Schizoid personality disorder: overview, features, history, and care

Outside view

A profound contact disorder characterizes the affected persons. Emotional connection and devotion to the environment are considerably reduced, the spontaneous ability to experience and the direct addressing of feelings are strongly inhibited. Their emotional relationship to people and things appears unusually loose and non-committal. A lack of "emotional authenticity", a general flattening of emotions (affects) and a lack of expectable emotional reactions to the emotional states of fellow human beings are often conspicuous. Deep-seated mistrust with a tendency to hardly open up or reveal themselves intimately keeps the affected person at a distance from other people.

While on the one hand there may be a desire for intimate communion with others or a fellow human being, on the other hand communication and emotional expression are blocked. As a result, a strong sense of inner conflict arises within the schizoid person. Some of these affected people appear rigid and wooden, while others are overly friendly and trustworthy. When put under pressure (e.g. by living too closely together), they often react abruptly and alienatingly. They then withdraw completely unexpectedly for outsiders, close themselves off and avoid all contact for some time. Both perfect self-control and sudden outburst are usually sides of these personalities.

Changes and new things initiated from the outside are usually seen as a danger from which one must protect oneself - preferably through withdrawal or control. People with a schizoid disorder therefore often develop a high degree of intuitive abilities as a compensatory measure, with which they want to protect themselves and at the same time gain superiority and control. These trained skills help the schizoid person to cope with everyday life, but quickly put a strain on closer social contacts.

Outwardly, many affected persons usually show a "smooth" surface without visible emotional resonance. Gestures or facial expressions (e.g. a smile or nod) are seldom returned and their own feelings are not expressed. Even when directly provoked, they find it immensely difficult to express inner aggression or hostility. Schizoid personalities can therefore appear passive and unemotional in such situations - even though this often does not correspond to their true emotional state. Therefore, they often have problems reacting appropriately to important or unpleasant life events.

To outsiders, schizoid people sometimes appear to live rather directionless lives, "drifting" toward their goals. These individuals may also appear self-absorbed and detached from their surroundings - immersed in excessive daydreaming or as if "in a fog". In interpersonal interactions, some schizoids also pay too little attention to subtle, subliminal details. For example, they overlook social cues and then unintentionally break the usual social rules. As a result, others may perceive their behavior as inappropriate, socially awkward, or superficial.

Inside view

Schizoid people usually experience themselves as uninvolved observers of the world around them - but not as participants. Although many usually like to live a secluded life, they can grow tired of "standing outside looking in." The thought of being an inadequate oddball can be triggered in schizoids when it becomes clear how different they are from others. Many become especially aware of this when they observe others directly, watch movies, or read books that deal with relationships.

Some describe in their treatment the feeling of living "inside a shell" or "under a glass bell" and of having missed the connection. They complain that "life passes them by" and they have to watch others from a distance. In such situations, people with SPS may acknowledge painful feelings about being loners who do not fit into society. Even though they do not really feel the need to be close to others, they may then believe that they should strive for a more conventional life.

School and career

Insofar as the prerequisites exist, schizoid personalities not infrequently develop a high degree of intellectual differentiation. Many schizoids are "head people" and tend to have a pronounced emphasis on the mind with a retreat into thinking ("flight into the intellect"). Although this makes them more receptive to mental stimuli rather than sensual pleasures, some nevertheless possess a strong sense of aesthetics and beauty.

Self-irony is also mentioned as a frequent resource as a strength, in addition to thinking that tends towards the abstract, which often enables new ways of looking at things. Schizoid traits in the clinically inconspicuous range are also associated with creativity. Thus, in an initial study, individuals with schizoid tendencies showed a better capacity for divergent thinking.

Occupationally, schizoid people tend more towards theoretical fields of work as well as activities that are carried out alone or in constant small groups. These include service occupations where the opportunities for interaction between client and provider are limited and formalized to an increased degree by social norms. Where occupational activity is possible alone and in social isolation, extremely good performance can occasionally be achieved.

At school, they sometimes perform poorly, which does not correspond to their intellectual abilities. However, there are also affected persons with high compensatory abilities who - according to some authors - even choose professions in which less formalized social relationships play a major role. Here too, however, the authors perceive a certain "emotional inauthenticity".

Disease value

The described behaviors are only considered a personality disorder (PS) if they are chronic, inflexible and extremely pronounced. Mild forms are referred to as schizoid personality. Loners may show schizoid behavioural traits, but these traits only become pathological when they are rigid and inappropriate and lead to suffering or impairment.

The possible negative consequences of full-blown schizoid PS have so far been observed to be:

• significantly lower quality of life,
• an unfavourable influence on the psychological functioning level over 15 years (lower GAF values)
• and one of the lowest levels of "life success" of any personality disorder (defined as social status, wealth, and successful intimate relationships).

Certain schizoid characteristics (such as emotional detachment) are also a significant risk factor for serious suicide attempts.

According to ICD

The ICD-10 lists SPS under F60.1. At least four of the following characteristics or behaviors must be present:

1. only a few activities, if any, give pleasure;
2. shows emotional coolness, aloofness or flattened affectivity;
3. reduced ability to express warm, tender feelings for others or anger;
4. appears indifferent to praise or criticism from others;
5. little interest in sexual experiences with another person (taking into account age);
6. almost always preference for activities that can be done alone;
7. excessive use of fantasies and introspection;
8. Has no or does not desire close friends or trusting relationships (or at most one);
9. clear lack of a sense of applicable social norms and conventions. If they are not followed, this happens unintentionally.

According to DSM

According to the DSM-5, it is a profound pattern characterized by aloofness in social relationships and a limited range of emotional expression in interpersonal settings. Onset is in early adulthood and the pattern manifests in a variety of situations. At least four of the following criteria must be met:

1. Has no desire for close relationships nor enjoys them, including being part of a family.
2. Almost always chooses solitary pursuits.
3. Has little, if any, interest in sexual experiences with another person.
4. Only a few activities, if any, give pleasure (anhedonia).
5. Has no close friends or confidants, except first-degree relatives.
6. Appears indifferent to praise and criticism from others.
7. Shows emotional coldness, aloofness, or limited affectivity.

The symptoms may not be better explained by another disorder (e.g., schizophrenia, bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder).

Delimitation

A major problem in diagnosis is the overlap with other personality disorders or diseases. For example, some symptoms may resemble the negative symptoms seen in schizophrenia simplex (e.g. impoverished thinking and flattened affect). However, schizoid PS is a consistent pattern over time, whereas schizophrenia is a sudden decline in previously unremarkable individuals.

Other personality disorders

Unlike schizoid PS, in anxious-avoidant personality disorder (AEVPS) it is primarily the fear of shaming and the negative value judgement of others that makes contact difficult for sufferers. However, there are also clear similarities. This is why some believe that SPS and EVPS are different variants of the same disorder.

People with schizotypal PS show much more severe abnormalities in behaviour, language and perception than schizoids, e.g. magical thinking, bizarre beliefs and strange ways of speaking. However, both personality disorders are also increasingly combined with SPS and then represent a comorbidity.

Autism

It can also be difficult to distinguish from Asperger's syndrome (AS), which begins in childhood, as some autistic people (up to 26%) simultaneously meet the criteria for schizoid PS. In both Asperger's syndrome and SPS, social communication (facial expressions, gestures, eye contact, etc.) can be striking. An essential difference, however, is that schizoid people usually appear reserved, reserved and closed (or even "secretive") and are rather reluctant to talk about themselves; they try to avoid self-revelation.

In stark contrast, people with Asperger's are often very open-hearted, honest and direct, and sometimes unintentionally intrusive. There is often little shyness about giving others a glimpse into one's inner life. This is evident in the open - and occasionally naive - personal self-presentation of autistic people in their autobiographies and during interviews in public. They often desire contact with other people, but have problems perceiving complex feelings in the other person or reacting appropriately to them.

Further distinguishing features are the weaker social interaction, hardly any stereotypical behaviour and stronger affect narrowing in schizoid people. In contrast to autism, normal emotionality and inconspicuous social behaviour can usually be observed until puberty. More typical of Asperger's, on the other hand, are restricted, repetitive behaviors and a lack of reciprocity in social interactions. In AS, however, the lack of reciprocity is based less on indifference or disinterest and more on eccentric determination in pursuing a particular special topic - without regard to whether the other interlocutors are interested in it or not.