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Schizoid Personality Disorder:
Self-Imposed Social Isolation
Schizoid personality disorder prevents people from forming normal social relationships and results in social isolation. The individual afflicted with schizoid personality disorder does not desire social relationships and appears to be indifferent to others.
The cause of schizoid personality disorder is unknown, but it may be connected, as the name schizoid implies, to schizophrenia. The risk factors for schizoid personality disorder and schizophrenia are similar, and schizoid personality disorder may precede schizophrenia onset, major depressive episodes, and certain delusional disorders.
What we know about schizoid personality disorder is limited. The very nature of the condition makes it unlikely that someone suffering from schizoid personality disorder will seek treatment. Men are more often diagnosed with schizoid personality disorder than women, and the disorder appears to produce more severe and debilitating symptoms in men. This gender discrepancy may be because society sees social isolation and withdrawal in men as more unusual than in women.
Statistically, it is estimated that 6.5 percent of Americans — 3.1 percent of the adult US population, meet the diagnostic criteria for schizoid personality disorder, but exact numbers are unknown due to the disorder's tendency towards social isolation.
Symptoms and Diagnosis of Schizoid Personality Disorder
A number of habits, personality traits, and other symptoms are common to schizoid personality disorder, and must be present for a diagnosis. Diagnosis is made according to the criteria in the DSM-IV, which defines schizoid personality disorder 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..."
To be diagnosed with schizoid personality disorder, the DSM-IV also requires the presence of at least four of the following symptoms:
- 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 affectivity.
From the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, 1994.
While schizoid personality disorder shares some symptoms with schizophrenia, including social withdrawal and low affect (emotional range), the personality disorder does not produce symptoms as severe as schizophrenia. Schizoid personality disorder does not hinder daily functioning to the extent of schizophrenia, and the hallucinations, delusions, and inability to differentiate between real and psychotic events so common to schizophrenia are rarely present in schizoid personality disorder.
Schizophrenia is not the only disorder that must be ruled out when diagnosing schizoid personality disorder. Other conditions that may mimic schizoid personality symptoms include:
- delusional disorders
- mood disorders with psychotic features
- autism
- Asperger's syndrome, a milder variant of autism
- chronic substance abuse
- personality changes due to underlying medical conditions
- schizotypal personality disorder
- paranoid personality disorder
- avoidant personality disorder
- obsessive compulsive personality disorder.
Treatment and Schizoid Personality Disorder
Without treatment, people with schizoid personality disorder often withdraw as completely as possible from society and only rarely seek treatment. Social isolation and avoidance of interpersonal relationships makes it unlikely that others will encourage the schizoid personality disorder patient to seek help, or to offer support outside of therapy.
Individuals who are treated for schizoid personality disorder have few therapeutic options available. While a number of medications help reduce social anxiety, it is not clear that schizoid personality disorder has any connection with social anxiety. Unlike avoidant personality disorder, which is characterized by extreme shyness and social discomfort, schizoid personality disorder seems more the result of a deficiency in socialization urges than with anxiety.
Psychotherapy has been known to help with schizoid personality disorder, but the schizoid personality's inability to relate to others makes it difficult for therapists to build trust and meaningful connections with the patient. Group therapy has been known to benefit schizoid personality disorder, but only if the group is tightly controlled with clear limits on the amount of social interaction.
Resources
American Psychiatric Association. Diagnostic criteria for 301.20: Schizoid personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, Washington, DC, 1994.
Grohol, J. (updated 2005). Schizoid personality disorders: Symptoms.
Long, P.W. (nd). Schizoid personality disorder.
National Institutes of Health. (2004). Landmark survey reports on the prevalence of personality disorders in the United States.
National Library of Medicine. (updated 2003). Schizoid personality disorder. MedlinePlus Medical Encyclopedia.
National Mental Health Association. (nd). Personality disorders.
