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Schizoid Personality Disorder 

Schizoid personality. Schizoid individuals are socially withdrawn, introverted, eccentric. When schizophrenic individuals have chronically disoriented thinking and schizoid individuals do not. The hallmark of schizoid personality is the avoidance of human contact. Schizoid people structure their lives in order to avoid human contact. They become quite involved in their own private fantasy world, often to the exclusion of life around them. Many schizoid individuals, although they appear almost immobile and affect-less, will have violent fantasies, strongly sexual fantasies and may live in the schizoid personality disorder.

They usually choose solitary jobs as night watchmen or they can bury themselves in the stacks in the library or in a laboratory. In an interview, schizoid individuals will be uncomfortable, they’ll make infrequent eye contact. They’ll show you little emotion. Occasionally you may hear an odd usage of a word, but by-and-large, these people do not have the eccentricities that we’ll talk about in the schizotypal personality. The schizoid person usually feels quite frightened by human interaction. He or she finds it frightening and confusing and painful and so isolation is thought to be in self-defense. In DSM IV the definition of a schizoid person is one who doesn’t want relationships. Not even in his deepest heart of hearts. The major defense of the schizoid individual is avoidance, and secondly withdrawal.

The diagnostic criteria involve a pervasive pattern of indifference to social relationships, and restricted range of emotional experience and expression. Certainly in psychotherapy some schizoid patients talk about bleak childhoods that are devoid of emotional warmth. There is a lot of speculation about genetic factors that are involved in the development of schizoid personality.

Epidemiology. It may be as prevalent as 2% of the population, based on some of the large scale epidemiological studies that have been done. It is diagnosed more frequently in men than in women. There is very little known about the course or prognosis for this, either in terms of who becomes less schizoid over time or which schizoid individuals go on to develop schizophrenia.

Differential diagnosis. Think about schizophrenia. But schizophrenia involves a chronic thought disorder and schizoid individuals usually function better than schizophrenic individuals do, socially and occupationally, although there are obviously exceptions to that.

Schizotypal individuals have oddities of perception and communication and usually poor work histories. People often say you can tell a schizotypal walking down the street from across the street because they are just odd. Schizoid individuals often just look quiet and withdrawn.

Also, think about avoidance personality disorders and here is where DSM IV says that avoidant people are people who secretly long for relationships but are afraid to have them. Schizoid people don’t want them. Paranoid personality disorder is one thing to think about in the differential, but paranoid individuals have a great ability to engage people socially. They are often also more verbally aggressive than schizoid individuals and are also less absorbed.

Treatment. Individual psychotherapy is quite difficult. But for most schizoid individuals who do present for therapy, as they begin to trust the therapist they also begin to share their fantasy lives, which can be quite vivid. Group psychotherapy has not been useful for schizoid individuals. There is no specific role for medication that has been defined.

This is similar to schizoid personality with the additional features of strange or eccentric looking, having oddities of perception and communication, odd word usages. Schizotypal personality disorder is the one personality disorder that we know to be genetically linked to schizophrenia. In fact it was created out of the Danish adoption studies found a group of people with this symptom cluster who were much more heavily concentrated in the biological relatives of schizophrenics. These are people who have milder forms of psychotic-like symptoms, derealization, ideas of reference, perceptual illusions. Many of them will feel that they have special powers. There’s the woman with the crystal ball. In an interview, schizotypal people will be withdrawn like schizoid individuals, but their speech is often quite peculiar. They’ll use words in odd ways. They’ll express ideas un-clearly. Again, the major defense of this disorder is a withdrawal into fantasy. The diagnostic criteria emphasizes a pervasive pattern of deficits.