Schizoid Personality Disorder PDF

Schizoid Personality Disorder A lack of, and indifference to, interpersonal relationships Schizoid Personality Disorder Have you ever seen anyone who seems to enjoy his or her life of solitude? – Who you’ve never seen with friends? – Who has never sought out friends? – Who seems immune to loneliness...

Schizoid Personality Disorder A lack of, and indifference to, interpersonal relationships Schizoid Personality Disorder Have you ever seen anyone who seems to enjoy his or her life of solitude? – Who you’ve never seen with friends? – Who has never sought out friends? – Who seems immune to loneliness and boredom? – Who often lives in his or her own world? Schizoid Personality Disorder Have you ever seen anyone who seems to enjoy his or her life of solitude? – Who you’ve never seen with friends? – Who has never sought out friends? – Who seems immune to loneliness and boredom? – Who often lives in his or her own world? Neither have I… Schizoid Personality Disorder Schizoids often choose to be by themselves, thus – Go through life with markedly reduced interpersonal stress – Immune to the demands that others might put on them Does this old adage ring true? Schizoid Personality Disorder – Case Example Leonard is a tall, slender man referred to the Employee Assistance Program at the university by his supervisor. When asked why he was being seen, Leonard replied, “Maybe he thought I’d do better by now.” He offers no other explanation, cannot explain why his supervisor might be dissatisfied, and does not seem especially concerned. He has worked at the library for not quite a year. At first, he was assigned to book checkout, but was unable to engage the patrons interpersonally and was eventually reassigned to work alone in the stacks, a position he prefers. Schizoid Personality Disorder – Case Example The most notable aspect of his presentation is an absence of emotion. There is no restrained anger, nor even any sign of fear or annoyance. Nor is there any anxiety or curiosity about what he might experience. In fact, Leonard seems quite detached from the surrounding world, responding slowly but automatically, as if he were just going through the motions. Eye contact is minimal. Schizoid Personality Disorder – Case Example Gathering information from Leonard takes time. Sometimes, he seems to misunderstand the questions. Sentences loaded with emotional nuance take a long time for him to process. Even when he does understand, his responses are brief and nearly devoid of emotional content. The few facial expressions he uses seem inappropriate to the content of his words. Schizoid Personality Disorder – Case Example And yet, Leonard is not malicious. Rather, he is simply not connected to the interviewer, nor the world. No mention is made of friends, coworkers, or any significant relationships, either past present. Instead, he prefers to spend his free time alone, watching television or working on model airplanes, which are “all I need.” Nevertheless, he cannot name a show or series he likes. He does not understand the idea of a “favorite.” Schizoid Personality Disorder – Case Example When asked if he is close to anyone in his family, he is confused by the idea of “closeness,” but does mention that his older sister had suggested that work at the university would give him health insurance coverage. Further inquiry reveals that although his family lives in the area, it is they who stay in touch with him, while Leonard has been known to move without notifying anyone for months. Schizoid Personality Disorder – Case Example Leonard’s conduct cannot be seen as insubordinate, because he has no understanding of what “insubordinate” might mean. When it is explained to him that if job improvements were not seen, termination might result, he seems to understand but is not perturbed by the possibility.” Schizoid Personality Disorder – Definition A pervasive pattern of detachment from social relationships and a restricted range of expression of emotion in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following… Schizoid Personality Disorder – Diagnostic Criteria (1) neither desires nor enjoys close relationships, including being part of a family – This criteria serves as a fundamental difference between the schizoid personality and nearly all others – Other personalities can be thought of as solutions to the problem of the core fear of loneliness Dependents make themselves lovable and approving Histrionics seek attention Narcissists seek approval and validation – The need for closeness that is central to most of us is absent – Difficult to understand… Schizoid Personality Disorder – Diagnostic Criteria (2) almost always chooses solitary activities – These individuals are not hostile They are simply indifferent – When approached or acknowledge by others Often sense that a response of some kind would be desired – These individuals » Don’t know how to respond appropriately » Have no desire to respond – This is often times confused with Aloofness, condescension, arrogance – No proclivity to engage others Schizoid Personality Disorder – Diagnostic Criteria Schizoid Personality Disorder – Diagnostic Criteria (3) has little, if any, interest in having sexual experiences with another person – Many have a healthy sex drive, but prefer masturbation Masturbation or sexual abstinence is preferred to tolerating emotional closeness – Sex means having to deal with people which is not a preference Schizoid Personality Disorder – Diagnostic Criteria Schizoid Personality Disorder – Diagnostic Criteria (4) takes pleasure in few, if any, activities – Affective difficulties characterized by an unwavering absence of feeling Restricted ability to experience pleasure of any kind Lack of fear, annoyance, anxiety, or curiosity – Results in a paucity of interests and hobbies Presents in monotone speech and unvarying facial expression – Lifestyles typically lack Fascination, immersion, intimacy, and even joy Transcendental or peak experiences – These often require the ability to fuse with something more ultimate than the self Schizoid Personality Disorder – Diagnostic Criteria Schizoid Personality Disorder – Diagnostic Criteria (5) lacks close friends or confidants other than first-degree relatives – Central theme: detachment from human relationships – Relationships are not found to be rewarding Seen as aversive, over-stimulating, and confusing – Neither the want or need for social stimulation – Often times these individuals find more comfort in the presence of inanimate objects e.g. Leonard and his airplanes Schizoid Personality Disorder – Diagnostic Criteria (6) appears indifferent to the praise or criticism of others – e.g. Leonard and his work performance There is little concern for his supervisor’s assessment of his work performance – Sees little connection or relation to his own happiness If terminated – Leonard would likely go through the motions of getting another job that supports his existence in a basic way – This is in stark contrast to most other personality styles Schizoid Personality Disorder – Diagnostic Criteria (7) shows emotional coldness, detachment, or flattened affectivity – This may seem like extreme introversion to many The similarity between extreme introverts and schizoid personalities extends only to their asocial nature Introverts – Able to experience and express emotion Schizoids – Recognized for flattened affectivity – Other personalities are seen as innately expressive, emotional, and social creatures The lack of these characteristics leaves the schizoid seeming robotic and mechanical Diagnostic Criteria??? Notice anything strange about these diagnostic criteria? (a)Diagnostic Criteria??? Many of the criteria are defined by a lack of something – Almost as if there could be an “a” or an “an” prefix on some other descriptive term for a personality It’s difficult (and possibly problematic) to describe something in this way – Take everything away and nothing substantive remains – How can you give a rich description of a vacuum? Like describing a black hole Result – Perspectives on the construct are not well integrated – Many therapists claim to never have seen a true Schizoid personality I certainly have not… From Normality to Abnormality This personality style will be more difficult to imagine for many – We all know someone who is an extreme introvert Not an avoidant personality, though… – We all want to be left alone from time to time… To quiet our own thoughts or think things through To let down the façade of friendliness that is required at a work party or visits from relatives – Sooner or later enough is enough Schizoids feel this way the majority of the time – Often turn to isolative hobbies Stamp or rock collecting Mechanical gadgetry Mathematics or computer science Differential Diagnosis Schizoid Personality Disorder and Delusional Disorder, Schizophrenia and Mood Disorders with Psychotic Features – In order to give the diagnosis of Schizoid: The personality disorder must have been present before the onset of psychotic symptoms The personality disorder must persist with the psychotic symptoms are in remission Differential Diagnosis Schizoid Personality Disorder and Avoidant Personality Disorder – Can appear similar upon initial presentation Both display – Lack of interpersonal relationships – Engagement in many solitary activities – Difference lies in the desire for relationships Avoidant Personality Disorder – Avoids relationships due to a fear of rejection Schizoid Personality Disorder – May also fear such criticism, but will not desire relationships » As a result, self-enforced solitude appears less problematic Differential Diagnosis Schizoid Personality Disorder and Those with Milder Forms of Autistic Disorder and Asperger’s Disorder – Tough… Both display severely impaired social interaction and stereotyped behaviors and interests – Consult with others The Interpersonal Perspective How does the Schizoid personality develop from an interpersonal perspective? – Not sure… Many clinicians believe it to be a deficit from the very beginning of life – Most infants develop one of several types of attachment to caretakers Future schizoid personalities remain weakly attached, if at all – Behaviors normally reinforcing caregiving such as coos, smiles, and giggles are infrequent or absent The Interpersonal Perspective Although detached from life, they nevertheless exist in a social world – Schizoid patients are likely to: “ignore others’ presence and refuse to speak or respond. He remains totally unresponsive, is constantly lost in his own thoughts, and appears compulsively uncommunicative. He doggedly ignores all social overtures, and resists intrusions into his privacy. Whenever possible, he avoids others and becomes totally reclusive. When around others, he is totally disinterested and relentlessly stays in his own private world. He strikes others as being disengaged, hermetic, and mute.” – Schizoids are impressive not for what they do, but for what they fail to do The Interpersonal Perspective Schizoid is probably best described as the reverse of the histrionic personality – Histrionic personality Turned radically outward toward the social world Demonstrative, dramatic, spontaneous, and theatrical Hyper-sexualized Cognitively scattered and unable to focus – Schizoid personality Radically detached Unanimated, robotic and lacking in energy and vitality Little or no interest in sex Focus intensely and creatively The Cognitive Perspective Early Experience – “Square peg in a round hole” – Teased and bullied at school – “Inept at family activities” Core Beliefs – “I am different, a loner, an oddity, a misfit, nothing/worthless, boring and dull, half a person, have an ugly personality, not normal” – “People are cruel, hostile, out to get me, unfulfilling, don’t like me, pick on weakness” – “The World is hostile” The Cognitive Perspective Conditional Assumptions – “If I try and befriend others, they will notice I am different and ridicule me” – “If I speak to others, they will notice how dull I am and will reject and taunt me” – “If people don’t fit in, they will not be welcome and cannot have friends” – “If I try and talk to others, there will be nothing to say and no point in this communication.” “People should only talk if they have something to say.” – “If people see I am anxious, they will consider me weak and pick on me” – “If I aggravate people, then they will hurt me” The Cognitive Perspective Negative Automatic Thoughts – “I don’t fit in – there is nothing to say” “Others will taunt me for this” Behaviors – Avoid all contact/talk with others – Look at the ground in social situations