Schizoid personality disorder
Overview
Schizoid personality disorder (SPD) is a personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...

 characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and sometimes (sexual) apathy
Apathy
Apathy is a state of indifference, or the suppression of emotions such as concern, excitement, motivation and passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical or physical life.They may lack a sense of purpose or meaning in...

, with a simultaneous rich, elaborate, and exclusively internal fantasy world
Fantasy (psychology)
Fantasy in a psychological sense is broadly used to cover two different senses, conscious and unconscious. In the unconscious sense, it is sometimes spelled "phantasy".-Conscious fantasy:...

. SPD is not the same as schizophrenia, although they share some similar characteristics such as detachment or blunted affect
Blunted affect
Blunted affect is the scientific term describing a lack of emotional reactivity on the part of an individual. It is manifest as a failure to express feelings either verbally or non-verbally, even when talking about issues that would normally be expected to engage the emotions...

; there is increased prevalence of the disorder in families with schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

.

Some psychologists argue that the definition of SPD is flawed due to cultural bias
Cultural bias
Cultural bias is the phenomenon of interpreting and judging phenomena by standards inherent to one's own culture. The phenomenon is sometimes considered a problem central to social and human sciences, such as economics, psychology, anthropology, and sociology...

: "One reason schizoid people are pathologized
Medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals to study, diagnose, prevent or treat...

 is because they are comparatively rare.
Encyclopedia
Schizoid personality disorder (SPD) is a personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...

 characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and sometimes (sexual) apathy
Apathy
Apathy is a state of indifference, or the suppression of emotions such as concern, excitement, motivation and passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical or physical life.They may lack a sense of purpose or meaning in...

, with a simultaneous rich, elaborate, and exclusively internal fantasy world
Fantasy (psychology)
Fantasy in a psychological sense is broadly used to cover two different senses, conscious and unconscious. In the unconscious sense, it is sometimes spelled "phantasy".-Conscious fantasy:...

. SPD is not the same as schizophrenia, although they share some similar characteristics such as detachment or blunted affect
Blunted affect
Blunted affect is the scientific term describing a lack of emotional reactivity on the part of an individual. It is manifest as a failure to express feelings either verbally or non-verbally, even when talking about issues that would normally be expected to engage the emotions...

; there is increased prevalence of the disorder in families with schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

.

Some psychologists argue that the definition of SPD is flawed due to cultural bias
Cultural bias
Cultural bias is the phenomenon of interpreting and judging phenomena by standards inherent to one's own culture. The phenomenon is sometimes considered a problem central to social and human sciences, such as economics, psychology, anthropology, and sociology...

: "One reason schizoid people are pathologized
Medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals to study, diagnose, prevent or treat...

 is because they are comparatively rare. People in majorities tend to assume that their own psychology is normative
Normative
Normative has specialized contextual meanings in several academic disciplines. Generically, it means relating to an ideal standard or model. In practice, it has strong connotations of relating to a typical standard or model ....

 and to equate difference with inferiority". Therefore "[t]he so-called schizoid personality disorder is one of the more blatant examples of the APA
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...

’s pathologizing of normal human differences."

History

The term schizoid was coined in 1908 by Eugen Bleuler
Eugen Bleuler
Paul Eugen Bleuler was a Swiss psychiatrist most notable for his contributions to the understanding of mental illness and for coining the term "schizophrenia."-Biography:...

 to designate a natural 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 also labeled the exaggeration
Exaggeration
Exaggeration is a representation of something in an excessive manner. The exaggerator has been a familiar figure in Western culture since at least Aristotle's discussion of the alazon: 'the boaster is regarded as one who pretends to have distinguished qualities which he possesses either not at all...

 of this tendency the “schizoid personality”.

Studies on the schizoid personality have developed along two distinct paths; (1) the descriptive psychiatry
Descriptive psychiatry
Descriptive psychiatry is based on the study of observable symptoms and behavioral phenomena rather than underlying psychodynamic processes. In descriptive psychiatry, the clinical psychiatrist focuses on empirically observable behaviors and conditions, such as words spoken or actions taken.Modern...

 tradition
which focuses on overtly observable, behavioral, and describable symptoms (finding its clearest exposition in the DSM-IV revised); and (2) the dynamic psychiatry
Dynamic psychiatry
Dynamic psychiatry is that which is based on the study of emotional processes, their origins, and the mental mechanisms underlying them, rather than observable behavioral phenomena, in contrast with descriptive psychiatry which is based on the study of observable symptoms and behavioral phenomena...

 tradition
which includes the exploration of covert or unconscious motivations and character structure
Character structure
A character structure is a system of relatively permanent traits that are manifested in the specific ways that an individual relates and reacts to others, to various kinds of stimuli, and to the environment...

 as elaborated by classic psychoanalysis and object-relations theory.

The descriptive tradition began in Ernst Kretschmer's
Ernst Kretschmer
Ernst Kretschmer Prof. Dr. med. Dr. phil. h.c., was a German psychiatrist who researched the human constitution and established a typology...

 (1925) description of observable schizoid behaviors, which he organized into three groups of characteristics:
  1. unsociability, quietness, reservedness, seriousness, and eccentricity
  2. timidity, shyness with feelings, sensitivity, nervousness, excitability, and fondness of nature and books
  3. pliability, kindliness, honesty, indifference, silence, and cold emotional attitudes.


These characteristics were the precursors of the DSM-IV division of schizoid character into three distinct personality disorders, though Kretschmer himself did not conceive of separating these behaviors to the point of radical isolation, rather he considered them to be simultaneously present as varying potentials in schizoid individuals. For Kretschmer, the majority of schizoids are not either oversensitive or cold, but they are oversensitive and cold "at the same time" in quite different relative proportions, with a tendency to move along these dimensions from one behavior to the other.

The second path, that of dynamic psychiatry, began with observations by Eugen Bleuler (1924) who observed that the schizoid person and schizoid pathology were not things to be set apart. In 1940, W. R. D. Fairbairn
Ronald Fairbairn
William Ronald Dodds Fairbairn was a Scottish psychiatrist, psychoanalyst and a central figure in the development of the object relations theory of psychoanalysis.-Life:He was born in Edinburgh in 1889...

 presented his seminal work on the schizoid personality in which most of what is known today about schizoid phenomena is derived. Here Fairbairn delineated four central schizoid themes: (1) the need to regulate interpersonal distance as a central focus of concern; (2) the ability to mobilize self preservative defenses and self-reliance; (3) a pervasive tension between the anxiety laden need for attachment and the defensive need for distance, manifesting in observable behavior as indifference; and (4) an overvaluation of the inner world at the expense of the outer world. Following Fairbairn, the dynamic psychiatry tradition has continued to produce rich explorations on the schizoid character, most notably from writers Nannarello (1953); Laing (1960); Winnicott (1965); Guntrip (1969); Khan
Masud Khan
Mohammed Masud Raza Khan was an Indian-born British psychoanalyst. His training analyst was Donald Winnicott.-Early life:...

 (1974); Akhtar
Salman Akhtar
Salman Akhtar is a psychoanalyst who also holds a professorship at the Jefferson Medical College in Philadelphia....

 (1987); Seinfeld (1991); Manfield (1992); and Klein (1995).

Signs and Symptoms

People with SPD are often perceived as aloof, cold, and indifferent, which causes interpersonal difficulty. Most individuals diagnosed with SPD have trouble establishing personal relationships or expressing their feelings in a meaningful way, and may remain passive in the face of unfavorable situations. Their communication with other people may be indifferent and concise at times. Because of their lack of meaningful communication with other people, those who are diagnosed with SPD are not able to develop accurate reflections of themselves with respect to how well they are getting along with others. Such reflections are important for a person's self awareness and ability to assess the impact of their own actions in social situations. R.D. Laing suggests that without being enriched by injections of interpersonal reality, there occurs an impoverishment in which one's self image becomes increasingly empty and volatilized, leading the individual himself to feel unreal.

According to Gunderson, people with SPD "feel lost" without the people they are normally around because they require a sense of security and stability. However, when the patient's personal space is violated, they feel suffocated and feel the need to free themselves and be independent. People who have SPD tend to be happiest when they are in a relationship in which the partner places few emotional or intimate demands on them; it is not people as such that they want to avoid, but both negative and positive emotions, emotional intimacy, and self disclosure.

This means that it is possible for schizoid individuals to form relationships with others based on intellectual, physical, familial, occupational, or recreational activities as long as these modes of relating do not require or force the need for emotional intimacy, which the affected individual will reject.

Donald Winnicott
Donald Winnicott
Donald Woods Winnicott was an English paediatrician and psychoanalyst who was especially influential in the field of object relations theory. He was a leading member of the British Independent Group of the British Psychoanalytic Society, and a close associate of Marion Milner...

 summarizes the schizoid need to modulate emotional interaction with others with his comment that schizoid individuals "prefer to make relationships on their own terms and not in terms of the impulses of other people," and failing to attain that, they prefer isolation.

The 'Secret schizoid'

According to Ralph Klein, there are many fundamentally schizoid individuals who present with an engaging, interactive personality style which contradicts the observable characteristic emphasized by the DSM-IV and ICD-10 definitions of the schizoid personality. Klein classifies these individuals as secret schizoids, presenting themselves as socially available, interested, engaged, and involved in interacting in the eyes of the observer, while at the same time remaining emotionally withdrawn and sequestered within the safety of the internal world.

While withdrawal or detachment from the outer world is a characteristic feature of schizoid pathology, it is sometimes overt and sometimes covert. When overt, it matches the typical description of the schizoid personality offered in the DSM-IV. However, according to Klein, it is "just as often" a covert, hidden internal state of the patient in which what meets the objective eye may not be what is present in the subjective, internal world of the patient. Klein therefore cautions that one should not miss identifying the schizoid patient because one cannot see the patient's withdrawal through the patient's defensive, compensatory, engaging interaction with external reality. Klein suggests that one need only ask the patient what his or her subjective experience is in order to detect the presence of the schizoid refusal of emotional intimacy.

Descriptions of the schizoid personality as "hidden" behind an outward appearance of emotional engagement have been recognized as far back as 1940 with Fairbairn's description of 'schizoid exhibitionism,' in which he remarked that the schizoid individual is able to express a great deal of feeling and to make what appear to be impressive social contacts while in reality giving nothing and losing nothing; because he is only "playing a part," his own personality is not involved. According to Fairbairn, "[the person] disowns the part which he is playing and thus the schizoid individual seeks to preserve his own personality intact and immune from compromise." Further references to the secret schizoid come from Masud Khan
Masud Khan
Mohammed Masud Raza Khan was an Indian-born British psychoanalyst. His training analyst was Donald Winnicott.-Early life:...

, Jeffrey Seinfeld, and Philip Manfield, who gives a palpable description of an SPD individual who actually "enjoys" regular public speaking engagements, but experiences great difficulty in the breaks when audience members would attempt to engage him emotionally. These references expose the problems involved in relying singularly on outer observable behavior for assessing the presence of personality disorders in certain individuals.

Avoidant Attachment Style

The question of whether SPD qualifies as a full personality disorder or simply as an avoidant attachment style is a contentious one. If what has been known as schizoid personality disorder is no more than an attachment style requiring more distant emotional proximity, then many of the more problematic reactions these individuals show in interpersonal situations may be partly accounted for by the social judgments commonly imposed on those with this style. To date several sources have confirmed the synonymy of SPD and avoidant attachment style which leaves open the question of how researchers might best approach this subject in future diagnostic manuals, and in therapeutic practice. However, characteristically - and depending on the severity of the disorder - individuals do not seek social interactions merely due to lack of interest, as opposed to the avoidant personality type in which there is craving for interactions, but then fear of rejection.

Schizoid Sexuality

People with SPD are sometimes sexually apathetic, though they do not typically suffer from anorgasmia
Anorgasmia
Anorgasmia, or Coughlan's syndrome, is a type of sexual dysfunction in which a person cannot achieve orgasm, even with adequate stimulation. In males the condition is often related to delayed ejaculation . Anorgasmia can often cause sexual frustration...

. Many schizoids have a healthy sex drive but some prefer to masturbate rather than deal with the social aspects of finding a sexual partner. Therefore, their need for sex may appear to be less than those who do not have SPD, as individuals with SPD prefer to remain alone and detached. When having sex, individuals with SPD often feel that their personal space is being violated, and they commonly feel that masturbation
Masturbation
Masturbation refers to sexual stimulation of a person's own genitals, usually to the point of orgasm. The stimulation can be performed manually, by use of objects or tools, or by some combination of these methods. Masturbation is a common form of autoeroticism...

 or sexual abstinence
Sexual abstinence
Sexual abstinence is the practice of refraining from some or all aspects of sexual activity for medical, psychological, legal, social, philosophical or religious reasons.Common reasons for practicing sexual abstinence include:*poor health - medical celibacy...

 is preferable to the emotional closeness they must tolerate when having sex. Significantly broadening this picture are notable exceptions of SPD individuals who engage in occasional or even frequent sexual activities with others.

Harry Guntrip describes the "secret sexual affair" entered into by some married schizoid individuals as an attempt to reduce the quantity of emotional intimacy focused within a single relationship, a sentiment echoed by Karen Horney's
Karen Horney
Karen Horney born Danielsen was a German-American psychoanalyst. Her theories questioned some traditional Freudian views, particularly his theory of sexuality, as well as the instinct orientation of psychoanalysis and its genetic psychology...

 resigned personality who may exclude sex as being "too intimate for a permanent relationship, and instead satisfy his sexual needs with a stranger. Conversely he may more or less restrict a relationship to merely sexual contacts and not share other experiences with the partner." More recently, Jeffrey Seinfeld, professor of social work at New York University, has published a volume on SPD in which he details examples of "schizoid hunger" which may manifest as sexual promiscuity. Seinfeld provides an example of a schizoid woman who would covertly attend various bars to meet men for the purposes of gaining impersonal sexual gratification, an act, says Seinfeld, which alleviated her feelings of hunger and emptiness.

Salman Akhtar describes this dynamic interplay of overt versus covert sexuality and motivations of some SPD individuals with greater accuracy. Rather than following the narrow proposition that schizoid individuals are either sexual or asexual, Akhtar suggests that these forces may both be present in an individual despite their rather contradictory aims. For Akhtar, therefore, a clinically accurate picture of schizoid sexuality must include both the overt signs: "asexual, sometimes celibate; free of romantic interests; averse to sexual gossip and innuendo," along with possible covert manifestations of "secret voyeuristic and pornographic interests; vulnerable to erotomania
Erotomania
Erotomania is a type of delusion in which the affected person believes that another person, usually a stranger or famous person, is in love with him or her. The illness often occurs during psychosis, especially in patients with schizophrenia or bipolar mania...

; tendency towards compulsive masturbation and perversions," although none of these necessarily apply to all people with SPD.

Causes

There is some evidence to suggest that there is an increased prevalence of schizoid personality disorder in relatives of people with schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

 or schizotypal personality disorder
Schizotypal personality disorder
Schizotypal personality disorder, or simply schizotypal disorder, is a personality disorder that is characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and often unconventional beliefs.-Genetic:...

. Unloving, intrusive or neglectful parenting is hypothesized to play a role.

DSM

The Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

fourth edition, a widely used manual for diagnosing mental disorders, defines schizoid personality disorder (in Axis II Cluster A) as:
A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood (age eighteen or older) and present in a variety of contexts, as indicated by four (or more) of the following:

  1. Neither desires nor enjoys close relationships, including being part of a family
  2. Almost always chooses solitary activities
  3. Has little, if any, interest in having sexual experiences with another person
  4. Takes pleasure in few, if any, activities
  5. Lacks close friends or confidants other than first-degree relatives
  6. Appears indifferent to the praise
    Praise
    Praise is the act of making positive statements about a person, object or idea, either in public or privately. Praise is typically, but not exclusively, earned relative to achievement and accomplishment...

     or criticism
    Criticism
    Criticism is the judgement of the merits and faults of the work or actions of an individual or group by another . To criticize does not necessarily imply to find fault, but the word is often taken to mean the simple expression of an objection against prejudice, or a disapproval.Another meaning of...

     of others
  7. Shows emotional coldness, detachment, or flattened affect

B. Does not occur exclusively during the course of schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

, a mood disorder
Mood disorder
Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature...

 with psychotic features, another psychotic disorder
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

, or a pervasive developmental disorder
Pervasive developmental disorder
Pervasive developmental disorders is a diagnostic category refers to a group of disorders characterized by delays or impairments in communication, social behaviors, and cognitive development.Pervasive developmental disorders include Autism, Asperger's syndrome, Rett's syndrome, Childhood...

 and is not due to the direct physiological effects of a general medical condition.


It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

In the draft of the DSM-V it is proposed that schizoid personality disorder should be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

World Health Organization

The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

's ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

 lists schizoid personality disorder as Schizoid personality disorder.
It is characterized by at least four of the following criteria:

  1. Emotional coldness, detachment or reduced affect
    Affect (psychology)
    Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...

    .
  2. Limited capacity to express either positive or negative emotions towards others.
  3. Consistent preference for solitary activities.
  4. Very few, if any, close friends or relationships, and a lack of desire for such.
  5. Indifference to either praise
    Praise
    Praise is the act of making positive statements about a person, object or idea, either in public or privately. Praise is typically, but not exclusively, earned relative to achievement and accomplishment...

     or criticism
    Criticism
    Criticism is the judgement of the merits and faults of the work or actions of an individual or group by another . To criticize does not necessarily imply to find fault, but the word is often taken to mean the simple expression of an objection against prejudice, or a disapproval.Another meaning of...

    .
  6. Taking pleasure in few, if any, activities.
  7. Indifference to social norm
    Norm (sociology)
    Social norms are the accepted behaviors within a society or group. This sociological and social psychological term has been defined as "the rules that a group uses for appropriate and inappropriate values, beliefs, attitudes and behaviors. These rules may be explicit or implicit...

    s and conventions.
  8. Preoccupation with fantasy
    Fantasy (psychology)
    Fantasy in a psychological sense is broadly used to cover two different senses, conscious and unconscious. In the unconscious sense, it is sometimes spelled "phantasy".-Conscious fantasy:...

     and introspection
    Introspection
    Introspection is the self-observation and reporting of conscious inner thoughts, desires and sensations. It is a conscious and purposive process relying on thinking, reasoning, and examining one's own thoughts, feelings, and, in more spiritual cases, one's soul...

    .
  9. Lack of desire for sexual
    Human sexuality
    Human sexuality is the awareness of gender differences, and the capacity to have erotic experiences and responses. Human sexuality can also be described as the way someone is sexually attracted to another person whether it is to opposite sexes , to the same sex , to either sexes , or not being...

     experiences with another person.


It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Millon's Subtypes

Theodore Millon
Theodore Millon
Theodore Millon is an American psychologist known for his work on personality disorders.-Biography:Millon was born in 1928, the only child of immigrant Jewish parents from Lithuania and Poland. His 19th-century ancestors came from the town of Valozhyn, then a part of the Russian Empire...

 identified four subtypes of schizoid. Any individual schizoid may exhibit none or one of the following:
  • Languid schizoid
including depressive
Depressive personality disorder
Depressive Personality Disorder is a controversial psychiatric diagnosis that denotes a personality disorder with depressive features....

 features
  • Remote schizoid
including avoidant
Avoidant personality disorder
Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...

, schizotypal
Schizotypal personality disorder
Schizotypal personality disorder, or simply schizotypal disorder, is a personality disorder that is characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and often unconventional beliefs.-Genetic:...

 features
  • Depersonalized schizoid
including schizotypal
Schizotypal personality disorder
Schizotypal personality disorder, or simply schizotypal disorder, is a personality disorder that is characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and often unconventional beliefs.-Genetic:...

 features
  • Affectless schizoid
including compulsive
Obsessive-compulsive personality disorder
Obsessive–compulsive personality disorder is a personality disorder characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency.- Signs and symptoms :The primary symptoms of OCPD...

 features

Dynamic Diagnostic Criteria

Ralph Klein, 1995 brought new light into the commonly held beliefs about the schizoid which focus mainly on the schizoid’s apparent disinterest in relationships. Clarifying the causes and conditions underlying the above characteristics, Klein describes a schism in the object of relations of the schizoid. This split involves: (1) the "slave/master" relationship: characterized by exploitation, appropriation, and dehumanization; and (2) the "self in exile:" the aversive recoiling from the exploitative relationship that the self goes into exile. The distanced or unresponsive self in exile is the more commonly recognized aspect of the schizoid. As Klein states: "[the] seeming detachment from feelings should never be accepted as the real state of affairs."

Of particular significance is the correlation between the Narcissistic disorder and the schizoid. For example, the "over entitlement" of the narcissist in a family can result in the "under-entitlement" of the schizoid sibling. It is also the disavowed shame of the narcissist that is often absorbed by, or projected onto the schizoid; thus giving rise to the experience of psychic invasion, and the development of sense of vulnerability to intrusiveness. Paradoxically, a schizoid may also be attracted to exploitative relationships in which they long to experience significance and recognition by serving a need of the other. Yet this same person may be highly aware of any forms of corruption or exploitation outside of this relationship. In this approach diagnosis is based on the dynamic of this split and its consequences, as opposed to diagnosis on the basis of a list of external behaviors.

Guntrip Criteria

Ralph Klein, Clinical Director of the Masterson Institute delineates the following nine characteristics of the schizoid personality as described by Harry Guntrip
Harry Guntrip
Harry Guntrip was a psychologist known for his major contributions to object relations theory. He was a Fellow of the British Psychological Society and a psychotherapist and lecturer at the Department of Psychiatry, Leeds University, and also a Methodist minister. He was described by John D...

: introversion, withdrawnness, narcissism
Narcissism
Narcissism is a term with a wide range of meanings, depending on whether it is used to describe a central concept of psychoanalytic theory, a mental illness, a social or cultural problem, or simply a personality trait...

, self-sufficiency, a sense of superiority, loss of affect
Affect (psychology)
Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...

, loneliness, depersonalization, and regression
Regression (psychology)
Regression, according to psychoanalyst Sigmund Freud, is a defense mechanism leading to the temporary or long-term reversion of the ego to an earlier stage of development rather than handling unacceptable impulses in a more adult way...

.

Introversion

According to Guntrip, "By the very meaning of the term, the schizoid is described as cut off from the world of outer reality in an emotional sense. All this libidinal
Libido
Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...

 desire and striving is directed inward toward internal objects and he lives an intense inner life often revealed in an astonishing wealth and richness of fantasy
Fantasy (psychology)
Fantasy in a psychological sense is broadly used to cover two different senses, conscious and unconscious. In the unconscious sense, it is sometimes spelled "phantasy".-Conscious fantasy:...

 and imaginative life whenever that becomes accessible to observation. Though mostly his varied fantasy life is carried on in secret, hidden away." The schizoid person is cut off from outer reality to such a degree that he or she experiences outer reality as dangerous. It is a natural human response to turn away from sources of danger and toward sources of safety. The schizoid individual, therefore, is primarily concerned with avoiding danger and ensuring safety.

Withdrawnness

According to Guntrip, withdrawnness means detachment from the outer world, the other side of introversion. While there are many schizoid individuals who will present with obvious withdrawnness (a clear and obvious timidity, reluctance, or avoidance of the external world and interpersonal relationships), this defines only a portion of such individuals. Many fundamentally schizoid people present
Human behavior
Human behavior refers to the range of behaviors exhibited by humans and which are influenced by culture, attitudes, emotions, values, ethics, authority, rapport, hypnosis, persuasion, coercion and/or genetics....

 with an engaging, interactive personality style
Personality type
Personality type refers to the psychological classification of different types of individuals. Personality types are sometimes distinguished from personality traits, with the latter embodying a smaller grouping of behavioral tendencies. Types are sometimes said to involve qualitative differences...

. Such a person can appear to be available, interested, engaged, and involved in interacting with others; however, in reality, he or she is emotionally withdrawn and sequestered in a safe place in an internal world. While withdrawnness or detachment from the outer world is a characteristic feature of schizoid pathology
Psychopathology
Psychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes...

, it is sometimes overt and sometimes covert. When it is overt it matches the usual description of the schizoid personality. Just as often, it is a covert, hidden internal state of the patient.

In summary, (1) what meets the objective
Objectivity (philosophy)
Objectivity is a central philosophical concept which has been variously defined by sources. A proposition is generally considered to be objectively true when its truth conditions are met and are "mind-independent"—that is, not met by the judgment of a conscious entity or subject.- Objectivism...

 eye may not be what is present in the subjective
Subjectivity
Subjectivity refers to the subject and his or her perspective, feelings, beliefs, and desires. In philosophy, the term is usually contrasted with objectivity.-Qualia:...

, internal world of the patient; (2) one should not mistake introversion for indifference; and (3) one should not miss identifying the schizoid patient because one cannot see the forest of the patient's withdrawnness through the trees of the patient's defensive, compensatory, engaging interaction with external reality.

Narcissism

Guntrip: "Narcissism
Narcissism
Narcissism is a term with a wide range of meanings, depending on whether it is used to describe a central concept of psychoanalytic theory, a mental illness, a social or cultural problem, or simply a personality trait...

 is a characteristic that arises out of the predominately interior life the schizoid lives. His love objects are all inside him and moreover he is greatly identified with them so that his libidinal attachments appear to be in himself. The question, however, is whether the intense inner life of the schizoid is due to a desire for hungry incorporation of external objects or due to withdrawal from the outer to a presumed safer inner world." The need for attachment as a primary motivational force is as strong in the schizoid person as in any other human being. However, because the schizoid's love objects are internal, he or she finds safety without connecting and attaching to objects in the real world.

Self-sufficiency

Guntrip writes, "This introverted narcissistic self-sufficiency, which does without real external relationships while all emotion
Emotion
Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...

al relations are carried on in the internal world, is a safeguard against anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

 breaking out in dealing with actual people." The more that schizoids can rely on themselves, the less they have to rely on other people and expose themselves to the potential dangers and anxieties associated with that reliance or, even worse, dependence. The vast majority of schizoid individuals show an enormous capacity for self-sufficiency, for the ability to operate alone, independently and autonomously, in managing their worlds.

Sense of superiority

Guntrip states, "a sense of superiority naturally goes with self-sufficiency. One has no need of other people, they can be dispensed with... There often goes with it a feeling of being different from other people." The sense of superiority of the schizoid has nothing to do with the grandiose self of the narcissistic disorder. It does not find expression in the schizoid through the need to devalue or annihilate others who are perceived as offending, criticizing, shaming, or humiliating. This type of superiority was described by a young schizoid man:
"If I am superior to others, if I am above others, then I do not need others. When I say that I am above others, it does not mean that I feel better than them, it means that I am at a distance from them, a safe distance."

It is a feeling of being horizontally, rather than vertically distant.

Loss of affect

According to Guntrip, "Loss of affect in external situations is an inevitable part of the total picture." Because of the tremendous investment made in the self—the need to be self-contained, self-sufficient, and self-reliant—there is inevitable interference in the desire and ability to feel another person’s experience, to be empathic
Empathy
Empathy is the capacity to recognize and, to some extent, share feelings that are being experienced by another sapient or semi-sapient being. Someone may need to have a certain amount of empathy before they are able to feel compassion. The English word was coined in 1909 by E.B...

 and sensitive. Often these things seem secondary, a luxury that has to await securing one's own defensive, safe position. The subjective experience is one of loss of affect. For some patients, the loss of affect is present to such a degree that the insensitivity becomes manifest in the extreme as cynicism
Cynicism (contemporary)
Cynicism is an attitude or state of mind characterized by a general distrust of other's apparent motives, or a general lack of faith or hope in the human race. It is a form of jaded negativity, and other times, realistic criticism or skepticism...

, callousness, or even cruelty. The patient appears to have no awareness of how his or her comments or actions affect and hurt other people. More frequently, the loss of affect is manifest within the patient as genuine confusion, a sense of something missing in his or her emotional life.

Loneliness

According to Guntrip, "Loneliness is an inescapable result of schizoid introversion and abolition of external relationships
Interpersonal relationship
An interpersonal relationship is an association between two or more people that may range from fleeting to enduring. This association may be based on limerence, love, solidarity, regular business interactions, or some other type of social commitment. Interpersonal relationships are formed in the...

. It reveals itself in the intense longing for friendship and love which repeatedly break through. Loneliness in the midst of a crowd is the experience of the schizoid cut off from affective rapport." This is a central experience of the schizoid that is often lost to the observer. Contrary to the familiar caricature
Caricature
A caricature is a portrait that exaggerates or distorts the essence of a person or thing to create an easily identifiable visual likeness. In literature, a caricature is a description of a person using exaggeration of some characteristics and oversimplification of others.Caricatures can be...

 of the schizoid as uncaring and cold, the vast majority of schizoid persons who become patients express at some point in their treatment their longing for friendship
Friendship
Friendship is a form of interpersonal relationship generally considered to be closer than association, although there is a range of degrees of intimacy in both friendships and associations. Friendship and association are often thought of as spanning across the same continuum...

 and love
Love
Love is an emotion of strong affection and personal attachment. In philosophical context, love is a virtue representing all of human kindness, compassion, and affection. Love is central to many religions, as in the Christian phrase, "God is love" or Agape in the Canonical gospels...

. This is not the schizoid patient as described in the DSMs. Such longing, however, may not break through except in the schizoid’s fantasy life, to which the therapist may not be allowed access for quite a long period in treatment. If longing is immediately present, however, it is more likely avoidant personality disorder
Avoidant personality disorder
Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...

.

There is a very narrow range of schizoid individuals, the classic DSM-defined schizoids, for whom the hope of establishing relationships is so minimal as to be almost extinct. The longing for closeness and attachment is almost unidentifiable to this type of schizoid. These individuals will not voluntarily become patients; the schizoid individual who becomes a patient does so often because of the twin motivations of loneliness and longing. This type of schizoid patient still believes that some kind of connection and attachment is possible, and is well suited to psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

. Yet the irony
Irony
Irony is a rhetorical device, literary technique, or situation in which there is a sharp incongruity or discordance that goes beyond the simple and evident intention of words or actions...

 of the DSMs is that they may lead the psychotherapist to approach the schizoid patient with a sense of therapeutic pessimism
Pessimism
Pessimism, from the Latin word pessimus , is a state of mind in which one perceives life negatively. Value judgments may vary dramatically between individuals, even when judgments of fact are undisputed. The most common example of this phenomenon is the "Is the glass half empty or half full?"...

, if not nihilism
Nihilism
Nihilism is the philosophical doctrine suggesting the negation of one or more putatively meaningful aspects of life. Most commonly, nihilism is presented in the form of existential nihilism which argues that life is without objective meaning, purpose, or intrinsic value...

, misreading the patient by believing that the patient’s wariness is indifference and that caution is coldness.

Depersonalization

Guntrip describes depersonalization as a loss of a sense of identity and individuality
Individual
An individual is a person or any specific object or thing in a collection. Individuality is the state or quality of being an individual; a person separate from other persons and possessing his or her own needs, goals, and desires. Being self expressive...

. Depersonalization is a dissociative defense, often described by the schizoid patient as "tuning out," "turning off", or as the experience of a separation between the observing and the participating ego. It is experienced most profoundly by those with schizoid personality disorder when anxieties seem overwhelming. It is a more extreme form of loss of affect: whereas the loss of affect is a more chronic state in schizoid personality disorder, depersonalization is an acute defense against more immediate experiences of overwhelming anxiety or danger.

Regression

Guntrip defined regression as "Representing the fact that the schizoid person at bottom feels overwhelmed by their external world and is in flight from it both inwards and as it were backwards to the safety of the metaphor
Metaphor
A metaphor is a literary figure of speech that uses an image, story or tangible thing to represent a less tangible thing or some intangible quality or idea; e.g., "Her eyes were glistening jewels." Metaphor may also be used for any rhetorical figures of speech that achieve their effects via...

ical womb." Such a process of regression encompasses two different mechanisms: inward and backwards. Regression inward speaks to the magnitude of the reliance on primitive forms of fantasy and self-containment, often of an autoerotic
Autoeroticism
Autoeroticism is the practice of stimulating oneself sexually. The term was popularized toward the end of the 19th century by British sexologist Havelock Ellis, who defined autoeroticism as "the phenomena of spontaneous sexual emotion generated in the absence of an external stimulus proceeding,...

 or even objectless
Asexuality
Asexuality , in its broadest sense, is the lack of sexual attraction and, in some cases, the lack of interest in sex. Sometimes, it is considered a lack of a sexual orientation...

 nature. Regression backwards to the safety of the womb is a unique schizoid phenomenon and represents the most intense form of schizoid defensive withdrawal in an effort to find safety and to avoid destruction by external reality. The fantasy of regression to the womb is the fantasy of regression to a place of ultimate safety.

The description of the nine characteristics first articulated by Guntrip should bring more clearly into focus some of the major differences that exist between the traditional descriptive (track 1, DSM) portrait of the schizoid disorder and the traditional psychoanalytically informed (track 2, object relations) view. All nine characteristics are internally consistent. Most, if not all, should be present in order to diagnose a schizoid disorder.

Akhtar's Phenomenological Profile

In an article in the American Journal of Psychotherapy, Salman Akhtar
Salman Akhtar
Salman Akhtar is a psychoanalyst who also holds a professorship at the Jefferson Medical College in Philadelphia....

, M.D., provides a comprehensive phenomenological profile of Schizoid Personality Disorder in which classic and contemporary descriptive views are synthesized with psychoanalytic observations. This profile is summarized in a table (reproduced below) listing clinical features, involving six areas of psychosocial functioning and designated by "overt" and "covert" manifestations. Dr. Akhtar states that "these designations do not imply conscious or unconscious but denote seemingly contradictory aspects that are phenomenologically more or less easily discernible," and that "this manner of organizing symptomology emphasizes the centrality of splitting and identity confusion in schizoid personality."
Clinical Features of Schizoid Personality Disorder
Area Features
Overt Covert
Self-Concept
  • compliant
  • stoic
  • noncompetitive
  • self-sufficient
  • lacking assertiveness
  • feeling inferior and an outsider in life
  • cynical
  • inauthentic
  • depersonalized
  • alternately feeling empty, robot-like, and full of omnipotent, vengeful fantasies
  • hidden grandiosity
  • Interpersonal Relations
  • withdrawn
  • aloof
  • have few close friends
  • impervious to others' emotions
  • afraid of intimacy
  • exquisitely sensitive
  • deeply curious about others
  • hungry for love
  • envious of others' spontaneity
  • intensely needy of involvement with others
  • capable of excitement with carefully selected intimates
  • Social Adaptation
  • prefer solitary occupational and recreational activities
  • marginal or eclectically sociable in groups
  • vulnerable to esoteric movements owing to a strong need to belong
  • tend to be lazy and indolent
  • lack clarity of goals
  • weak ethnic affiliation
  • usually capable of steady work
  • quite creative and may make unique and original contributions
  • capable of passionate endurance in certain spheres of interest
  • Love and Sexuality
  • asexual, sometimes celibate
  • free of romantic interests
  • averse to sexual gossip and innuendo
  • secret voyeuristic interests
  • vulnerable to erotomania
    Erotomania
    Erotomania is a type of delusion in which the affected person believes that another person, usually a stranger or famous person, is in love with him or her. The illness often occurs during psychosis, especially in patients with schizophrenia or bipolar mania...

  • tendency towards compulsive perversions
  • Ethics, Standards, and Ideals
  • idiosyncratic moral and political beliefs
  • tendency towards spiritual, mystical and para-psychological interests
  • moral unevenness
  • occasionally strikingly amoral and vulnerable to odd crimes, at other times altruistically self sacrificing
  • Cognitive Style
  • absent-minded
  • engrossed in fantasy
  • vague and stilted speech
  • alternations between eloquence and inarticulateness
  • autistic thinking
  • fluctuations between sharp contact with external reality and hyperreflectiveness about the self
  • autocentric use of language


  • One patient with SPD commented that he could not fully enjoy the life he has because he feels that he is living in a shell. Furthermore, he noted that his inability distressed his wife. According to Beck and Freeman, "Patients with schizoid personality disorders consider themselves to be observers, rather than participants, in the world around them."

    Differential Diagnosis

    Although SPD shares several aspects with other psychological conditions, there are some important differentiating features:
    psychological condition Features
    Depression
    Depression (mood)
    Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...

    While people who have SPD may also suffer from clinical depression, this is certainly not always the case. Unlike depressed people, persons with SPD generally do not consider themselves inferior to others, although they will probably recognize that they are different.
    Avoidant personality disorder
    Avoidant personality disorder
    Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...

    Unlike avoidant personality disorder, those affected with SPD do not avoid social interactions due to anxiety or feelings of incompetence, but because they are genuinely indifferent to social relationships; however, in a 1989 study, "schizoid and avoidant personalities were found to display equivalent levels of anxiety, depression, and psychotic tendencies as compared to psychiatric control patients." One SPD patient remarked that previous knowledge, expectations, or assumptions may result in such elevated levels. Patients can mentally simulate damaging scenarios in order to flatten negative effects, should one occur.
    Asperger syndrome
    Asperger syndrome
    Asperger's syndrome that is characterized by significant difficulties in social interaction, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development...

    Asperger syndrome is an autism-spectrum disorder. Unlike AS, SPD does not involve an impairment in nonverbal communication (i.e., a lack of eye-contact or unusual prosody
    Prosody (linguistics)
    In linguistics, prosody is the rhythm, stress, and intonation of speech. Prosody may reflect various features of the speaker or the utterance: the emotional state of the speaker; the form of the utterance ; the presence of irony or sarcasm; emphasis, contrast, and focus; or other elements of...

    ) or a pattern of restricted interests or repetitive behaviors (e.g., a strict adherence to routines or rituals, or an unusually intense interest in a single topic). Compared to AS, SPD is characterized by prominent conduct disorder, better adult adjustment, and a slightly increased risk of schizophrenia.


    Under stress, some people with schizoid personality features may occasionally experience instances of brief reactive psychosis
    Brief reactive psychosis
    Brief reactive psychosis - referred to in the DSM IV-TR as "brief psychotic disorder with marked stressor" - is the psychiatric term for psychosis which can be triggered by an extremely stressful event in the life of a patient....

    . Schizoid individuals are also prone to developing pathological reliance on fantasizing activity as concomitant with their withdrawal from the world. Viewed in this fashion, fantasy constitutes a core component of the self in exile, though on closer examination fantasizing in schizoid individuals reveals as far more complicated than a means of facilitating withdrawal. Fantasy is also relationship with the world and with others by proxy. It is a substitute relationship, but a relationship nonetheless, characterized by idealized, defensive, and compensatory mechanisms. It is an expression of the self in exile because it is self-contained and free from the dangers and anxieties associated with emotional connection to real persons and situations. According to Klein it is "an expression of the self struggling to connect to objects, albeit internal objects. Fantasy permits schizoid patients to feel connected, and yet still free from the imprisonment in relationships. In short, in fantasy one can be attached (to internal objects) and still be free." This aspect of schizoid pathology has been generously elaborated in works by Laing (1960); Winnicott; (1971); and Klein (1995).

    According to Seinfeld, schizoid individuals frequently act out with substance and alcohol abuse and other addictions which serve as substitutes for human relationships. The substitute of a nonhuman for a human object serves as a schizoid defense. Providing examples of how the schizoid individual creates a personal relation with the drug, Seinfeld tells how "one addict called heroin his 'soothing white pet.' Another referred to crack as his 'bad mama.' I knew a female addict who termed crack her 'boyfriend.' Not all addicts name their drug, but there often is the trace of a personal feeling about the relationship." The object relations view emphasizes that the drug use and alcoholism reinforce the fantasy of union with an internal object, while enabling the addict to be indifferent to the external object world. Addiction is therefore viewed as a schizoid and symbiotic defense.

    S. C. Ekleberry suggests that marijuana
    Cannabis (drug)
    Cannabis, also known as marijuana among many other names, refers to any number of preparations of the Cannabis plant intended for use as a psychoactive drug or for medicinal purposes. The English term marijuana comes from the Mexican Spanish word marihuana...

     "may be the single most egosyntonic
    Egosyntonic
    Egosyntonic is a psychological term referring to behaviors, values, feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image....

     drug for individuals with SPD because it allows a detached state of fantasy and distance from others, provides a richer internal experience than these individuals can normally create, and reduces an internal sense of emptiness and failure to participate in life. Also, alcohol, readily available and safe to obtain, is another obvious drug of choice for these individuals. Some will use both marijuana and alcohol and see little point in giving up either. They are likely to use in isolation for the effect on internal processes."

    According to Ralph Klein, suicide may also be a running theme for schizoid individuals, though they are not likely to actually attempt one. They might be down and depressed when all possible connections have been cut off, but as long as there is some relationship or even hope for one the risk will be low. The idea of suicide
    Suicide
    Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

     is a driving force against the person's schizoid defenses. As Klein says: "For some schizoid patients, its presence is like a faint, barely discernible background noise, and rarely reaches a level that breaks into consciousness. For others, it is an ominous presence, an emotional sword of Damocles
    Damocles
    Damocles is a figure featured in a single moral anecdote commonly referred to as "the Sword of Damocles," which was a late addition to classical Greek culture. The figure belongs properly to legend rather than Greek myth. The anecdote apparently figured in the lost history of Sicily by Timaeus of...

    . In any case, it is an underlying dread that they all experience."

    Treatment

    Since schizoid traits are very similar to negative schizophrenic symptoms, atypical antipsychotics may have efficacy in alleviating them. Those who do seek treatment have the option of medication or therapy. For medication, the schizoid personality disorder seems to have similar negative symptoms of schizophrenia such as anhedonia
    Anhedonia
    In psychology and psychiatry, anhedonia is defined as the inability to experience pleasure from activities usually found enjoyable, e.g. hobbies, exercise, social interaction or sexual activity....

    , blunted affect, and low energy. The medication that is most recently used to treat the negative symptoms is risperidone
    Risperidone
    Risperidone is a second generation or atypical antipsychotic, sold under the trade name . It is used to treat schizophrenia , schizoaffective disorder, the mixed and manic states associated with bipolar disorder, and irritability in people with autism...

    . Before this, there was no psychotropic medication that made an impact on the negative symptoms. According to Joseph, low doses of risperidone or olanzapine
    Olanzapine
    Olanzapine is an atypical antipsychotic, approved by the FDA for the treatment of schizophrenia and bipolar disorder...

     also work for the social deficits and blunted affect; Wellbutrin (bupropion) for anhedonia. Furthermore, the use of SSRIs
    Selective serotonin reuptake inhibitor
    Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...

    , TCAs
    Tricyclic antidepressant
    Tricyclic antidepressants are heterocyclic chemical compounds used primarily as antidepressants. The TCAs were first discovered in the early 1950s and were subsequently introduced later in the decade; they are named after their chemical structure, which contains three rings of atoms...

    , MAOIs
    Monoamine oxidase inhibitor
    Monoamine oxidase inhibitors are a class of antidepressant drugs prescribed for the treatment of depression. They are particularly effective in treating atypical depression....

    , low dose benzodiazepines, and beta-blockers may help social anxiety
    Social anxiety
    Social anxiety is anxiety about social situations, interactions with others, and being evaluated or scrutinized by other people...

     in the SPD. However, social anxiety may not be a main concern for the people who have SPD. Supportive psychotherapy is also used in an inpatient or outpatient setting by a trained personnel that focuses on areas such as: coping skills, improving social skills and social interactions, communication, and self esteem issues. Mark Zimmerman suggested the following questions for evaluation of patients with SPD:
    • Do you have close relationships with friends or family? If yes, with whom? If no, does this bother you?
    • Do you wish you had close relationships with others?
    • Some people prefer to spend time alone, others prefer to be with people. How would you describe yourself?
    • Do you frequently choose to do things by yourself?
    • Would it bother you to go a long time without a sexual relationship? Does your sex life seem important or could you get along as well without it?
    • What kind of activities do you enjoy?
    • Do you confide in anyone who is not in your immediate family?
    • How do you react when someone criticizes you?
    • How do you react when someone compliments you?


    In the assessment process, note if these individuals make eye contact, smile or express affect nonverbally.

    According to Beck and Freeman, people with SPD have "defective perceptual scanning which results in missing environmental cues. The defective perceptual scanning is characterized by a tendency to miss differences and to diffuse the varied elements of experience." The perception of varied events only increases their fear for intimacy and limits them in their interpersonal relationships. Also because of their aloofness, this barrier does not allow them to use their social skills and behavior to help them pursue relationships. Therefore, socialization groups may help these people with SPD. As said by Will, educational strategies also work with people who have SPD by having them identify their positive and negative emotions. They use the identification to learn about their own emotions; the emotions they draw out from others; and feeling the common emotions with other people whom they relate with. This can help people with SPD create empathy with the outside world.

    Shorter-term Treatment

    According to Ralph Klein, Clinical Director of the Masterson Institute, the concept of closer compromise means that the schizoid patient may be encouraged to experience intermediate positions between the extremes of emotional closeness, and permanent exile.

    As mentioned by Laing without being enriched by injections of interpersonal reality there occurs an impoverishment in which the schizoid individual's self-image becomes more and more empty and volatilized, leading the individual himself to feel unreal. Therefore, to create a more adaptive and self-enriching interaction with others in which one "feels real," the patient is encouraged to take risks by creating less interpersonal distance through greater connection, communication, and the sharing of ideas, feelings, and actions. Closer compromise means that while the schizoid patient's vulnerability to the anxieties is not overcome, it is modified and managed more adaptively. Here the therapist repeatedly conveys to the patient that anxiety is inevitable, yet manageable, without any illusion that the schizoid vulnerability to such anxiety can be permanently dispensed with. The limiting factor is the point at which the dangers of intimacy become overwhelming and the patient must again retreat.

    Klein suggests that closer compromise must be directly stated as the patient's responsibility; "It seems to me that in order to accomplish your goals, it is necessary to put yourself at risk," or "It seems to me that your willingness to come here (to treatment) and struggle with your anxieties must be mirrored by your willingness to challenge yourself outside of here," or "It seems to me that your efforts to connect with me are only half the battle; the other half must take place in the more dangerous arena of your life outside this office," i.e. therapist is always conveying that these are the therapists impressions. He or she is not reading the patient's mind or imposing an agenda, but is simply stating a position. Also, the therapist's position is an extension of the patient's therapeutic wish ("your goals," "your willingness," and "your efforts"). Finally, the therapist specifically directs attention to the need for employing these actions outside the therapeutic setting.

    Longer-term therapy

    Klein suggests that working through is the second longer-term tier of psychotherapeutic work with schizoid patients. Its goals are to change fundamentally the old ways of feeling and thinking, and to rid oneself of the vulnerability to experiencing those emotions associated with old feelings and thoughts. A new therapeutic operation of 'remembering with feeling' is called for.

    One must remember with feeling the coming into being of one's false self through childhood. (The concept of false self and true self
    True Self
    True Self is fourth album by the Chicago-based music group Soil. It was released in the US on May 2, 2006 via DRT Entertainment. This is the band's first album with new vocalist AJ Cavalier. True Self leaked onto P2P and BitTorrent sites on March 4, almost two months before its official release...

     comes from D. W. Winnicott
    Donald Winnicott
    Donald Woods Winnicott was an English paediatrician and psychoanalyst who was especially influential in the field of object relations theory. He was a leading member of the British Independent Group of the British Psychoanalytic Society, and a close associate of Marion Milner...

    , and is viewed as representative of schizoid phenomenology.) This means that one must remember the conditions and proscriptions that were imposed on the individual’s freedom to experience the self in company with others. Ultimately, remembering with feeling leads the patient to the understanding that he or she had no choice in the process of developing a schizoid stance toward others. The patient did not have the opportunity to choose from a selection of possible ways of experiencing the self and of relating with others, rather, the patient had few if any options. The false self was simply the best way in which the patient could experience repetitive predictable acknowledgment, affirmation, and approval (the emotional supplies necessary for emotional survival), while warding off the effects associated with the abandonment depression.

    If the goal of shorter-term therapy is for patients to understand that they are not the way they appear to be and can act differently, then the longer-term goal of working through is for patients to understand who and what they are as human beings, what they truly are like and what they truly contain. The goal of working through is not achieved by the patient’s sudden discovering of a hidden, fully formed talented and creative self living inside but is a process of slowly freeing oneself from the confinement of abandonment depression in order to have the opportunity to uncover a potential. It is a process of experimentation with the spontaneous, nonreactive elements that can be experienced in relationship with others.

    Working through abandonment depression is a complicated, lengthy, and conflicted process which can be an enormously painful experience in terms of what is remembered and what must be felt. It involves a mourning, a grieving, for the loss of the illusion that the patient had adequate support for the emergence of the real self
    Real self
    The Real self theory in politics and philosophy proposes that people often have a private "real will" , that is different from their public "expressed will".-References:...

    . Also, it is a mourning for the loss of an identity, the false self, which the person constructed and with which he or she has negotiated much of his or her life. The dismantling of the false self requires a relinquishing the only way of being that the patient has ever known of his interactions with others, an interaction which was better than no stable, organized experience of the self, no matter how false, defensive, or destructive that identity may be.

    According to Klein the dismantling of the false self "leaves the impaired real self with the opportunity to convert its potential and its possibilities into actualities." The process of working through brings with it its own unique rewards, of which the most important element in new self-awareness is the growing realization by the individual that they have a fundamental, internal need for relatedness, which they may express in a variety of ways. "Only schizoid patients", suggests Klein, "who have worked through the abandonment depression ... ultimately will believe that the capacity for relatedness and the wish for relatedness are woven into the structure of their beings, that they are truly part of who the patients are and what they contain as human beings. It is this sense that finally allows the schizoid patient to feel the most intimate sense of being connected with humanity more generally, and with another person more personally. For the schizoid patient, this degree of certainty is the most gratifying revelation, and a profound new organizer of the self experience."

    Epidemiology

    SPD is uncommon in clinical settings. It occurs slightly more commonly in males.

    SPD is rare compared with other personality disorders. Its prevalence is estimated at less than 1% of the general population.

    As an interesting comment on the usual low-prevalence figures for this disorder, Philip Manfield in Split Self, Split Object, Arenson (1992) states that "I believe that the schizoid condition is far more common... comprising perhaps as many as 40 percent of all personality disorders. This huge discrepancy is probably largely because someone with a schizoid disorder is less likely to seek treatment than someone with other axis-II disorders." Manfield backs this claim with a study by Valliant & Drake (1985) who found that over 40% of a particular sample group of inner city males were schizoid.

    See also

    • Hikikomori
      Hikikomori
      is a Japanese term to refer to the phenomenon of reclusive people who have chosen to withdraw from social life, often seeking extreme degrees of isolation and confinement because of various personal and social factors in their lives...

    • Narcissistic defences
      Narcissistic defences
      "Narcissistic defences have been defined as those processes whereby the idealized aspects of the self are preserved and the limitations of the self and [of] others denied"....

    • Schizoid withdrawal
    • Schizotypy
      Schizotypy
      Schizotypy is a psychological concept which describes a continuum of personality characteristics and experiences ranging from normal dissociative, imaginative states to more extreme states related to psychosis and in particular, schizophrenia...


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