According to the DSM-5, the essential feature of schizoid personality disorder is a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. Individuals with schizoid personality disorder typically exhibit:
– lack a desire for intimacy
– socially isolated
– choose solitary activities or hobbies that do not include interaction with others
– have no close friends or confidants, except possibly a first-degree
– indifferent to the approval or criticism of others
– may be oblivious to the normal subtleties of social interaction and often do not respond appropriately to social cues so that they seem socially inept or superficial and self-absorbed
– usually display a "bland" exterior without visible emotional reactivity
– rarely reciprocate gestures or facial expressions (such as smiles or nods)
– rarely experience strong emotions (such as anger and joy)
– often display a constricted affect and appear cold and aloof.
However, Dr. Otto Kernberg believes that the DSM-5 description of schizoid personality disorder somewhat distorts its true nature.In his book “Severe Personality Disorders: Psychotherapeutic Strategies” (1984), Otto Kernberg states that schizoid personalities may experience an acute awareness of their surrounding environment, an emotional attunedness to others, and yet a sense of unavailability of feelings. In contrast to what DSM states, many of them are not "humorless or dull and without affect in situations in which an emotional response would be appropriate," and they experience very intense suffering because of their lack of easy access to their feelings for others. However, for practical purposes, the diagnostic category does permit the clinical diagnosis of this common type of personality disorder
The intense clinical involvement with schizoid personalities reveals them to possess a much more complex intrapsychic reality than they initially convey. Here the neglect of psychodynamic explorations of the schizoid personality impoverishes its description.
What makes diagnosing schizoid personality challenging?
Schizoid psychology is usually easy to recognize, given the relative indifference of schizoid people to making a conventional impression on the interviewer.The central diagnostic challenge is assessing the strength of the client’s ego: schizoid people may be misunderstood as both more and less troubled than they are, depending on what they share with the interviewer. Less ortentously,
some obsessive and compulsive people, especially in the borderline-to-psychotic range, are easily misconstrued as more schizoid than they are.
What steps are necessary to determine the presence of psychotic processes in a patient?
It is critical, first of all, to evaluate how disturbed a person in the schizoid range is.
It is critical to consider possible psychotic processes in an intake interview:
– questions about hallucinations and delusions
– attention to the presence or absence of disordered thinking
– evaluation of the patient’s capacity to distinguish ideas from actions
– in puzzling instances, psychological testing are warranted with people who present with a schizoid style.
Medication and/or hospitalization may be indicated when the results of such inquiries suggest psychosis.
Misunderstanding a schizophrenic person as a nonpsychotic schizoid personality can be a costly blunder. It is an equally unfortunate mistake, however, to assume that a patient is at risk of decompensation simply because he or she has a schizoid character. Schizoid people are often seen as sicker than they are, and for a therapist to make this error compounds the insults these clients have absorbed throughout a life in which their individuality may have always been equated with lunacy.
How to differentiate schizoid and obsessive-compulsive personality disorders?
Schizoid people often isolate themselves and spend a great deal of time thinking, even ruminating, about the major issues in their fantasy life. They can also, because of their conflict about closeness, appear wooden and affectless, and may respond to questions with intellectualization.
Some have quirks of behavior that are or appear to be compulsive, or they use compulsive defenses to arrange their lives by an idiosyncratic set of rituals that protects them from disturbing intrusions. Consequently, they can be misunderstood as having an obsessive or obsessive–compulsive personality structure. Many people combine schizoid and obsessive or compulsive qualities, but insofar as the two kinds of personality organization can be discussed as “pure” types, there are some important differences.
(c) Yuliia Holopiorova,
Ukrainian association for Transference-Focused Psychotherapy