express aggressiveness or hostility, even when provoked directly. These individuals can seem vague or drifting about their goals and their lives may appear directionless.
Comorbidity
Schizoid personality disorder is often found to occur with at least one of several disorders or pathologies. Sometimes, a person with SPD may meet criteria for an additional personality disorder; when this happens, it is most often avoidant, schizotypal, or paranoid personality disorder. Alexithymia (the inability to identify and describe emotions) is often present in SPD.
While SPD shares several symptoms with other mental disorders, there are some important differentiating features:
| Table 2. Differential Diagnosis | |
|---|---|
| Psychological condition | Features |
| Depression | People who have SPD may also suffer from clinical depression. However, this is not always the case. Unlike a person with depression, persons with SPD generally do not consider themselves inferior to others. They may recognize instead that they are different. |
| Avoidant personality disorder (AvPD) | While people affected with AvPD avoid social interactions due to anxiety or feelings of incompetence, those with SPD do so because they are genuinely indifferent to social relationships. A 1989 study, however, found that “schizoid and avoidant personalities were found to display equivalent levels of anxiety, depression, and psychotic tendencies as compared to psychiatric control patients.” There also seems to be some shared genetic risk between SPD and AvPD. Several sources to date have confirmed the synonymy of SPD and avoidant attachment style. |
| Other personality disorders | Schizoid and narcissistic personality disorders can seem similar in some respects (e.g., both show identity confusion, may lack warmth and spontaneity, and avoid deep relationships with intimacy). Another commonality observed by Akhtar is preferring ideas over people. |
| Autism Spectrum Disorder | There may be substantial difficulty in distinguishing milder forms of autism spectrum disorder. SPD is classified as a schizophrenia-like personality disorder. There is some overlap, as some people with autism also qualify for a diagnosis of schizotypal or SPD. However, one of the distinguishing features of SPD is a restricted affect and an impaired capacity for emotional experience and expression. Persons with autism may fail to recognize social cues such as verbal hints or body language. |
Prevalence
Studies suggest that SPD disorder has a prevalence of less than 1%. There is no difference observed in the frequency between males and females.
Etiology
Although not much is definitively known regarding the etiology of schizoid personality disorder, it is assumed that genetics significantly contributes to the disorder. Twin studies using self-report questionnaires have estimated heritability rates for schizoid personality disorder to be about 30%.
Treatment
People with schizoid personality disorder rarely seek treatment for their condition. This is an issue found in many personality disorders, which prevents many people who are afflicted with these conditions from coming forward for treatment: they tend to view their condition as not conflicting with their self-image and their abnormal perceptions and behaviors as rational and appropriate.
Case StUdy: Schizoid Personality Disorder
Edgar is a 26-year-old man. Despite extraordinary intelligence, Edgar was not able to complete or participate in any educational programs. He wanted to have a normal life with family and friends, but thought that he was rootless and he felt that other people thought that he was peculiar or odd. He felt that he was an outsider. As a child, he went to various schools because his parents moved around. He was thought of as a lonely wolf and did not participate in the social life, games, or sports with his peers. During class, he was often absent-minded, being absorbed in his own thoughts and fantasies. From around the age of thirteen, he became interested in computers and was quite advanced in his understanding of mathematics. Edgar became exceedingly isolated with his computer as his sole companion and remains detached from people to this day. He has never been in a relationship and expressed no desire to be in one. Edgar is diagnosed with schizoid personality disorder because of his pervasive pattern of detachment from social relationships, his emotional flatness, his lack of desire for relationships, and his preference for solitary activities.
Figure 2. Some schizoid individuals can form relationships based on occupational activities.
The vignette above illustrates the difficulties for those with schizoid personality disorder in establishing stable relationships with significant others like peers and family. Often it is regarded as unusual that a person with schizoid personality disorders complains that they feel isolated. Many schizoid patients, on the contrary, claim to be quite satisfied with their loneliness and it is quite unusual that they wish to have a family. Also, schizoid persons usually accept their situation or even deny any desire for closer relationships.
People who have SPD tend to be happiest when in relationships in which their partner places few emotional or intimate demands on them and does not expect phatic or social niceties. It is not necessarily people they want to avoid, but negative or positive emotional expectations, emotional intimacy, and self-disclosure. Therefore, it is possible for individuals with SPD to form relationships with others based on intellectual, physical, familial, occupational, or recreational activities, as long as there is no need for emotional intimacy. Donald Winnicott explains this is because schizoid individuals “prefer to make relationships on their own terms and not in terms of the impulses of other people.” Failing to attain that, they prefer isolation. In general, friendship among schizoids is usually limited to one person, often also schizoid, forming what has been called a union of two eccentrics.
Key Takeaways: schizoid personality disorder
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This video provides a brief overview of schizoid personality disorder.
You can view the transcript for “Schizoid Personality Disorder in a Minute” here (opens in new window).
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Glossary
alexithymia: the inability to identify and describe emotions
schizoid personality disorder: a personality disorder characterized by a lack of interest in social relationships, a solitary lifestyle, and detachment from others
