Schizoid Personality Disorder

Primer

Schizoid Personality Disorder is a personality disorder characterized by a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings that begins by early adulthood. These individuals often appear to be socially isolated or “loners,” and do not desire intimacy.

Epidemiology
  • Prevalence rates are estimated to be between 3.1 to 4.9%.[1][2]
  • Increased prevalence among relatives with schizophrenia or schizotypal personality disorder
  • More commonly diagnosed in males
    • May cause more impairment for males than females
Prognosis
  • Individuals may be impaired in occupational settings, especially in situations where interpersonal relationships are required.
  • Individuals may have few friendships, date infrequently, and often do not marry, due to lack of social skills and lack of desire for sexual experiences.
  • In some cases, schizoid personality disorder can be an antecedent to delusional disorder or schizophrenia.[3]
    • Individuals may also experience brief (minutes to hours) episodes of psychosis during periods of high stress.
Comorbidity
Risk Factors

DSM-5 Diagnostic Criteria

Criterion A

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4 (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 or criticism of others
  7. Shows emotional coldness, detachment, or flattened affectivity
Criterion B

Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e. - “schizoid personality disorder (premorbid).”

Mnemonic

The memory aid schizoidD personality is Distant can help you remember the feature of this personality disorder. Whereas schizoTypal can be used to remember there is magical Thinking.

Psychopathology

Individuals with schizoid personality disorder may use defenses such as repression, suppression, isolation of affect, and displacement.

Differential Diagnosis

  • Other mental disorders with psychotic symptoms
    • Schizoid personality disorder can be distinguished from delusional disorder, schizophrenia, and a bipolar or depressive disorder with psychotic features because these disorders are all characterized by discrete, episodic periods of persistent psychotic symptoms (e.g. - delusions and hallucinations). To give an additional diagnosis of schizoid personality disorder, the personality disorder must have been present before the onset of psychotic symptoms and must persist when the psychotic symptoms are in remission.
  • Substance use disorders
    • Schizoid personality disorder must also be distinguished from symptoms that may develop in association with persistent substance use.
  • Autism spectrum disorder
    • Differentiating individuals with schizoid personality disorder from those with milder forms of autism spectrum disorder, can be difficult. Generally, in autism, there are more severely impaired social interaction, stereotyped behaviors, and fixed interests.
  • Obsessive-compulsive personality disorder
    • Individuals with obsessive-compulsive personality disorder may also show “social detachment,” but this stems from devotion to work and discomfort with emotions. Additionally, they have an underlying capacity and desire for intimacy.
  • Avoidant personality disorder
    • The social isolation in avoidant personality disorder is attributable to fear of being embarrassed or being found inadequate. Individuals with avoidant personality have excessive anticipation of rejection, while individuals with schizoid personality disorder have more pervasive detachment and little to no desire for social intimacy.
  • Paranoid personality disorder
    • Schizoid personality lacks the suspiciousness and paranoid ideation seen in paranoid personality disorder.
  • Schizotypal personality disorder
    • Behaviours are more odd in schizotypal personality disorder are more odd. Individuals with schizoid personality disorder also lack the cognitive and perceptual distortions seen in schizotypal personality disorder.
  • Personality change due to another medical condition
    • Schizoid personality disorder must be distinguished from personality change due to another medical condition, in which the traits that emerge are attributable to the effects of another medical condition on the central nervous system (e.g. - traumatic brain injury).

Treatment

Psychotherapies such as cognitive behavioural therapy and psychodynamic therapy can be effective. Patients with schizoid personality can be introspective and over time may be able to build trust with a therapist to reveal schizoid fantasies.[5][6] Group therapy may also be helpful, but patients may require protection from the aggression of other group members.

Recommended Reading

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Guidelines

Personality Disorder Guidelines

Guideline Location Year PDF Website
World Federation of Societies of Biological Psychiatry (WFSBP) International 2009 - Link

Resources

For Patients
For Providers
Articles
Research

References

1) Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological psychiatry, 62(6), 553-564.
2) Hasin, D. S., & Grant, B. F. (2015). The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Social psychiatry and psychiatric epidemiology, 50(11), 1609-1640.
3) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
4) American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
5) Robinson, H. Dungeons and Dragons: The Use of a Fantasy Game in the Psychotherapeutic Treatment of a Young Adult.
6) Orcutt, C. (2018). Schizoid Fantasy: Refuge or Transitional Location?. Clinical social work journal, 46(1), 42-47.