Schizoid personality disorder

Definition

Schizoid personality disorder is a condition in which affected people avoid social activities and consistently shy away from interaction with others. If you have schizoid personality disorder, you may be seen as a loner, and you may feel as though you have no idea how to form personal relationships.

To others, you may appear dull or humorless. Because you don't tend to show emotion, you may appear as though you don't care about what's going on around you. However, although you may seem aloof, you may actually feel extremely sensitive and lonely.

The cause of schizoid personality disorder is unknown. Therapy and medications can help.

Symptoms

People with schizoid personality disorder are loners. If you have this condition, you're likely to:

• Prefer being alone and usually choose solitary activities
• Prize independence and have few close friendships
• Feel confused about how to respond to normal social cues and generally have little to say
• Lack any desire for sexual relationships
• Feel unable to experience pleasure
• Come off as dull, indifferent or emotionally cold
• Feel unmotivated and tend to underperform at school or work
• Consistently play the role of a follower rather than a leader

Some of these tendencies may have first become noticeable during your childhood.

If you have schizoid personality disorder, you may not know how to form friendships, or you may feel too anxious around other people to try, so you simply give up and turn inward.

The schizophrenic spectrum
Schizoid personality disorder is considered part of the "schizophrenic spectrum" of disorders, which includes schizotypal personality disorder and schizophrenia. These conditions all have similar symptoms, such as a severely limited ability to make social connections along with a lack of emotional expression. The main distinction is that — unlike schizotypal personality disorder and schizophrenia — people with schizoid personality disorder are in touch with reality. If you have schizoid personality disorder, you're unlikely to experience paranoia or hallucinations.

In addition, schizoid personality disorder isn't marked by odd speech. Although your tone may not be animated, what you say makes sense. In contrast, the conversational patterns of people with schizotypal personality disorder are typically strange and hard to follow.

When to see a doctor
Treatment for a personality disorder may be more effective if it begins as early as possible.

If someone close to you has urged you to seek help for symptoms common to schizoid personality disorder, make an appointment, starting with a primary care physician or mental health professional.

If you suspect a loved one may have schizoid personality disorder, gently suggest that the person seek medical attention. It might help to offer to accompany your loved one to the first appointment.

Causes

The exact causes of schizoid personality disorder are unknown, although a combination of genetic and environmental factors — particularly in early childhood — are thought to contribute to development of all personality disorders.

If you have schizoid personality disorder, you may have had a parent who was cold or unresponsive to emotional needs. Or, you may have been hypersensitive or thin-skinned in early adolescence and had these needs treated with annoyance or scorn.

A family history — such as having a parent who has any of the disorders on the schizophrenic spectrum — also increases your chances of developing the disorder.

Risk factors

Personality development is affected by genetic tendencies as well as environmental factors, particularly during childhood. Factors that increase your risk of developing schizoid personality disorder include:

• Having a parent or other relative who has schizoid personality disorder, schizotypal personality disorder or schizophrenia
• Experiencing a childhood environment of neglect or scorn
• Suffering child abuse or mistreatment
• Having an emotionally detached parent

Complications

People with schizoid personality disorder are at an increased risk of:

• Developing schizotypal personality disorder, schizophrenia or other delusional disorder
• Drug addiction, particularly to psychedelic drugs
• Alcohol addiction
• Major depression
• Anxiety disorder
• Panic disorder
• Social phobia
• Other personality disorders

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you or your family has noticed, and for how long.
• Write down key personal information, including traumatic events in your past and any current, major stressors.
• Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications or supplements you're taking.
• Take a family member or friend along, if possible. Someone who has known you for a long time may be able to ask questions or share information with the doctor that you don't remember to bring up.
• Write down the questions you want to be sure to ask your doctor so that you can make the most of your appointment.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out.

For schizoid personality disorder, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are possible causes for my symptoms or condition?
• Is my condition likely temporary or chronic?
• How could treatment help me?
• What types of treatments are likely to be effective for me?
• Are there medications that can help?
• If you're recommending medications, what are the possible side effects?
• How much can I expect my symptoms to improve with treatment?
• I have these other health conditions. How can I best manage them together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• What are the problems or symptoms that concern you?
• How much do these symptoms bother you?
• Have you noticed that your symptoms get worse in certain situations? If yes, what are those situations, and how do you handle them?
• Do you have close friends or family? If no, does it bother you?
• How would you describe yourself?
• Do you frequently choose to do things by yourself?
• Do you confide in anyone who is not in your immediate family?
• What do you prefer to do in your free time?
• Have you ever thought about harming yourself or others? Have you ever actually done so?
• Have your family members or friends expressed concern about your behavior?
• Have any of your close relatives been diagnosed with or treated for mental illness?
• Do you drink alcohol or use drugs? If so, how often?

What you can do in the meantime
While you're waiting for your appointment, it may be helpful to ask friends or family members if they have felt concerned about your behavior. You'll also want to find out about your family's medical history, including any history of mental illness. If you have fantasies about hurting yourself or someone else, go to an emergency room or call 911 or your local emergency number immediately.

Tests and diagnosis

Diagnosing schizoid personality disorder is usually based on an in-depth interview with your doctor about your symptoms as well as your medical and personal history. Your doctor may perform a physical exam to rule out other conditions that may be causing or contributing to your symptoms. You may also be referred to a mental health professional for further evaluation.

To be diagnosed with schizoid personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. Criteria for schizoid personality disorder to be diagnosed include four or more of the following characteristics:

• You neither desire nor enjoy close relationships, including being part of a family
• You almost always choose solitary activities
• You have little, if any, interest in sexual experiences with another person
• You take pleasure in few, if any, activities and rarely experience strong emotions
• You don't have any close friends or confidants other than first-degree relatives
• You seem not to care about praise or criticism
• You seem emotionally cold, detached or unexpressive

For schizoid personality disorder to be diagnosed, doctors may first need to rule out conditions with similar symptoms, such as autism or Asperger's syndrome.

Treatments and drugs

If you have schizoid personality disorder, you may prefer to go your own way and avoid interacting with others, including doctors. You may be so used to a life without emotional closeness that you're not sure you want to change — or that you can. And if you do come into treatment, you may find it extremely hard to open up about your inner life.

However, a therapist with experience treating schizoid personality disorder is likely to understand your need for personal space and private thoughts, and will continue reaching out to you without pushing. With a skilled and patient therapist, you can make significant progress.

• Medications. There's no specific drug treatment for schizoid personality disorder. However, doctors may prescribe medications to help treat some symptoms, as well as associated conditions such as anxiety and depression. For example, the psychological inability to experience pleasure can be treated with bupropion (Wellbutrin). Risperidone (Risperdal) or olanzapine (Zyprexa) can help with flattened emotions and social problems.
• Psychotherapy. Cognitive behavior therapy helps you change the beliefs and behaviors that are problems for you. If you have schizoid personality disorder, this type of therapy can help you increase your sensitivity to interpersonal cues and develop social skills. For example, you might learn appropriate ways to react in common social situations, such as being introduced to a new person. Treatment will also help you feel less anxious in social situations.
• Group therapy. Treatment can be more effective if you can interact with others who are also practicing new interpersonal skills. Group therapy may also provide a support structure and increase your social motivation.