Schizoid Personality Disorder DSM-5 301.20 (F60.1)

Schizoid Personality Disorder DSM-5 301.20 (F60.1)

DSM-5 Category: Personality Disorders

Introduction

Schizoid personality disorder (SPD), is a cluster A personality disorder, a group made up of odd and peculiar personality disorders. A rare disease, it only occurs in approximately less than 1 percent of the population (Mayo Clinic, 2013). Initially, there was a move to remove SPD from DSM-5, which was unsuccessful. (Triebwasser, Chemerinski, Roussos, & Siever, 2012) SPD is known for its characteristics such as not having close personal relationships and choosing to remain detached from others in society. Individuals that are said to fit the definition for SPD have a tendency to engage in introverted activities and arrange their life in such a way that even their choices of professions require very minimal interaction with others. An individual with SPD will take on a job position even if their abilities far exceed the job criteria (Mayo Clinic, 2013). With SPD, the individual views themselves as bystanders instead of as an active member in society.

Schizoid personality disorder is not commonly seen in clinical settings; however there is a higher prevalence in males, especially in offender populations (Nirestean, Lukacs, Cimpan, & Taran, 2012). The grounds for schizoid personality disorder remains largely unknown. It appears to be associated with schizophrenia, though it is usually not as immobilizing as schizophrenia (Merrill, 2012) .

SPD has some similarities with schizophrenia, with some common characteristics with its negative symptoms of schizophrenia; these include lack of emotion, avoidance and lack of motivation (Martens, 2010). Other personality disorders that have parallel traits with SPD are antisocial personality disorder (ASPD), narcissistic personality disorder (NPD), and avoidant personality disorder (Martens, 2010).

Symptoms of Schizoid Personality Disorder

Individuals with Schizoid personality disorder are fearful of the world, ultimately entering into a secluded and hidden environment that they create. They lean towards extreme submissiveness and give the impression of only seeking any form of validation from within. On the other hand, their lack of constructive connection and emotional apathy frequently places them in a situation where they can easily be manipulated by other individuals (Martens, 2010). Internally, they may struggle with individual feelings of community seclusion and isolation, and have an increased risk for depression (Mayo Clinic, 2013).

The criteria for SPD from the DSM-5 are as follows (American Psychiatric Association, 2013):

A persistent pattern of disinterest from social interactions and a limited variety of expression of emotions in a close personal settings, starting in early adulthood and there in an array of contexts, as shown by at least four (or more) of the subsequent:

  • neither wants nor likes close relationships, counting being part of a family
  • almost constantly picks introverted activities
  • has little if any, thought in engaging in any sexual experiences
  • seldom derives pleasure from any activities
  • has no close friends other than immediate relatives
  • appears apathetic to the admiration or disapproval of others
  • shows emotional coldness, detachment, or flattened affectivity

Epidemiology

Schizoid Personality Disorder is more common in men as well as in first-degree relatives of those with schizophrenia. Furthermore, patients with SPD may ultimately end up having schizophrenia, thus showing the close association between SPD and schizophrenia (Mayo Clinic, 2013).

Risk Factors of Schizoid Personality Disorder

A number of risk factors can enhance an individual’s chance of developing schizoid personality disorder (Mayo Clinic, 2013). These factors focus on situations surrounding the individual’s childhood experiences, as well as heritability. An individual’s risk is increased if they have any relative who has either had or has SPD, schizophrenia or schizotypal personality disorders. An individual who was raised in a home, where emotional needs went unmet likewise has an increased risk of developing SPD. An individual who was hypersensitive as a teenager, and who felt emotionally disconnected, as well as one who was abandoned as a child, or suffered mistreatment as a child, all have an increased chance of developing SPD.

Differential Diagnosis

It is important to make a distinction between SPD and other similar disorders such as schizophrenia, other cluster A personality disorders, or a personality change occurring as a result of an illness or substance use. Unlike schizophrenia, SPD does not involve hallucinations, and patients tend to be successful in the work environment (Nirestean, Lukacs, Cimpan, & Taran, 2012).

While individuals with Schizotypal Personality Disorder tend to experience anxiety as a result of social paranoia, those with Schizoid PD experience anxiety as a result of not wanting any close relationships (Martens, 2010). Whereas those with avoidant personality disorder dislike social isolation, those with SPD are indifferent about seclusion (Martens, 2010)(CITE). While patients with paranoid personality disorder have the ability to display deep emotions when wrongly accused, those with SPD do not possess that ability.

Complications

In addition to having SPD, these individuals have a greater risk of developing other mental health disorders (Mayo Clinic, 2013). These include major depressive disorder, anxiety disorders, and developing schizophrenia, schizotypal personality disorder, or other kinds of delusional disorders.

Treatment for Schizoid Personality Disorder

Treating patients with SPD can be challenging as there appears to be a tainted understanding of the illness and physician. (Nirestean, Lukacs, Cimpan, & Taran, 2012) These patients appear not to be thankful for a physician’s care, and many times frequently wait before obtaining medical care.

Patients with SPD tend to be aloof about the need to change, which can result in defiance to any therapeutic approach. In addition to being the least hospitalized, they are also the least diagnosed due to the similarity with the other cluster A personality disorders (Nirestean, Lukacs, Cimpan, & Taran, 2012).

Psychotherapy

Psychotherapy may be beneficial for some patients with SPD. The therapist would have to be cognizant of the lack of emotional awareness and give the patient the space needed.

Group therapy

A goal of individual treatment may be a group setting in which you can interact with others who are also practicing new interpersonal skills. In time, group therapy may also provide a support structure and increase your social motivation.

Social Impact

Patients with SPD tend to do well in the work environment, but are not eager to connect emotionally with others (Merrill, 2012). For this reason, they function best in work roles where they are required to work alone. They also do not derive pleasure from sexual experiences, and lack emotion, so this affects any possibility of romantic relationships (Esterberg, Goulding, & Walker, 2010).

There lies an inclination to form emotional connections with animals or objects, instead of humans (Esterberg, Goulding, & Walker, 2010).

References

American Psychiatric Association. (2013). Personality disorders. In Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition ed.). Washington, DC: American Psychiatric Publishing Inc.

Esterberg, M., Goulding, S., & Walker, E. (2010, Dec 1). A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence. Journal of Psychopathology and Behavioral Assessment, 32(4), 515-528. Retrieved March 13, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992453/

Martens, W. (2010). Schizoid personality disorder linked to unbearable and inescapable loneliness. The European Journal of Psychiatry, 24(1). Retrieved March 12, 2014, from http://scielo.isciii.es/scielo.php?pid=S0213-61632010000100005&script=sci_arttext

Mayo Clinic. (2013, July 27). Complications. Retrieved March 14, 2014, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/schizoid-personality-disorder/basics/complications/con-20029184

Mayo Clinic. (2013, July 27). Risk Factors. Retrieved March 14, 2014, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/schizoid-personality-disorder/basics/risk-factors/con-20029184

Mayo Clinic. (2013, July 27). Schizoid personality disorder. Retrieved March 12, 2014, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/schizoid-personality-disorder/basics/complications/con-20029184

Merrill, D. (2012, Nov 10). Schizoid personality disorder. Retrieved 3 12, 2014, from MedlinePlus: http://www.nlm.nih.gov/medlineplus/ency/article/000920.htm

Nirestean, A., Lukacs, E., Cimpan, D., & Taran, L. (2012, Jan 12). Schizoid personality disorder—the peculiarities of their interpersonal relationships and existential roles. Personality and Mental Health, 6(1), 69-74. Retrieved March 12, 2014, from http://onlinelibrary.wiley.com/doi/10.1002/pmh.1182/pdf

Triebwasser, J., Chemerinski, E., Roussos, P., & Siever, L. (2012). Schizoid personality disorder. Journal of Personality Disorders, 919-26. doi:10.1521/pedi.2012.26.6.919.


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