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Schizoid Personality Disorder (ScPD)

By

Mark Zimmerman

, MD, Rhode Island Hospital

Reviewed/Revised Sep 2023
View PATIENT EDUCATION

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.

The estimated median prevalence is 0.9% but may be as high as 3.1% (1, 2 General references 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... read more ). Some studies suggest it is slightly more common among men, whereas other studies find no gender difference. 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 depressive disorder (unipolar depressive 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 Overview of Personality Disorders Personality disorders in general are pervasive, enduring patterns of thinking, perceiving, reacting, and relating that cause significant distress or functional impairment. Personality disorders... read more , 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 disorder is characterized by a pervasive pattern of unwarranted distrust and suspicion of others that involves interpreting their motives as malicious. Diagnosis is by clinical... 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 .

General references

  • 1. Grant BF, Hasin DS, Stinson FS, et al: Prevalence, correlates, and disability of personality disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 65(7):948-958, 2004. doi: 10.4088/jcp.v65n0711

  • 2. Morgan TA, Zimmerman M: Epidemiology of personality disorders. In Handbook of Personality Disorders: Theory, Research, and Treatment. 2nd ed, edited by WJ Livesley, R Larstone, New York, NY: The Guilford Press, 2018, pp. 173-196.

Etiology of Schizoid Personality Disorder

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.

Symptoms and Signs of Schizoid Personality Disorder

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.

Diagnosis of Schizoid Personality Disorder

  • Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR) criteria

  • 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.

Differential diagnosis

Clinicians should distinguish schizoid personality disorder from the following:

Diagnosis reference

  • 1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed Text Revision (DSM-5-TR). Washington, DC, American Psychiatric Association, 2022, pp 741-744.

Treatment of Schizoid Personality Disorder

  • Social skills training

No controlled studies have been published about psychotherapies or pharmacotherapy 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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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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