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Q3. Describe the diagnostic features, causes and treatment of Schizoid personality disorder.


Schizoid personality disorder (SPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy.

Affected individuals may simultaneously demonstrate a rich, elaborate and exclusively internal fantasy world. They may demonstrate significant creativity, particularly in the areas of fiction writing[citation needed] and visual arts.

Diagnostic Features




  1. The essential feature of schizoid personality disorder is a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. This pattern begins by early adulthood and is present in a variety of contexts.
    1. Individuals appear to lack a desire for intimacy, seem indifferent to opportunities to develop close relationships, and do not seem to derive much satisfaction from being part of a family or other social group (Criterion Al). 
    2. They prefer spending time by themselves, rather than being with other people. They often appear to be socially isolated or "loners" and almost always choose solitary activities or hobbies that do not include interaction with others (Criterion A2). 
    3. They prefer mechanical or abstract tasks, such as computer or mathematical games. They may have very little interest in having sexual experiences with another person (Criterion A3).
    4. They take pleasure in few, if any, activities (Criterion A4). There is usually a reduced experience of pleasure from sensory, bodily, or interpersonal experiences, such as walking on a beach at sunset or having sex. 
    5. These individuals have no close friends or confidants, except possibly a first-degree relative (Criterion A5).
    6. Individuals with schizoid personality disorder often seem indifferent to the approval or criticism of others and do not appear to be bothered by what others may think of them (Criterion A6). 
    7. They usually display a "bland" exterior without visible emotional reactivity and rarely reciprocate gestures or facial expressions, such as smiles or nods (Criterion A7). They claim that they rarely experience strong emotions such as anger and joy. They often display a constricted affect and appear cold and aloof. 
  2. Schizoid personality disorder should not be diagnosed if the pattern of behavior occurs exclusively during the course of schizophrenia, a bipolar or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder, or if it is attributable to the physiological effects of a neurological (e.g., temporal lobe epilepsy) or another medical condition (Criterion B).

Culture-Related Diagnostic issues

Individuals from a variety of cultural backgrounds sometimes exhibit defensive behaviors and interpersonal styles that may be erroneously labeled as "schizoid." Immigrants from other countries or migrants from rural areas are sometimes mistakenly perceived as cold, hostile, or indifferent.

Gender-Related Diagnostic issues

Schizoid personality disorder is diagnosed slightly more often in males and may cause more impairment in them.

Differential Diagnosis

  • Other mental disorders with psychotic symptoms: distinguished from delusional disorder, schizophrenia, and a bipolar or depressive disorder with psychotic features because these disorders are all characterized by a period of persistent psychotic symptoms (e.g., delusions and hallucinations). 
  •  Autism spectrum disorder: differentiated by more severely impaired social interaction and stereotyped behaviors and interests
  •  Personality change due to another medical condition: distinguished when the traits that emerge are attributable to the effects of another medical condition on the central nervous system.
  •  Substance use disorders: must be distinguished from symptoms that may develop in association with persistent substance use.
  •  Other personality disorders and personality traits: If an individual has personality features that meet criteria for one or more personality disorders in addition to schizoid personality disorder, all can be diagnosed - schizotypal personality disorder, avoidant personality disorder and obsessive-compulsive personality disorder. 

Causes 

Extensive research on the genetic, neurobiological, and psychosocial contributions to schizoid personality disorder remains to be conducted (Phillips, Yen, & Gunderson, 2003). But combination of genetic and environmental factors is a possible cause.
  • Childhood shyness is reported as a precursor to later adult schizoid personality disorder. It may be that this personality trait is inherited and serves as an important determinant in the development of this disorder.
  • Abuse and neglect in childhood are also reported among individuals with this disorder (Johnson, Bromley, & McGeoch, 2005). A parent who was cold and unresponsive to emotional needs.
  • Family environment of the affected persons - typically emotionally reserved, have a high degree of formality and have a communication style that is aloof and impersonal.
  • Parents of children with autism are more likely to have schizoid personality disorder (Constantino et al., 2009). It is possible that a biological dysfunction found in both autism and schizoid personality disorder combines with early learning or early problems with interpersonal relationships to produce the social deficits that define schizoid personality disorder (Hopwood & Thomas, 2012).
  • Bio-psychological model states that no single factor is responsible but the complex and likely intertwined nature of all three factors – biological and genetic factors, social factors and psychological factors.

Treatment 

It is rare for a person with this disorder to request treatment except in response to a crisis such as extreme depression or losing a job (Kelly et al., 2007). 

Therapists often begin treatment by pointing out the value in social relationships. The person with the disorder may even need to be taught the emotions felt by others to learn empathy (Skodol & Gunderson, 2008). 

Because their social skills were never established or have atrophied through lack of use, people with schizoid personality disorder often receive social skills training. The therapist takes the part of a friend or significant other in a technique known as role-playing and helps the patient practice establishing and maintaining social relationships (Skodol & Gunderson, 2008). This type of social skills training is helped by identifying a social network—a person or people who will be supportive (Bender, 2005). 

Short-tem therapy approach helps individual resolve the immediate crisis or problem. Long term psychotherapy is typically avoided. Cognitive Behavioral Therapy, Group Therapy, Family Therapy and Marital Therapy can be used.

* * *

Schizoid personality disorder is an uncommon condition in which people avoid social activities and consistently shy away from interaction with others. Person shows a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

The exact causes of schizoid personality disorder are unknown, although a combination of genetic and environmental factors — particularly in early childhood — are thought to increase the risk of developing the disorder. The treatment options include medications, psychotherapy and other therapies.

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