Schizoid personality disorder

What is schizoid personality disorder? 

Schizoid personality disorder (SPD) tends to surface during early adulthood and gradually develops into a long-standing pattern of emotional and social detachment. Due to their difficulty in expressing emotions, people with SPD tend to be introverted and may come across as cold and distant. They will typically fear any kind of intimacy and relationships and sexual experiences are therefore severely limited.

Although sufferers may be more open with family members, they rarely maintain close bonds. They are largely uninterested in social interaction and consider it safer and more comfortable to be solitary and follow rigid, familiar routines. They often like to daydream, even though they are very much in touch with reality.

Schizoid personality disorder on the schizophrenic spectrum

Schizoid personality disorder is considered to be part of the schizophrenic spectrum of disorders. This refers to a group of Class A personality disorders that have similar symptoms of behaviour - particularly the lack of emotional expression and the inability to form social connections. These include schizophrenia and schizotypal personality disorder.

Symptoms of schizoid personality disorder

People with schizoid personality disorder are often considered to be 'loners' who start developing signs of emotional and social detachment during early adulthood. In some cases, schizoid personality disorder symptoms can first become noticeable during childhood and across a range of social and personal situations.

Someone with schizoid personality disorder will typically display the following behaviours:

• avoidance of social activities
• do not express any strong feelings
• little interest in or desire for sexual relationships
• emotional coldness and detachment
• experience confusion about how to respond to normal social cues
• almost always choose solitary activities and jobs
• feel unmotivated and tend to underperform at school or work
• value independence and have very few close friendships
• enjoy few activities, if any
• indifferent to praise or criticism
• exhibit little observable change in mood
• feel unable to experience pleasure

Covert and overt schizoid personalities

In addition to the typical symptoms, those with schizoid personality disorder may show signs of a 'covert' schizoid personality or an 'overt' one. Those with covert symptoms may not appear to have the personality disorder on the surface. They will come across as sociable and will have stable jobs and many acquaintances. However, they do not have any deep emotional bonds and will keep their feelings very private. 

Overt schizoids in comparison will show obvious signs of a personality disorder. In conversations, they may come across as boring and emotionless, and they tend to prefer having very little social contact. People with overt schizoid personality disorder are more likely to spend time alone and so not many people will come into contact with them. 

Causes of schizoid personality disorder 

The cause of schizoid personality disorder is generally unknown. However, several theories have been suggested to try to explain the development of the disorder:

• Social theorists consider learned behaviour responses to cause the disorder.
• Biological theorists suggest chromosomal or nervous system disorders as the cause.
• Psychodynamic theorists believe deficiencies in ego development are related.

These are just theories though and there is currently insufficient evidence to back any of them up. Research has also suggested that the disorder may be associated with schizophrenia as many of the same risk factors are shared. 

Risk factors for developing schizoid personality disorder

The various risk factors that are thought to increase a person's chances of developing schizoid personality disorder include:

• Having a parent or close relative who has schizoid personality disorder, or one of the other conditions listed on the schizophrenic spectrum.
• Growing up with a parent who was cold or unresponsive to emotional needs.
• Hypersensitivity or being 'thin-skinned' in early teenage years and having these needs treated with scorn or annoyance.
• Suffering a form of abuse or neglect as a child.

As schizoid personality disorder appears to originate within the family and childhood environment, a key preventative measure is thought to be the provision of a nurturing upbringing for children where they can express themselves freely.

When is it time to seek help?

Although in many cases schizoid personality disorder symptoms will decrease in severity over time, the condition is long-term and can significantly impact well-being. In some cases living with the condition can be so stressful that sufferers go on to develop complications such as depression, anxiety disorders as well as alcohol and drug addictions. The condition can also cause a great deal of distress to loved ones and family members who may misunderstand their behaviour. This therefore can make life more stressful for those with the condition. 

Seeking help as soon as possible is essential for the successful treatment of schizoid personality disorder. However, social isolation tends to prevent those affected from making this important step to recovery. Their lack of motivation for change may be a further obstacle, and if they do seek help, they may struggle to interact with the professionals providing their treatment. Often those with the condition don't even feel as if there is anything wrong.

Despite these complications, many people respond well to schizoid personality disorder treatment and most programmes are designed to focus on the maintenance of relationships.

Diagnosis of schizoid personality disorder

A trained mental health professional will typically diagnose schizoid personality disorder. This will begin with a physical examination to determine whether any other problems may be causing your symptoms, followed by a psychiatric assessment. This may involve questionnaires to assess your symptoms and thoughts, as well as an interview to explore your childhood, relationships and job history. This helps the mental health professional identify potential risk factors of schizoid personality disorder. 

Your responses from all the tests will help your doctor or psychologist reach a diagnosis, but they will also compare your symptoms to the criteria stated in the Diagnostic and Statistical Manual of Mental Disorders (DSM). If you show four or more of the characteristics listed for schizoid personality disorder, you are likely to be referred for appropriate treatment.

Schizoid personality disorder treatment

The recommended form of schizoid personality disorder treatment tends to be psychotherapy with a counsellor or psychotherapist specialising in treating this condition. Medications can also be prescribed to help with troubling symptoms and additional problems that may be related, including depression, anxiety and addiction.

Counselling

The goals of counselling for schizoid personality disorder tend to be solution-focused to help individuals solve immediate problems and crises. Often those who do seek treatment are under a great deal of stress or pressure and are finding it increasingly difficult to deal with their symptoms. They may struggle to commit to long-term treatment, therefore therapists may choose to use simple treatment goals to alleviate stressors in the individual's life.

Another incentive for therapists working with people with schizoid personality disorder is to provide the right balance of support and stability to ensure a trusting relationship can develop between the client and therapist. This will be gradual and may never fully develop, but therapists will respect their client's boundaries and will not look to confront them on these issues.

Cognitive behavioural therapy (CBT) 

Many therapists will employ cognitive-restructuring exercises in schizoid personality disorder treatment. This is because they can help to address certain types of irrational thoughts that may be influencing the person's behaviour. CBT enables those affected to become more self-aware of their behaviour and thought patterns and can teach them coping skills to promote progression. The overall aim here is to help ease their anxiety and reluctance in pursuing social relationships.

Dialectical behaviour therapy (DBT)

DBT was originally developed to support those with borderline personality disorder but is now used to help with a range of conditions. This therapy can help people identify unhelpful behaviours and learn new ways of coping and can be particularly helpful for those with personality disorders. 

Group therapy 

Due to the reduced capacity of those with schizoid personality disorder to form relationships, health professionals need to ensure they use an approach that is non-intrusive and allows for the gradual alleviation of fears of social interaction.

Group therapy is particularly effective for this, but tends to be better as an advanced form of treatment rather than something introduced early on. Here sufferers have the chance to conquer fears of intimacy by engaging with others in a supportive environment. The therapist will be careful to protect them from criticism in the group during these sessions.

Medication

The most common types of medication prescribed to individuals with schizoid personality disorder tend to be antidepressants, but stimulants may be given to provide a mental boost. These can be useful in cases where the person is feeling particularly low and unmotivated and needs something to give them an extra boost in social situations.

Self-help techniques

It is generally thought that sufferers can significantly help themselves if they make attempts to socialise. This may go against their core nature, but it can help with any feelings of loneliness and will make a difference to their health and well-being in the long term.

Neglecting all social aspects of life can have negative consequences. Getting a job or joining a club that requires being around people is considered particularly important for helping those with schizoid personality disorder overcome symptoms.