Click here to view next page of this article New Treatments for Schizoid Personality DisorderThe schizoid personality disorder is a pervasive pattern of social detachment and restricted emotional expression. The presence of schizoid personality disorder is indicated by four or more of the seven DSM-IV diagnostic criteria scitzoid personality disorder. Introversion versus extraversion is one of the fundamental dimensions of personality. Facets of introversion include low warmth (e.g., cold, detached, impersonal), low gregariousness (socially isolated, withdrawn), and low positive emotions (reserved, constricted or flat affect, anhedonic) that resemble closely the central symptoms of schizoid personality disorder. However, only a small minority of the population would be diagnosed with a schizoid personality disorder, although a substantial proportion of the population is introverted. Schizoid personality disorder is less common than the other PDs in most clinical settings. An exact prevalence is difficult to provide, as revisions of the diagnostic criteria have resulted in substantial variability in how often it is diagnosed. In addition, many persons who were diagnosed with schizoid personality disorder. EtiologyResearch has supported heritability for the personality dimension of introversion-extraversion. A genetic link of SZPD to schizophrenia is less clear. An association has often been found for the odd-eccentric PDs, which includes SZPD along with the PPD and STPD. However, this research also suggests that the association is confined largely to the schizotypal traits. Psychosocial models for the etiology of SZPD are lacking. It is likely that a sustained history of isolation during infancy and childhood with encouragement and modeling of interpersonal withdrawal, indifference, and detachment by parental figures contributes to the development of schizoid personality traits. The central pathology of SZPD appears to be anhedonic deficits or an excessively low ability to experience positive affectivity. A fundamental distinction of schizophrenic symptoms is between positive and negative symptoms. Positive symptoms include hallucinations, delusions, inappropriate affect, and loose associations; negative symptoms include flattened affect, alogia, and avolition. SZPD may represent subthreshold negative symptoms. Differential DiagnosisSZPD can be confused with STPD and AVPD, as both involve social isolation and withdrawal. STPD, however, also includes intense social anxiety and cognitive-perceptual aberrations. The symptoms of schizophrenia. Course and Natural HistoryPersons with SZPD have been socially isolated and withdrawn as children. They may not have been accepted well by their peers and may even have experienced some ostracism. As adults, they have few friendships. Those that do occur are likely to have been initiated by their peers or colleagues. They have had few sexual relationships and may never marry. TreatmentPersons with SZPD rarely present for treatment, whether it is for their schizoid traits or a concomitant Axis I disorder. They feel little need for treatment, as their isolation is often ego-syntonic. Their social isolation is of more concern to their relatives, colleagues, or friends than to If persons with SZPD are seen for treatment for a concomitant Axis I disorder (e.g., a sexual arousal disorder or a substance dependence), it is advisable to work within the confines and limitations of the schizoid personality traits. Charismatic, engaging, emotional, or intimate It is also important not to presume that persons with SZPD are simply inhibited, shy, or insecure. Such persons are more appropriately diagnosed with AVPD. Persons with SZPD are perhaps best treated with a supportive psychotherapy that One may not be able to increase the desire for social involvements but one can increase the ability to relate to, communicate with, and get along with others. Persons with SZPD may not want to develop intimate relationships but they often want to interact and relate more effectively and comfortably with others. Role-playing and videotaped interactions can at times be useful in this respect. Persons with SZPD can have Group therapy is often useful as a setting in which patients can gradually develop self-disclosure, experience the interest of others, and practice social interactions with immediate and supportive feedback. However, persons with SZPD are prone to being rejected by a group because of There have been many studies of the pharmacological treatment of STPD but no comparable studies of SZPD. STPD and SZPD share many features, but the responsivity of STPD to pharmacotherapy usually reflects the |