Affecting less than 1% of the general population and more men than women, Schizoid Personality Disorder is one of the most misunderstood of all the personality disorders. Because of its similarity in name and the use of the term “schizoid” in popular culture, Schizoid Personality Disorder is sometimes mistaken for Schizophrenia. While it is viewed clinically as on the schizophrenia spectrum, Schizoid Personality Disorder is not Schizophrenia and differs significantly. People with Schizoid Personality Disorder do not present with the detachment from reality that is the defining characteristic of schizophrenia. They make sense when they speak.
Defining Schizoid Personality Disorder
When talking about personality disorders, it is imperative to understand just what that means. A personality disorder is more than just a quirkiness or eccentricity. A personality disorder is characterized by deeply ingrained and enduring specific patterns of beliefs and behavior that markedly deviate from accepted cultural behavioral standards. Early signs of personality disorders typically emerge in adolescence, and cause long-term problems in maintaining relationships and the ability to function within established societal boundaries.
Personality disorders are essentially long-standing problems of self-identify and interpersonal functioning. There are ten personality disorders as defined by the current Diagnostic and Statistical Manual (DSM-5). All personality disorders share four common features, although the degree to which each presents will vary:
- Distorted thought patterns
- Impaired affectivity (emotional response)
- Impaired impulse control
- Problems with interpersonal functioning
These personality disorders are grouped into “clusters” based on similarity on presentation:
- Cluster A: odd or eccentric presentation
- Cluster B: dramatic, emotional or erratic presentation
- Cluster C: anxious or fearful presentation
Schizoid Personality Disorder, often abbreviated as SzPD, is categorized as a Cluster A personality disorder.
Symptoms or What SzPD Might Look Like
Schizoid Personality Disorder is characterized by an enduring pattern of detachment from, and a general lack of interest in, social interactions and relationships (even sex). There is an aloofness that is often perceived as cold, uncaring or even rude especially to someone who doesn’t know the person.
People with this order tend to be loners, often choosing solitary activities and jobs over more social endeavors. They avoid or are markedly disinterested in the relationships in their lives, including relationships with family members. They are sometimes reasonably close to a first-degree relative such as a mother or sibling. This detachment from social engagement is pervasive across settings and impacts their ability to establish or maintain relationships.
People with SzPD are often perceived by others as humorless, aloof, cold or uncaring. Communication is hampered by vague or concrete speech and poor eye contact. They don’t read social cues and nuances well. They tend to see themselves as observers of life as opposed to active participants and avoid intimacy and connections to maintain their sense of self-sufficiency and independence. Loneliness is a persistent and inevitable consequence.
Many people with this disorder remain single and may even remain living with parents. Despite the avoidance of social engagement, some do enter relationships, but their symptoms tend to create dysfunction within the relationship. The presence of personality disorder within a marriage has been linked with decreased marital satisfaction and increased marital conflict.
Traits often emerge in childhood and become more apparent over time. These are often the kids who are loners and seem to like doing things by themselves. They have little interest in what others are doing. As teens, they may have little or no interest in dating, not because of fear, but rather due to general disinterest. By the time they are adults, the pattern becomes quite clear.
Diagnosing Schizoid Personality Disorder
It should be noted that while symptoms tend to emerge in adolescence, formal diagnosis of a personality disorder is most often made in adulthood. A personality disorder diagnosis requires specific time parameters that are usually unmet in the adolescent time frame.
The diagnosis of a personality disorder requires a thorough clinical assessment. This assessment is usually done by a psychiatrist or some other licensed mental health clinician with experience in the clinical assessment of personality disorders. This assessment involves not only evaluating patterns of behavior and functioning but also ruling out other possible causes for the presentation.
A medical exam should be a part of any complete assessment to rule out a medical etiology. The physiological effects from any number of medical conditions can affect a client’s behavioral and cognitive functioning. As noted in the DSM-5, if symptoms are the result of the effects of a medical condition, the diagnosis of Schizoid Personality Disorder cannot be made.2
As a part of the diagnostic assessment, the clinician will differentially diagnose, or rule out, other psychiatric disorders that can present in similar fashion:
Schizophrenia – People with schizoid personality disorder do not generally experience cognitive or perceptual disturbances like paranoia or hallucinations.
Schizotypal Personality Disorder – People with this disorder experience distorted thinking and perception. People with Schizoid Personality Disorder do not.
Autism Spectrum Disorder – Impairments in social functioning are less severe in persons with Schizoid Personality Disorder. Avoidance is based on general disinterest.
Avoidant Personality Disorder – This disorder is characterized by a fear of embarrassment or rejection. People with Schizoid Personality Disorder avoid based on disinterest in social relationships.
Depression – Depression involves a pervasive disturbance in mood. This disturbance is generally not seen in people with Schizoid Personality Disorder. They are often quite content in their lives and come into treatment due to pressure from others.
The clinical diagnosis of Schizoid Personality Disorder is made based on clinical presentation and history of cognitive, affective, interpersonal, and behavioral tendencies and functioning using specific diagnostic criteria, as outlined in the DSM-5.
To make the diagnosis of Schizoid Personality Disorder, there must be a pervasive pattern of detachment from and disinterest in relationships along with restricted emotional expression in social interactions.
Four (or more) of the following criteria must also be present:
- Neither desires nor enjoys close relationships, including those with family
- Preference for solitary activities, including jobs
- Little, if any, interest in sex with another person
- Takes little pleasure in activities
- Lack of close friends or confidants, except maybe a 1st-degree relative
- Appears indifferent to praise or criticism
- Presents as emotionally cold, detached or has a flattened affect
For a personality disorder to be diagnosed in persons under 18, the pattern must have been present for at least 1 year, except for antisocial personality disorders, which cannot be diagnosed in people under 18.
Causes of Schizoid Personality Disorder
Very little is known about the causes of Schizoid Personality Disorder. It has long been believed that Schizoid PD is somehow related genetically to schizophrenia, but the empirical support for that hypothesis is very weak. Some research suggests a genetic link to schizophrenia and has found a similar occurrence of Schizoid Personality Disorder among the relatives of people who have schizophrenia (about 5%).
There has been a suggestion of an association between Schizoid Personality Disorder and autism with expression based on genetic influences. That linkage is unclear. Empirical evidence is weak and more research is needed.
Other research suggests that the development of Schizoid Personality Disorder is, at least in part, a result of parenting style and early childhood influences. People with this disorder often report having parents who were cold, unaffectionate, neglectful or unresponsive to emotional needs.
The bottom line is, we don’t know the exact cause. It is likely a combination of factors that research has yet to fully uncover.
Treatment of Schizoid Personality Disorder
People with Schizoid Personality Disorder most often seek treatment at the urging of a loved one or to avoid a problem of some kind. Due to avoidance, they will often not seek treatment on their own. That said, below are the primary types of therapy they will seek:
- Psychotherapy Treatment for Schizoid Personality Disorder lies primarily with the use of psychotherapy or “talk” therapy. Individual therapy can help people with this disorder learn to establish and experience authentic relationships via the therapist-client dynamic.
- Cognitive Behavioral Therapy – CBT is helpful in addressing problematic beliefs and behaviors that impede optimal functioning. Cognitive restructuring can help to confront and redefine irrational or distortions in thinking that can negatively influence the person’s behavior.Studies have found that psychotherapy has been very effective for people with this disorder to alleviate symptoms and improve the quality of functioning.
Goals of therapy are generally focused on learning ways to cope with stressors that negatively impact the person and psychosocial skills. The treatment plan and goals should be clearly delineated at the outset of therapy.
There is no medication to “cure” a personality disorder. Pharmacotherapy for this and other personality disorders tends to be symptom- specific, addressing problematic symptoms that may occur and are amenable to pharmacological interventions. Some of those symptoms may include mood dysregulation (e.g., anxiety, depression, mood lability), perceptual disturbances such as hallucinations or impulsive behaviors such as self-harm. The goal of pharmacological intervention is to alleviate the severity of symptoms so that the person can more fully engage in their therapy.
While there is no one way to therapeutically address a personality disorder, psychotherapy or psychosocial interventions can help people manage their symptoms in meaningful ways. There is still much to learn about personality disorders and how best to treat them.