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Schizoid Personality Disorder (ScPD)

By Robert M. A. Hirschfeld, MD, DeWitt Wallace Senior Scholar and Professor, Department of Psychiatry, Weill Cornell Medical College

Schizoid personality disorder is characterized by a pervasive pattern of detachment from and general disinterest in social relationships and by expression of few emotions in relationships.

  • People with schizoid personality disorder seem to have no interest in close relationships with others and prefer to be by themselves.

  • Doctors diagnose schizoid personality disorder based on specific symptoms, including detachment from and disinterest in social relationships and limited expression of emotions.

  • Cognitive-behavioral therapy that focuses on acquiring social skills may help people with this disorder change.

Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.

People with schizoid personality disorder have difficulty relating to others meaningfully.

Schizoid personality disorder occurs in about 1 to 3% of the general population.

Other disorders are often also present. Up to half of people with schizoid personality disorder have had at least one episode of major depression. They often also have other personality disorders. The most common are schizotypal, paranoid, borderline, or avoidant personality disorder.

Causes

Genes are thought to play a role in the development of schizoid personality disorder. This disorder may be more common among people who have family members with schizophrenia or schizotypal personality disorder.

Having caregivers who were emotionally cold, neglecting, and detached during childhood may contribute to the development of schizoid personality disorder. Having such caregivers may reinforce the child's feeling that relationships with other people are not satisfying.

Symptoms

Detachment from others

People 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 first-degree relative (such as a parent or sibling). They rarely date and often do not marry. Because they prefer being by themselves, they tend to choose activities and hobbies that do not require interaction with others (such as 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 (such as walking on the beach).

These people do not seem bothered by what others think of think of them—whether good or bad. They may seem aloof or self-absorbed. They do not notice normal social cues and thus may seem socially inept.

Limited expression of emotions

People with schizoid personality disorder rarely react (for example, 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 people feel comfortable exposing themselves, they admit that they feel pain, especially in social interactions.

Persistence of symptoms

Symptoms of schizoid personality disorder tend to remain the same over time, more so than those of other personality disorders.

Diagnosis

  • A doctor's evaluation, based on specific criteria

Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5—see Classification and Diagnosis of Mental Illness), published by the American Psychiatric Association.

For doctors to diagnose schizoid personality disorder, people must have a persistent detachment from and general disinterest in social relationships and limited expression of emotions in interpersonal interactions, as shown by at least four of the following:

  • They do not want or enjoy close relationships, including those with family members.

  • They strongly prefer solitary activities.

  • They have little, if any, interest in sexual activity with another person.

  • They enjoy few, if any, activities.

  • They have no close friends or confidants, except possibly first-degree relatives.

  • They appear to be indifferent to the praise or criticism of others.

  • They are emotionally cold and detached and do not express emotion in response to events or interactions with others.

Also, symptoms must have begun by early adulthood.

Treatment

  • Cognitive-behavioral therapy that focuses on social skills

General treatment of schizoid personality disorder is the same as that for all personality disorders.

Because people with schizoid personality disorder are detached and aloof, doctors have difficulty establishing a cooperative, mutually respectful relationship with them. To establish a relationship and thus encourage people to participate in treatment, doctors may try to discuss topics that appeal to people who prefer activities that do not require interaction with others (such as stamp collecting).

There is not much information about the effect of psychotherapy or drug therapy on schizoid personality disorder.

Cognitive-behavioral therapy that focuses on acquiring social skills may help people change. For example, people may learn how to recognize social cues (spoken and unspoken, such as facial expressions and body language).