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Schizoid Personality Disorder: Signs and Treatment


Schizoid personality disorder, abbreviated as ScPD and sometimes SPD, is a cluster A “odd and eccentric” personality disorder. The key characteristic of this particular personality disorder is indifference toward other people, plus social isolation.

The Diagnostic Statistical Manual of Mental Disorders (DSM-5) describes ScPD as “a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity to form close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts.”

Prevalence and risk factors

The prevalence in the western cultures is reported to be just under 3%, which makes it one of the most common of the 10 personality disorders (PDs). However, it is indicated that there is a limited amount of literature on the prevalence of ScPD, especially given that comorbid conditions are common, e.g., schizophrenia.

As with the majority of PDs, the exact cause for developing the ScPD is not clear, however studies indicate both genetic and environmental factors contribute to the diagnosis of ScPD.

The evidence of genetic links to ScPD is suggested by increased prevalence of this PD if a parent or a first-degree relative has been previously diagnosed with ScPD or schizophrenia. Additionally, it is observed that SCPD is more common in men than women.

Individuals who grew up with a family who was not able to meet their emotional needs are also at increased risk of developing the ScPD. Similarly, children who have been abused, neglected or abandoned early on tend to exhibit more ScPD characteristics compared to the general population.

Signs and symptoms

Even though the diagnosis of personality disorders is primarily attributed only after 18 years of age, because the individual personality is assumed to be developing before that, the ScPD is an exception. This type of personality disorder can often be first noticed during childhood years, with symptom severity increasing with age.

The symptoms of the disorder can have an impact on multiple life domains including family relationships, school, and work performance. Typically, a person with ScPD will exhibit several of the below characteristics:

  • Is preoccupied with introspection.
  • Exhibits indifference to both positive and negative evaluation (e. g., does not respond to praise or affirmation, as well as to criticism or rejection).
  • Feels detached from other, both family, and peers.
  • Exhibits little or no desire at all in forming close relationships.
  • Exhibits behaviors that are not in line with social norms and.or expectations.
  • Does not experience fun or pleasure in activities.
  • Avoids, and does not enjoy social or family events, gatherings, celebrations.
  • Can be often seen or described as cold, withdrawn.
  • Exhibits flattened affectivity, e. g., is not romantically engaging.
  • Exhibits no interest in being part of a family or social group.
  • If forced to pick an activity, is primarily interested in solitary activities.
  • Has little if a ny interest in romantic or sexual experiences.
  • Typically has no close friends other than immediate relatives.

It is often described that individuals with SPD view themselves more as a bystander of their own life instead of an active member. Often, they take no part in and have no interest in the outside world, society, for example what is happening in the world, fashion, trends, discoveries.

Despite common perception, ScPD is not inherently violent, however it can be dangerous for the individual him- or herself. Even though there is no causal link between a diagnosis and violent behavior, there is an increased prevalence of self-harm in ScPD individuals. However, this is suggested to be in part due to co-occurring disorders, such as schizophrenia.

Treatment and help

The primary treatment option for individuals with SCPD is therapy. Unfortunately, it is very common for the individual with ScPD to not see the need for change, and they therefore rarely seek help. Moreover, the innate nature of this particular PD, namely the tendency for isolation makes it difficult to support them or assist them throughout the process of treatment.

Even when the treatment is sought out, interpersonal therapy has been shown to be more difficult because of reluctance and avoidance of social connections, building relationships with the clinician.

Alternatively, it is often suggested for the individuals with ScPD to join group therapy, which removes the “one-on-one” pressure and can be beneficial for developing social skills.

Medications for ScPD are only prescribed in the presence of other comorbid conditions (schizophrenia, depression), or extreme symptoms (anxiety), but not for the personality disorder itself.

What is it like living with schizoid personality disorder?

The particular PD characteristics of avoidance and indifference to social or romantic relationships does not mean they do not feel lonely or isolated. The separated lifestyle often leads to depression and in extreme cases suicidal thoughts.

Generally, individuals with ScPD do perform well at work, however only if its nature does not require collaboration or group decisions. They might find it easier to develop relationships that are centered on intellectual or occupational characteristics rather than close interpersonal bonds.

If you have a close one suffering from ScPD, you can help them by encouraging them to seek out treatment. It can require a lot of patience to maintain the relationship with the ScPD individual, try not to judge them or pursue them, push them into activities that make them uncomfortable.

Alternative activities that do not require an emotional investment can be more suitable for you to do together. It is important to understand that ScPD is not something voluntary, so an individual suffering from this PD will not likely reach out or ask for help, support or seek your company, therefore it can sometimes feel like a one-sided relationship. Nonetheless, your support and understanding can help them to lessen the feelings of isolation.

References

American Psychiatric Association. (2013). Schizoid personality disorder. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing.

Triebwasser, J., Chemerinski, E., Roussos, P., and Siever, L.J. (2012). Schizoid personality disorder. Journal of Personality Disorders.

Volkert, J., Gablonski, T.C., and Rabung, S. (2018). Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. The British Journal of Psychiatry.

Ward, S.A. (2018). The Black Hole: Exploring the Schizoid Personality Disorder, Dysfunction, and Deprivation with their Roots in the Prenatal and Perinatal Period. Journal of Prenatal & Perinatal Psychology & Health.

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