Today’s post is on Schizoid Personality Disorder, and the first step with this one should be explaining why there are two PD’s with very similar names; schizoid and schizotypal.
Both are derived from the same concept- the Greek prefix skhizein meaning “split”- but seem to act in different ways. Schizoid PD is purely a personality disorder, and its diagnostic criteria contains all of the negative social symptoms of schizophrenia, but usually none of the positive (thought-disordered or hallucinatory) symptoms. Schizotypal PD, on the other hand, is somewhere on the borderline between being a personality disorder and a schizophenic disorder; sometimes it evolves into “full” schizophrenia, while at other times it functions as a PD. It contains mostly the positive symptoms of schizophrenia- such as disordered thought and speech, and not-quite-psychotic experiences- with only traces of the negative symptoms.
The ICD criteria for Schizoid PD are:
- Emotional coldness, detachment or reduced affect.
- Limited capacity to express either positive or negative emotions towards others.
- Consistent preference for solitary activities.
- Very few, if any, close friends or relationships, and a lack of desire for such.
- Indifference to either praise or criticism.
- Taking pleasure in few, if any, activities.
- Indifference to social norms and conventions.
- Preoccupation with fantasy and introspection.
- Lack of desire for sexual experiences with another person.
So someone with schizoid PD can be seen as a stereotypical loner, an INTP turned up to eleven, someone detached from the world to some extent. People with SPD tend to describe themselves as observers of life, rather than participants in it. Fictional schizoid protagonists are uncommon, as this detachment from others and lessened motivation to take part in events would make it difficult to clearly write the traits into the main character. The closest example I can think of is Mersault from Camus’s The Stranger, in how he expresses his confusion over the concept of conventions and what is “the done thing”, and the way he cares little for his life’s direction or connections, living mostly because he exists.
Schizoid PD is unlike most people’s view of what makes up a mental illness, as the stereotype is that people with mental illnesses are often either violent, obviously “out there”, or distressed at their own condition (I’ve heard it summed up before as “mad, bad, or sad”).
Someone with SPD is none of those things, and they are very rarely found in psychiatrists offices, prisons, A&E, or any of the dramatic places and events an untreated personality disorder may sterotypically lead to. Instead, most people with it will have an uneventful life, with one or two hobbies, generally a steady job (though probably one they are over-qualified for), maybe a pet or a friend, whichever they would prefer.Arguably, SPD could be described as being on the extreme end of introversion, with some accompanying emotional detachment and the aversion to sex being added on.
It is one of the rarest personality disorders, with an estimated 1% prevalence. However, this could be simply because most people with it don’t get into trouble, and so would be unlikely to ever require a diagnosis. There is also no direct treatment for SPD: talk therapy is less likely to succeed for a schizoid patient as they would find it difficult/pointless to form the relationship necessary for therapeutic benefits. However, people with SPD can sometimes be prescribed anti-depressants if they have anhedonia (the inability to find things pleasurable) along with the other emotion-related differences.
Psychological Criticisms of SPD
One of the principles of the medical model of psychiatry is that a trait can be classified as dysfunctional, or a part of mental illness, if it causes distress to the person. A major criticism of SPD is that the person with it will rarely be distressed about their symptoms, it is instead others in their life who are worried about them i.e. family members worried that their son/daughter maybe doesn’t have many friends, or doesn’t want a relationship. Only one or two symptoms of SPD could really be classed as disordered, so it is ofen criticised by opponents to psychiatry.
Another factor is cross-cultural differences- it may be that the schizoid personality has only recently be classified as a disorder (in the DSM-IV, published in 1994) due to the increased Western emphasis on the extroverted, social, hyper-connected individual making the reserved and aloof schizoid traits seem more different and therefore “wrong”, while in other, more reserved cultures, someone having schizoid traits would not be seen as a problem.