SCHIZOID PERSONALITY DISORDER Diagnostic Features: Schizoid Personality Disorder is a condition characterized by excessive detachment from social relationships

and a restricted range of expression of emotions in interpersonal settings. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. This disorder should not be diagnosed if the distrust and suspiciousness occurs exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder or if it is due to the direct physiological effects of a neurological (e.g., temporal lobe epilepsy) or other general medical condition. Complications: Individuals with this disorder may have particular difficulty expressing anger, which contributes to the impression that they lack emotion. Their lives sometimes seem directionless, and they appear to drift in their goals. These individuals often react passively to adversity and have difficulty responding appropriately to important life events. Because of their lack of social skills and lack of desire for sexual experiences, individuals with this disorder have few friendships and often do not marry. Occupational functioning may be impaired, particularly if interpersonal involvement is required, but individuals with this disorder may do well when they work under conditions of social isolation. Comorbidity: In response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). If the psychotic episode lasts longer, this disorder may actually develop into Delusional Disorder or Schizophrenia. Individuals with this disorder are at increased risk for Major Depressive Disorder. Other Personality Disorders (especially Schizotypal, Schizoid, and Avoidant) often co-occur with this disorder. Associated Laboratory Findings: No laboratory test has been found to be diagnostic of this disorder.

Prevalence: Schizoid Personality Disorder is uncommon in clinical settings. This disorder occurs slightly more commonly in males. Course: This disorder may be first apparent in childhood and adolescence with solitariness, poor peer relationships, underachievement in school, which may attract teasing from their peers. The course of this disorder is chronic. Familial Pattern: This disorder is more common among first-degree biological relatives of those with Schizophrenia or Schizotypal Personality Disorder.

What is a personality disorder? Personality is vital to defining who we are as individuals. It involves a unique blend of traitsincluding attitudes, thoughts, behaviors, and moodsas well as how we express these traits in our contacts with other people and the world around us. Some characteristics of an individuals personality are inherited, and some are shaped by life events and experiences. A personality disorder can develop if certain personality traits become too rigid and inflexible. People with personality disorders have long-standing patterns of thinking and acting that differ from what society considers usual or normal. The inflexibility of their personality can cause great distress, and can interfere with many areas of life, including social and work functioning. People with personality disorders generally also have poor coping skills and difficulty forming healthy relationships. Unlike people with anxiety disorders, who know they have a problem but are unable to control it, people with personality disorders generally are not aware that they have a problem and do not believe they have anything to control. Because they do not believe they have a disorder, people with personality disorders often do not seek treatment.

What is schizoid personality disorder? Schizoid personality disorder is one of a group of conditions called eccentric personality disorders. People with these disorders often appear odd or peculiar. People with schizoid personality disorder also tend to be distant, detached, and indifferent to social relationships. They generally are loners who prefer solitary activities and rarely express strong emotion. Although the names sound alike and they might have some similar symptoms, schizoid personality disorder is not the same thing as schizophrenia. Many people with schizoid personality disorder can function fairly well. They tend to choose jobs that allow them to work alone, such as night security officers and library or laboratory workers. What are the symptoms of schizoid personality disorder? People with schizoid personality disorder often are reclusive, organizing their lives to avoid contact with other people. Many never marry and continue to live with their parents as adults. The following are additional traits of people with this disorder:

They do not desire or enjoy close relationships, even with family members. They choose solitary jobs and activities. They take pleasure in few activities, including sex. They have no close friends, except first-degree relatives. They have difficulty relating to others. They are indifferent to praise or criticism. They are aloof and show little emotion. They might daydream and/or create vivid fantasies of complex inner lives. What causes schizoid personality disorder? Little is known about the cause of schizoid personality disorder, but both genetics and environment are suspected to play a role. Some mental health professionals speculate that a bleak childhood where warmth and emotion were absent contributes to the development of the disorder. The higher risk for schizoid personality disorder in families of schizophrenics suggests that a genetic susceptibility for the disorder might be inherited. How common is schizoid personality disorder? It is difficult to accurately assess the prevalence of this disorder because people with schizoid personality disorder rarely seek treatment. Schizoid personality disorder affects men more often than women and is more common in people who have close relatives with schizophrenia. Schizoid personality disorder usually beings in early adulthood. How is schizoid personality disorder diagnosed? If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no laboratory

tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms. If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder. How is schizoid personality disorder treated? People with this disorder rarely seek treatment because their thoughts and behavior generally do not cause them distress. Their inability to form relationships with others also poses a challenge for therapists because trust is an important component of treatment. Psychotherapy a form of counseling is the most commonly used treatment for schizoid personality disorder. Treatment likely will focus on increasing general coping skills, as well as on improving social interaction, communication, and selfesteem. Medicine is generally not used to treat schizoid personality disorder itself. Medicine might, however, be prescribed if the person also suffers from an associated psychological problem, such as depression. What are the complications of schizoid personality disorder? A lack of social interaction is the main complication of this disorder. People with schizoid personality disorder are rarely violent, as they prefer not to interact with people. What is the outlook for people with schizoid personality disorder? Although some of their behaviors might be odd, people with schizoid personality disorder are generally able to function in everyday life. However, they might not form any meaningful relationships or have families of their own. Can schizoid personality disorder be prevented? There is no known way to prevent schizoid personality disorder.

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Causes The causes of schizoid personality disorder are unknown. This disorder may be related to schizophrenia and it shares many of the same risk factors. However, schizoid personality disorder is not as disabling as schizophrenia. It does not cause hallucinations, delusions, or the complete disconnection from reality that occurs in untreated (or treatment-resistant) schizophrenia. Symptoms A person with schizoid personality disorder:

Appears aloof and detached Avoids social activities that involve emotional intimacy with other people Does not want or enjoy close relationships, even with family members

Exams and Tests Like other personality disorders, schizoid personality disorder is diagnosed based on a psychological evaluation and the history and severity of the symptoms. Treatment People with this disorder rarely seek treatment, and little is known about which treatments work. Talk therapy may not be effective, because people with schizoid personality disorder have difficulty relating well to others. However, one approach that appears to help is to put fewer demands for emotional closeness or intimacy on the person with this condition. People with schizoid personality disorder often do better in relationships that do not focus on emotional closeness. They are better at handling relationships that focus only on recreation, work, or intellectual activities and expectations. Outlook (Prognosis) Schizoid personality disorder is a long-term (chronic) illness that usually dos not improve much over time. Social isolation often prevents the person from seeking the help or support that might improve the outcome. Limiting emotional intimacy may help people with this condition make and keep connections with other people. Alternative Names Personality disorder - schizoid

Schizoid personality disorder is characterized by a persistent withdrawal from social relationships and lack of emotional responsiveness in most situations. It is sometimes referred to as a "pleasure deficiency" because of the seeming inability of the person affected to experience joyful or pleasurable responses to life situations. Description A person with schizoid personality disorder has little or no interest in developing close interpersonal relationships. They appear aloof, introverted and prefer being alone. Those who know them often label them as shy or a "loner." They turn inward in an effort to shut out social relationships. It is common for a person with schizoid personality disorder to avoid groups of people or appear disinterested in social situations even when they involve family. They are often perceived by others as socially inept. A closely related trait is the absence of emotional expression. This apparent void of emotion is routinely interpreted by others as disinterested, lacking concern and insensitive to the needs of others. The person with schizoid personality disorder has particular difficulty expressing anger or hostility. In the absence of any recognizable emotion, the person portrays a dull demeanour and is easily overlooked by others. The typical person with schizoid personality disorder prefers to be viewed as "invisible" since it aids their quest to avoid social contact with others. The person with schizoid personality disorder may be able to hold a job and meet the expectations of an employer if the responsibilities do not require more than minimal interpersonal involvement. People with this disorder may be married, but do not develop close intimate relationships with their spouse and typically show no interest in sexual relations. Their speech is typically slow and monotonous with a lethargic demeanour. Because their tendency is to turn inward, they can easily become preoccupied with their own thoughts to the exclusion of what is

happening in their environment. Attempts to communicate may drift into tangents or confusing associations. They are also prone to being absent minded. Causes and symptoms Causes The schizoid personality disorder has its roots in the family of the affected person. These families are typically emotionally reserved, have a high degree of formality, and have a communication style that is aloof and impersonal. Parents usually express inadequate amounts of affection to the child and provide insufficient amounts of emotional stimulus. This lack of stimulus during the first year of life is thought to be largely responsible for the person's disinterest in forming close, meaningful relationships later in life. People with schizoid personality disorder have learned to imitate the style of interpersonal relationships modelled in their families. In this environment, affected people fail to learn basic communication skills that would enable them to develop relationships and interact effectively with others. Their communication is often vague and fragmented, which others find confusing. Many individuals with schizoid personality disorder feel misunderstood by others. Symptoms DSM-IV-TR specifies seven diagnostic criteria for schizoid personality disorder:

Avoids close relationships: People with this disorder show no interest or enjoyment in developing interpersonal relationships; this may also include family members. They perceive themselves as social misfits and believe they can function best when not dependent on anyone except themselves. They rarely date, often do not marry, and have few, if any, friends. Prefers solitude: They prefer and choose activities that they can do by themselves without dependence upon or involvement by others. Examples of activities they might choose include mechanical or abstract tasks such as computer or mathematical games.

Avoids sex: There is typically little or no interest in having a sexual experience with another person. This would include a spouse if the affected person is married. Lacks pleasure: There is an absence of pleasure in most activities. A person with schizoid personality disorder seems unable to experience the full range of emotion accessible to most people. Lacks close friends: People affected with this disorder typically do not have the social skills necessary to develop meaningful interpersonal relationships. This results in few ongoing social relationships outside of immediate family members. Indifferent to praise or criticism: Neither positive nor negative comments made by others elicit an emotionally expressive reaction. They don't appear concerned about what others might think of them. Despite their tendency to turn inward to escape social contact, they practice little introspection. Emotional detachment: Their emotional style is aloof and perceived by others as distant or "cold." They seem unable or uninterested in expressing empathy and concern for others. Emotions are significantly restricted and most social contacts would describe their personality as very bland, dull or humorless. The person with schizoid personality disorder rarely picks up on or reciprocates normal communicational cues such as facial expressions, head nods, or smiles.

Demographics Of all personality disorders , schizoid personality disorder is the least commonly diagnosed personality disorder in the general population. The prevalence is approximately one percent. It is diagnosed slightly more often in males. Diagnosis The symptoms of schizoid personality disorder may begin in childhood or adolescence showing as poor peer relationships, a tendency toward self-isolation, and underachievement in school. Children with these tendencies appear socially out-of-step with peers and often become the object of malicious teasing by their peers, which increases the feelings of isolation and social ineptness they feel.

For a diagnosis of schizoid personality disorder to be accurately made, there must be an ongoing avoidance of social relationships and a restricted range of emotion in interpersonal relationships that begin by early adulthood. There must also be the presence of at least four of the above-mentioned symptoms. A common difficulty in diagnosing schizoid personality disorder is distinguishing it from Autistic Disorder and Asperger's Disorder , which are characterized by more severe deficits in social skills. Other individuals who would display social habits that might be viewed as "isolating" should not be given the diagnosis of schizoid personality disorder unless the personality traits are inflexible and cause significant obstacles to adequate functioning. The diagnosis is based on a clinical interview to assess symptomatic behavior. Other assessment tools helpful in diagnosing schizoid personality disorder include:

Minnesota Multiphasic Personality Inventory (MMPI-2) Millon Clinical Multiaxial Inventory (MCMI-II) Rorschach Psychodiagnostic Test Thematic Apperception Test (TAT)

Treatments A major goal of treating a patient diagnosed with schizoid personality disorder is to combat the tendencies toward social withdrawal. Strategies should focus on enhancing self-awareness and sensitivity to their relational contacts and environment. Psychodynamically oriented therapies A psychodynamic approach would typically not be the first choice of treatment due to the patient's poor ability to explore his or her thoughts, emotions, and behavior. When this treatment is used, it usually centers around building a therapeutic relationship with the patient that can act as a model for use in other relationships. Cognitive-behavioral therapy

Attempting to cognitively restructure the patient's thoughts can enhance selfinsight. Constructive ways of accomplishing this would include concrete assignments such as keeping daily records of problematic behaviors or thoughts. Another helpful method can be teaching social skills through role-playing. This might enable individuals to become more conscious of communication cues given by others and sensitize them to others' needs. Group therapy Group therapy may provide the patient with a socializing experience that exposes them to feedback from others in a safe, controlled environment. It can also provide a means of learning and practicing social skills in which they are deficient. Since the patient usually avoids social contact, timing of group therapy is of particular importance. It is best to develop first a therapeutic relationship between therapist and patient before starting a group therapy treatment. Family and marital therapy It is unlikely that a person with schizoid personality disorder will seek family therapy or marital therapy. If pursued, it is usually on the initiative of the spouse or other family member. Many people with this disorder do not marry and end up living with and are dependent upon first-degree family members. In this case, therapy may be recommended for family members to educate them on aspects of change or ways to facilitate communication. Marital therapy (also called couples therapy ) may focus on helping the couple to become more involved in each other's lives or improve communication patterns. Medications Some patients with this disorder show signs of anxiety and depression which may prompt the use of medication to counteract these symptoms. In general, there is to date no definitive medication that is used to treat schizoid symptoms. Prognosis Since a person with schizoid personality disorder seeks to be isolated from others, which includes those who might provide treatment, there is only a slight chance that most patients will seek help on their own initiative. Those who do may stop

treatment prematurely because of their difficulty maintaining a relationship with the professional or their lack of motivation for change. If the degree of social impairment is mild, treatment might succeed if its focus is on maintenance of relationships related to the patient's employment. The patient's need to support him- or herself financially can act as a higher incentive for pursuit of treatment outcomes. Once treatment ends, it is highly likely the patient will relapse into a lifestyle of social isolation similar to that before treatment. Prevention Since schizoid personality disorder originates in the patient's family of origin, the only known preventative measure is a nurturing, emotionally stimulating and expressive caretaking environment.