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Diseases and Conditions
Schizoid personality disorder
From MayoClinic.com
Special to CNN.com

Introduction

Schizoid personality disorder is a condition in which people avoid social activities and consistently shy away from interaction with others. People with the disorder are generally loners with a profound inability to connect with others and form personal relationships.

To others, people with schizoid personality disorder may appear aloof, dull or humorless, and they are often ignored in social settings. People with the disorder show a flattened or restricted range of emotions, and can appear indifferent to what's going on around them. However, their inner life can be rife with a deep emotional need, sensitivity and confusion about the world around them.

It's unclear whether people with schizoid personality disorder willingly embrace isolation, or secretly crave intimacy but find interpersonal relations too distressing. What is clear is that people with schizoid personality disorder withdraw at the expense of relationships with people they care about, even spouses.

The cause of schizoid personality disorder is unknown, although genetics and environmental factors both come into play. It's difficult to treat people with schizoid personality disorder because they consider therapy intrusive. However, some therapeutic approaches and medications may help relieve some symptoms of this chronic condition.

Signs and symptoms

People with schizoid personality disorder are loners. Generally they:

  • Choose activities that don't require interaction with others
  • Prize solitude and independence
  • Are often unable to respond to normal social cues in social settings
  • Harbor little desire for sexual experiences with others
  • Can appear dull or indifferent to others
  • Are followers rather than leaders in groups

Some tendencies can appear in childhood and continue through adolescence and into early adulthood.

People with schizoid personality disorder may appear detached and aloof to outsiders, but some experts believe that they're actually quite sensitive and experience a deep longing for intimacy. However, people with schizoid personality disorder either are incapable of initiating and maintaining a personal relationship, or find themselves suffocated or anxious in the company of others. Thus they retreat into their inner worlds and view their environs with great confusion, or seek relationships for security but break away repeatedly.

Often, people with schizoid personality disorder populate the fringes of life — working the midnight shift at a grocery store or running the projector at a movie theater. They may live in the basement of their elderly parents' homes or in some cases become homeless, refusing outreach services.

Symptoms of schizoid personality disorder include:

  • Emotional coldness or aloofness
  • Indifference to praise or criticism and the feelings of others
  • Close friendships with no more than one or two people, including family members
  • Social withdrawal, or continual avoidance of social activities
  • Flattened emotions or lack of expressivity
  • Inability to experience pleasure (anhedonia)
  • General feeling of discomfort or restlessness (dysphoria)
  • Having little to say
  • Lack of motivation or persistence (avolition)
  • Tendency toward underperformance in school or work settings

The schizophrenic spectrum
Schizoid personality disorder is considered part of the "schizophrenic spectrum" of disorders, which includes schizotypal personality disorder and schizophrenia. These conditions all have similar symptoms, such as an incapacity for social relations and emotional inexpressiveness. The main distinction is that people with schizoid personality don't usually experience the perceptual distortions, paranoia or illusions characteristic of schizotypal personality or the psychotic episodes of schizophrenia.

Although their speech lacks enthusiasm, what people with schizoid personality disorder say is rarely abnormal or odd, as in the conversational patterns of people with schizotypal personality disorder.

Causes

The exact causes of schizoid personality disorder are unknown, although a combination of genetic and environmental factors — particularly in early childhood — are thought to contribute to development of all personality disorders.

A person with schizoid personality disorder may have had a parent who was cold or unresponsive to emotional needs, or might have grown up in a foster home where there was no love. Or, because people with schizoid personality disorder are often described as being hypersensitive or thin-skinned in early adolescence, a person with schizoid personality disorder may have had needs that others treated with exasperation or scorn.

A family history — such as having a parent who has any of the disorders on the schizophrenic spectrum — also increases the chances of developing the disorder.

Risk factors

Personality development is affected by genetic tendencies as well as environmental factors, particularly during childhood. Factors that increase the risk of developing schizoid personality disorder include:

  • Having a parent or other relative who has schizoid personality disorder
  • Experiencing a childhood environment of neglect or scorn
  • Suffering child abuse or mistreatment
  • Having an emotionally detached parent

When to seek medical advice

Because personality tends to become entrenched with age, treatment for a personality disorder has the possibility of being more effective if it begins as early as possible.

People with schizoid personality disorder tend to shun interaction with medical professionals and are likely to seek help only at the urging of relatives or teachers or intervention by the legal system.

If you suspect someone may have schizoid personality disorder, be on the lookout for signs and symptoms such as consistent emotional detachment and social isolation. You might gently suggest that the person seek medical attention, starting with a primary care physician or mental health professional.

Screening and diagnosis

There are no laboratory tests for schizoid personality disorder, and diagnosis usually comes after a thorough clinical interview. During this interview, the doctor will ask questions about symptoms and mental well-being, and take a medical, psychiatric and social history. A physical examination can help rule out other conditions, and a mental health professional will likely be consulted for further evaluation.

In order for someone to receive a diagnosis of schizoid personality disorder, he or she must meet at least four of the following criteria:

  • Neither desires nor enjoys close relationships, including being part of a family
  • Almost always chooses solitary activities
  • Has little, if any, interest in sexual experiences with another person
  • Takes pleasure in few, if any, activities and rarely experiences strong emotions
  • Lacks close friends or confidantes other than first-degree relatives
  • Appears indifferent to praise or criticism
  • Shows emotional coldness, detachment or flattened emotions

In addition, the symptoms must not occur exclusively during a bout of schizophrenia, a mood disorder with psychotic features, another psychotic disorder or a pervasive developmental disorder (such as autism or Asperger's syndrome). Also, a diagnosis of schizoid personality disorder may not be appropriate should symptoms be due to the direct physiological effects of a general medical condition.

Further complicating a diagnosis is that the symptoms of schizoid personality may resemble autism or Asperger's syndrome.

Complications

People with schizoid personality are at an increased risk of:

  • Developing schizotypal personality disorder, schizophrenia or other delusional disorder
  • Drug addiction, particularly to psychedelic drugs
  • Alcohol addiction
  • Major depression
  • Anxiety disorder
  • Panic disorder
  • Social phobia
  • Other personality disorders

Further, because people with schizoid personality disorder may have trouble interpreting and responding to social stimuli, they may have trouble warding off the predatory behavior of other people. As a result, they may be more prone to victimization than are most other people.

Treatment

Schizoid personality disorder can be difficult to treat because people with the disorder are inclined to go their own way and prefer not to come in contact with medical professionals. Further, they sometimes settle into complacency about their emotionally impoverished existence.

When they do come into treatment — either by family insistence or by the legal system — they can have trouble communicating with a therapist and react in a bland, detached manner. However, when a doctor shows respect for their personal space and private thoughts, people with a schizoid personality can respond effectively to treatment.

  • Medications. There's no specific drug treatment for schizoid personality. However, doctors may prescribe medications to help alleviate some symptoms, as well as associated conditions such as anxiety and depression. For example, the psychological inability to experience pleasure can be treated with bupropion (Wellbutrin). Risperidone (Risperdal) or olanzapine (Zyprexa) can help with flattened emotions and social problems.
  • Psychotherapy. Cognitive behavior therapy — which focuses on adjusting the thinking and behaviors that cause problems — can help a person with schizoid personality disorder develop social skills and increase sensitivity to interpersonal cues. For example, a person with schizoid personality disorder might learn appropriate ways to react when faced with certain stimuli, such as being introduced to someone at a party. The goal of treatment is to be supportive and practical, and to alleviate social anxiety and isolation.
  • Group therapy. Treatment can be more effective when people with the disorder can interact with others in practicing new interpersonal skills. Group therapy may also offer people with schizoid personality disorder a support structure and increase social motivation. However, group therapy isn't effective for everybody.

Prevention

Because schizoid personality disorder originates with the family and childhood environment, early intervention may help diminish the development of problem behaviors.

  • Schizoaffective disorder
  • Invega: New schizophrenia medication gets FDA approval
  • Childhood schizophrenia
  • Disorganized schizophrenia
  • Catatonic schizophrenia
  • Paranoid schizophrenia
  • Schizotypal personality disorder
  • Schizophrenia
  • Schizophrenia and drug abuse: Are they related?
  • December 08, 2006

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