Schizoid Personality Disorder

 Schizoid personality disorder (/ˈskɪtsɔɪd, ˈskɪdzɔɪd/, often abbreviated as SPD or SzPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment and apathy. Affected individuals may be unable to form intimate attachments to others and simultaneously possess a rich and elaborate but exclusively internal fantasy world.[6][12] Other associated features include stilted speech, a lack of deriving enjoyment from most activities, feeling as though one is an "observer" rather than a participant in life, an inability to tolerate emotional expectations of others, apparent indifference when praised or criticized, a degree of asexuality, and idiosyncratic moral or political beliefs.[13] Symptoms typically start in late childhood or adolescence.[6]

The cause of SPD is uncertain, but there is some evidence of links and shared genetic risk between SPD, other cluster A personality disorders (such as schizotypal personality disorder) and schizophrenia. Thus, SPD is considered to be a "schizophrenia-like personality disorder".[4][14] It is diagnosed by clinical observation, and it can be very difficult to distinguish SPD from other mental disorders (such as autism spectrum disorder, with which it may sometimes overlap).[15][16]

The effectiveness of psychotherapeutic and pharmacological treatments for the disorder has yet to be empirically and systematically investigated. This is largely because people with SPD rarely seek treatment for their condition.[6] Originally, low doses of atypical antipsychotics were also used to treat some symptoms of SPD, but their use is no longer recommended.[17] The substituted amphetamine bupropion may be used to treat associated anhedonia.[7] However, it is not general practice to treat SPD with medications, other than for the short-term treatment of acute co-occurring disorders (e.g. depression).[18] Talk therapies such as cognitive behavioral therapy (CBT) may not be effective, because people with SPD may have a hard time forming a good working relationship with a therapist.[6]

SPD is a poorly studied disorder, and there is little clinical data on SPD because it is rarely encountered in clinical settings. Studies have generally reported a prevalence of less than 1%[4][11][5] It is more common in males than in females.[11] SPD is linked to negative outcomes, including a significantly compromised quality of life, reduced overall functioning even after 15 years and one of the lowest levels of "life success" of all personality disorders (measured as "status, wealth and successful relationships").[8][9][10] Bullying is particularly common towards schizoid individuals.[3][19] Suicide may be a running mental theme for schizoid individuals, though they are not likely to actually attempt it.[20] Some symptoms of SPD (e.g. solitary lifestyle and emotional detachment), however, have been stated as general risk factors for serious suicidal behaviour.[21]

Signs and symptoms

People with SPD are often aloof, cold and indifferent, which causes interpersonal difficulty. Most individuals diagnosed with SPD have trouble establishing personal relationships or expressing their feelings meaningfully. They may remain passive in the face of unfavorable situations. Their communication with other people may be indifferent and terse at times. Schizoid personality types often lack the ability to assess the impact of their own actions in social situations.[22]

When someone violates the personal space of an individual with SPD, it suffocates them and they must free themselves to be independent. People who have SPD tend to be happiest when in relationships in which their partner places few emotional or intimate demands on them and doesn't expect phatic or social niceties. It is not necessarily people they want to avoid, but negative or positive emotional expectations, emotional intimacy and self-disclosure.[23] Therefore, it is possible for individuals with SPD to form relationships with others based on intellectual, physical, familial, occupational or recreational activities, as long as there is no need for emotional intimacy. Donald Winnicott explains this is because schizoid individuals "prefer to make relationships on their own terms and not in terms of the impulses of other people." Failing to attain that, they prefer isolation.[24] In general, friendship among schizoids is usually limited to one person, often also schizoid, forming what has been called a union of two eccentrics; "within it – the ecstatic cult of personality, outside it – everything is sharply rejected and despised".[25]

Although there is the belief people with schizoid personality disorder are complacent and unaware of their feelings, many recognize their differences from others. Some individuals with SPD who are in treatment say "life passes them by" or they feel like living inside a shell; they see themselves as "missing the bus" and speak of observing life from a distance.[26][27]

Aaron Beck and his colleagues report that people with SPD seem comfortable with their aloof lifestyle and consider themselves observers, rather than participants, in the world around them. But they also mention that many of their schizoid patients recognize themselves as socially deviant (or even defective) when confronted with the different lives of ordinary people – especially when they read books or see movies focusing on relationships. Even when schizoid individuals may not long for closeness, they can become weary of being "on the outside, looking in". These feelings may lead to depression or depersonalization. If they do, schizoid people often experience feeling "like a robot" or "going through life in a dream".[28]

According to Guntrip, Klein and others, people with SPD may possess a hidden sense of superiority and lack dependence on other people's opinions. This is very different from the grandiosity seen in narcissistic personality disorder, which is described as "burdened with envy" and with a desire to destroy or put down others. Additionally, schizoids do not go out of their way to achieve social validation.[29]:60 Unlike the narcissist, the schizoid will often keep their creations private to avoid unwelcome attention or the feeling that their ideas and thoughts are being appropriated by the public.[29]:174

The related schizotypal personality disorder and schizophrenia are reported to have ties to creative thinking, and it is speculated that the internal fantasy aspect of schizoid personality disorder may also be reflective of this thinking.[30][31][32] Alternatively, there has been an especially large contribution of people with schizoid symptoms to science and theoretical areas of knowledge, including maths, physics, economics, etc. At the same time, people with SPD are helpless at many practical activities due to their symptoms.[33]