SCHIZOID PERSONALITY DISORDER

BACKGROUND

The term "schizoid" was coined in 1908 by Eugen Bleuler to designate a human tendency to direct
attention toward one's inner life and away from the external world, a concept akin to introversion in that it
was not viewed in terms of psychopathology.
Bleuler labeled the exaggeration of this tendency the "schizoid personality". He described these
personalities as "comfortably dull and at the same time sensitive, people who in a narrow manner pursue
vague purposes". In 1910, August Hoch introduced a very similar concept called the "shut-in" personality.
Characteristics of it were reticence, seclusiveness, shyness and a preference for living in fantasy worlds,
among others. In 1925, Russian psychiatrist Grunja Sukhareva described a "schizoid psychopathy" in a
group of children, resembling today's SPD and Asperger's. About a decade later Pyotr Gannushkin also
included Schizoids and Dreamers in his detailed typology of personality types.
INTRODUTION

Schizoid personality disorder is an uncommon condition in which people avoid social activities and
consistently shy away from interaction with others. They also have a limited range of emotional
expression. If you have schizoid personality disorder, you may be seen as a loner or dismissive of others,
and you may lack the desire or skill to form close personal relationships. Because you don't tend to show
emotion, you may appear as though you don't care about others or what's going on around you.

Schizoid personality disorder is a pattern of indifference to social relationships, with a limited range of

emotional expression and experience. People with schizoid personality disorder rarely feel there is
anything wrong with them. The disorder manifests itself by early adulthood through social and emotional
detachments that prevent people from having close relationships. People with it are able to function in
everyday life, but will not develop meaningful relationships with others. They are typically loners and
may be prone to excessive daydreaming as well as forming attachments to animals. They may do well at
solitary jobs others would find intolerable. There is evidence indicating the disorder shares an underlying
genetic architecture with schizophrenia, and social withdrawal is a characteristic of both
disorders. Crucially, people with schizoid personality disorder are in touch with reality, unlike those with
schizophrenia or schizoaffective disorder.

CAUSE

The causes of schizoid personality disorder are not known, although it is believed that a combination of
genetic and environmental factors play a role. Schizoid personality disorder usually begins by early
adulthood, though some features may be noticeable during childhood. These features may cause you to
have trouble functioning well in school, a job, socially or in other areas of life. However, you may do
reasonably well in your job if you mostly work alone. Personality is shaped by a wide variety of factors
including inherited traits and tendencies, childhood experiences, parenting, education, and social
interactions. All of these factors may play some part in contributing to the development of SPD. People
with schizoid personality disorder seem to have no interest in close relationships with others and prefer
to be by themselves.
 RISK FACTORS

The established risk factors for schizoid personality disorder include:

 Family history of schizophrenia
 Long-term isolation and loneliness, beginning in early childhood
 Having cold, distant, neglectful parents
 Childhood sexual abuse
 Prenatal malnutrition or premature birth
 Low birth weight
 Traumatic brain injuries, especially in youth

SYMPTOMS

Personality disorders tend to show significant overlap in their symptoms. Nevertheless, there are specific
signs of schizoid personality disorder that do betray its presence.
The symptoms of schizoid personality disorder include:
 Disinterest in forming close relationships, even in the family
 Preference for solitary careers or hobbies
 An active fantasy life (but people with schizoid personality disorder still recognize the
difference between reality and fantasy)
 Inability to find pleasure in recreational activities
 Indifference to criticism, praise, or other kinds of acknowledgement
 Low or no interest in sexual or romantic relationships
 Muted or limited emotional responses to circumstances or events that triggers such reactions
in other people
 A humorless demeanor
 Lack of understanding of the rules of social behavior
 Living in the moment; a failure to develop long-term goals or ambitions
Men and women with schizoid personality disorders usually remain isolated, even when they are in a
room filled with other people. Their intent to keep themselves apart is obvious, and others may judge them
shy or anti-social because of their avoidant behavior.
But assumptions like this are incorrect. People with schizoid personalities aren’t intimidated by other
people or hostile to them. They simply lack the motivation to socialize and would rather do or think about
other things.

DIAGNOSED People seeking a

diagnosis for a personality disorder must undergo a full psychological evaluation, likely including
questionnaires and specialized tests.

Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual
of Mental Disorders, Fifth Edition  (DSM-5), published by the American Psychiatric Association. For
 schizoid personality disorder specifically to be diagnosed, at least four of these seven symptoms must be
uncovered:

 They do not want or enjoy close relationships, including those with family members.
 They strongly prefer solitary activities.
 They have little, if any, interest in sexual activity with another person.
 They enjoy few, if any, activities.
 They have no close friends or confidants, except possibly first-degree relatives.
 They appear to be indifferent to the praise or criticism of others.
 They are emotionally cold and detached and do not express emotion in response to events
or interactions with others.

Treating personality disorders is a complex undertaking, and anyone diagnosed with schizoid personality
disorder will be encouraged to consult with mental health experts to map out a comprehensive plan for
recovery. Also, symptoms must have begun by early adulthood.

TREATMENT

People with this personality disorder rarely seek treatment, because their thoughts and behavior generally do
not cause them distress. When treatment is sought, psychotherapy -- a form of counseling -- is the form of
treatment most often used. Treatment likely will focus on increasing general coping skills, as well as on
improving social interaction, communication, and self-esteem. Because trust is an important component of
therapy, treatment can be challenging for the therapist, because people with schizoid personality disorder have
difficulty forming relationships with others. Social skills training also can be an important component of
treatment.
There is little data on the effectiveness of various treatments on this personality disorder because it is
seldom seen in clinical settings. However, those in treatment have the option of medication and therapy.
Medication
No medications are indicated for directly treating schizoid personality disorder, but certain medications
may reduce the symptoms of SPD as well as treat co-occurring mental disorders. The symptoms of SPD
mirror the negative symptoms of schizophrenia, such as anhedonia, blunted affect and low energy, and
SPD is thought to be part of the "schizophrenic spectrum" of disorders, which also includes
the schizotypal and paranoid personality disorders, and may benefit from the medications indicated for
schizophrenia. Originally, low doses of atypical antipsychotics like risperidone or olanzapine were used to
alleviate social deficits and blunted affect. However, a 2012 review concluded that atypical antipsychotics
were ineffective for treating personality disorders.
In contrast, the substituted amphetamine bupropion may be used to treat anhedonia.
Likewise, modafinil may be effective in treating some of the negative symptoms of schizophrenia, which
are reflected in the symptomatology of SPD and therefore may help as
well. Lamotrigine, SSRIs, TCAs, MAOIs and hydroxyzine may help counter social anxiety in people with
SPD if present, though social anxiety may not be a main concern for the people who have SPD. However,
 it is not general practice to treat SPD with medications, other than for the short-term treatment of acute co-
occurring axis I conditions (e.g. depression).
Psychotherapy
Individual therapy that successfully attains a long-term level of trust may be useful, as it helps people with
the disorder to establish authentic relationships, in cases where this is desired.
Individual psychotherapy can gradually affect the formation of a true relationship between the patient and
therapist.

Long-term psychotherapy should not be pursued because this disorder is difficult to ameliorate. Instead,
therapy should focus on simple treatment goals to alleviate current pressing concerns or stressors within
the individual's life. Cognitive-restructuring may be proper to address certain types of clear, irrational
thoughts that are negatively influencing the patient's behaviors. This therapeutic plan should be clearly
defined at the onset of treatment. 

 Cognitive behavioral therapy is designed to change behavior. It can be a successful

treatment for this condition because it teaches you how to change your thoughts about and behaviors in
social situations. This may change reluctance to pursue social relationships.
 Group therapy is another option that can help you practice your social skills. This will help
you become more comfortable in social situations.
Individual therapy that successfully attains a long-term level of trust may be useful, as it helps people with
the disorder to establish authentic relationships, in cases where this is desired.
Individual psychotherapy can gradually affect the formation of a true relationship between the patient and
therapist. Long-term psychotherapy should not be pursued because this disorder is difficult to ameliorate.
Instead, therapy should focus on simple treatment goals to alleviate current pressing concerns or stressors
within the individual's life. Cognitive-restructuring may be proper to address certain types of clear,
irrational thoughts that are negatively influencing the patient's behaviors. This therapeutic plan should be
clearly defined at the onset of treatment.