Schizoid personality disorder
Schizoid personality disorder is
Symptoms typically start in late childhood or adolescence. The cause of SzPD is uncertain, but there is some evidence of links and shared genetic risk between SzPD, other cluster A personality disorders, and schizophrenia. Thus, SzPD is considered to be a "schizophrenia-like personality disorder". It is diagnosed by clinical observation, and it can be very difficult to distinguish SzPD from other mental disorders or conditions.
The effectiveness of psychotherapeutic and pharmacological treatments for the disorder has yet to be empirically and systematically investigated. This is largely because people with SzPD rarely seek treatment for their condition. Originally, low doses of atypical antipsychotics were used to treat some symptoms of SzPD, but their use is no longer recommended. The substituted amphetamine bupropion may be used to treat associated anhedonia. However, it is not general practice to treat SzPD with medications, other than for the short-term treatment of acute co-occurring disorders. Talk therapies such as cognitive behavioral therapy may not be effective, because people with SzPD may have a hard time forming a good working relationship with a therapist.
SzPD is a poorly studied disorder, and there is little clinical data on SzPD because it is rarely encountered in clinical settings. Studies have generally reported a prevalence of less than 1%. It is more commonly diagnosed in males than in females. SzPD is linked to negative outcomes, including a significantly compromised quality of life, reduced overall functioning even after 15 years, and one of the lowest levels of "life success" of all personality disorders. Bullying is particularly common towards schizoid individuals. Suicide may be a running mental theme for schizoid individuals, though they are not likely to attempt it. Some symptoms of SzPD, however, have been stated as general risk factors for serious suicidal behavior.
Signs and symptoms
Social isolation
SzPD is associated with a dismissive-avoidant attachment style. People with this disorder will rarely maintain close relationships and often exclusively choose to participate in solitary activities. People with schizoid personality disorder typically have no close friends or confidants, except for a close relative on occasions.They usually prefer hobbies and activities that do not require interaction with others. People with SzPD may be averse to social situations due to difficulties deriving pleasure from physical or emotional sensations, rather than due to social anhedonia.
One potential motivation for avoiding social situations is that they feel that it intrudes on their freedom. Relationships can feel suffocating for people with SzPD, and they may think of them as opportunities for entrapment.
Patients with this disorder are often independent and turn to themselves as sources of validation. They tend to be the 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.
Patients with SzPD can feel as if close emotional bonds are dangerous to themselves and others. They may have feelings of inadequacy or shame. Some people with SzPD may experience a deep desire to connect with others, yet will be terrified by the dangers inherent in doing so. Avoidance of social situations may be a method of avoiding being hurt or rejected.
Individuals with SzPD can 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 for schizoid individuals is usually limited to one other person, who is often also schizoid, forming what has been called a union of two eccentrics; "within it – the ecstatic cult of personality, outside it – everything is sharply rejected and despised". Their unique lifestyle can lead to social rejection and people with SzPD are at a higher risk of facing bullying or homelessness. This social rejection can reinforce their asocial behavior.
Sexuality
People with this disorder usually have little to no interest in sexual or romantic relationships; it is rare for people with SzPD to date or marry. Sex often causes individuals with SzPD to feel that their personal space is being violated, and they commonly feel that masturbation or sexual abstinence is preferable to the emotional closeness they must tolerate when having sex. Significantly broadening this picture are notable exceptions of SzPD individuals who engage in occasional or even frequent sexual activities with others. Individuals with SzPD have long been noted to have an increased rate of unconventional sexual tendencies, though if present, these are rarely acted upon. Schizoid people are often labeled asexual or present with "a lack of sexual identity". Kernberg states that this apparent lack of sexuality does not represent a lack of sexual definition but rather a combination of several strong fixations to cope with the same conflicts. People with SzPD are often able to pursue any fantasies with content on the internet while remaining completely unengaged with the outside world.Emotions
Sensory or emotional experiences typically provide little enjoyment for people with SzPD. They rarely display strong emotions or react to anything. People with SzPD can have difficulty expressing themselves and seem to be directionless or passive. Individuals with SzPD can also experience anhedonia. They can also have difficulty understanding others' emotions and social cues.It can be hard for people with SzPD to assess the impact of their actions in social situations. People with this condition are often indifferent towards criticism or praise and can appear distant, aloof, or uncaring to others. They may avoid others and expressing themselves as a method of keeping others distant and preventing themselves from being hurt. Remaining alone and expressionless can feel safe and comfortable for people with SzPD. Expressing themselves can make them feel shame or discomfort. People with SzPD may feel inadequate and can be sensitive, although they have difficulty expressing it. Alexithymia, or difficulties understanding one's own emotions, is common amongst people with SzPD. This leads to them isolating themselves to avoid the discomfort and stimulation that emotional experiences offer.
According to Guntrip, Klein, and others, people with SzPD may possess a hidden sense of superiority and lack dependence on other people's opinions. This is very different from the grandiosity seen in narcissistic personality disorder, which is described as "burdened with envy" and with a desire to destroy or put down others. Additionally, schizoid individuals do not go out of their way to achieve social validation. Unlike narcissists, schizoid people will often keep their creations private to avoid unwelcome attention or the feeling that their ideas and thoughts are being appropriated by the public. When forced to rely on others, a person with SzPD may feel panic or terror.