Schizoid personality disorder is characterized by a pervasive pattern of detachment from and general disinterest in social relationships and a limited range of emotions in interpersonal relationships. Diagnosis is by clinical criteria. Treatment is with cognitive-behavioral therapy. In schizoid personality disorder, the
ability to relate to others meaningfully is limited. About 3.1 to 4.9% of the general US population have schizoid personality disorder. It is slightly more common among men. Schizoid personality disorder may be more common among people with a family history of schizophrenia or schizotypal personality disorder. Comorbidities are common. Up to half of patients have had at least one episode of
major depressive disorder
Major depression (unipolar disorder) Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Exact cause is unknown... read more . They often also have other personality disorders, most
commonly schizotypal
Schizotypal Personality Disorder (STPD) Schizotypal personality disorder is characterized by a pervasive pattern of intense discomfort with and reduced capacity for close relationships, by distorted cognition and perceptions, and... read more ,
paranoid
Paranoid Personality Disorder (PPD) Paranoid personality disorders is characterized by a pervasive pattern of unwarranted distrust and suspicion of others that involves interpreting their motives as malicious. Diagnosis is by... read more ,
borderline
Borderline Personality Disorder (BPD) Borderline personality disorder is characterized by a pervasive pattern of instability and hypersensitivity in interpersonal relationships, instability in self-image, extreme mood fluctuations... read more , or
avoidant
Avoidant Personality Disorder (AVPD) Avoidant personality disorder is characterized by the avoidance of social situations or interactions that involve risk of rejection, criticism, or humiliation. Diagnosis is by clinical criteria... read more . Having caregivers who were emotionally cold, neglectful, and detached during childhood may contribute to the development of schizoid personality disorder by fueling the child's feeling that interpersonal relationships are not satisfying. Patients with schizoid personality disorder seem to have no desire for close relationships with other people, including relatives. They have no close friends or confidants, except sometimes a 1st-degree relative. They rarely date and often do not marry. They prefer being by themselves, choosing activities and hobbies that do not require interaction with others (eg, computer games).
Sexual activity with others is of little, if any, interest to them. They also seem to experience less enjoyment from sensory and bodily experiences (eg, walking on the beach). These patients do not seem bothered by what others think of them—whether good or bad. Because they do not notice normal clues of social interaction, they may seem socially inept, aloof, or self-absorbed. They rarely react (eg, by smiling or nodding) or show emotion in social situations. They have difficulty
expressing anger, even when they are provoked. They do not react appropriately to important life events and may seem passive in response to changes in circumstances. As a result, they may seem to have no direction to their life. Rarely, when these patients feel comfortable revealing themselves, they admit that they feel pain, especially in social interactions. Symptoms of schizoid personality disorder tend to remain stable over time, more so than those of other personality
disorders. Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) Symptoms and Signs of ScPD
For a diagnosis of schizoid personality disorder, patients must have a persistent pattern of
Detachment from and general disinterest in social relationships
Limited expression of emotions in interpersonal interactions
This pattern is shown by the presence of ≥ 4 of the following:
No desire for or enjoyment of close relationships, including those with family members
Strong preference for solitary activities
Little, if any, interest in sexual activity with another person
Enjoyment of few, if any, activities
Lack of close friends or confidants, except possibly 1st-degree relatives
Apparent indifference to the praise or criticism of others
Emotional coldness, detachment, or flattened affect
Also, symptoms must have begun by early adulthood.
Clinicians should distinguish schizoid personality disorder from the following:
Social skills training
No controlled studies have been published about psychotherapies or drug therapy for schizoid personality disorder.
Generally, efforts to share interest in impersonal topics (eg, possessions, collections, hobbies) that appeal to people who prefer solitary pursuits can help establish a relationship with a patient and perhaps facilitate a therapeutic interaction.
Cognitive-behavioral approaches that focus on acquiring social skills may also help patients change. Because patients with schizoid personality disorder lack interest in other people, they may not be motivated to change.
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