Schizoid personality disorder

Summary of "Schizoid personality disorder", from the book "Personality Disorders in Modern Life", by THEODORE MILLON, SETH GROSSMAN, CARRIE MILLON, SARAH MEAGHER, ROWENA RAMNATH.

The schizoid is the personality disorder that lacks a personality. Schizoids prefer
isolation because relationships seem to hold no rewards for them. They are often de-
scribed as detached and emotionally flat, but in general, they are rarely noticed by
anyone because they are so quiet and unobtrusive. The DSM-IV criteria for the
schizoid focuses solely on what schizoids are lacking: any sense of being emotional,
sexual, or interpersonal. Put on a continuum, the more normal variant of the schizoid
is seen as an introvert who may have more developed emotional capacities and, though
still preferring a solitary life, has a richly developed fantasy life. In the realm of nor-
mal personality, Oldham and Morris describe the solitary style: one who feels the
most free when alone in a calm, self-contained, and self-sufficient lifestyle. Millon
describes the retiring style as one who is capable of relating to others when necessary
but truly prefers to be alone. On the opposite end, the most severe schizoids may seem
to develop a kind of schizophrenic syndrome.
Several variations of the schizoid personality have been proposed. The languid
schizoid blends schizoid tendencies with depressive characteristics. Remote schizoids
have withdrawn so completely that they lost their innate capacity to feel and relate to
others. The depersonalized schizoid is viewed as dreamy, distant, and cognitively ab-
sent. The affectless schizoid shares with the compulsive the desire for structured set-
tings but not the compulsive’s conflict of autonomy versus obedience.
Biological explanations of the schizoid remain speculative, but the arguments be-
come more compelling as the schizoid moves into the realm of the more severely dis-
ordered. Schizoids are seen as chronically underactive or underaroused, which could
be explained by a biological deficit in normal functioning. There is some preliminary
genetic evidence for schizoid personality that is linked with schizophrenia, but other
possibilities exist, such as focal brain abnormalities in the limbic system or in the retic-
ular activating system.
Classical psychoanalysis has limited power to describe the schizoid personality pri-
marily because psychodynamics are based on the premise that the person presents one
view of self to the outside world but has deep inner struggles and conflicts that are hid-
den on the inside. The schizoid seems to be void on the inside. One exception to this
thinking is Fairbairn, who traced the schizoid’s lack of affection to the child who, at an
early age, learns that love (represented by the breast) implies death and thus withdraws
to protect the self. The object relationists, who focus on early interpersonal attach-
ments, have more to offer, defining schizoids by their lack of early attachments.
It may seem counterintuitive to have an interpersonal perspective on a disorder that
appears to have no interpersonal relationships, but living in a social world forces
schizoids to have a pattern for interacting with others and it is their intrinsic lack of
desire to do so that warrants interpersonal analysis. Kiesler describes this pattern as
escapist-unresponsive because they ignore others and become hermetic. Although they
are detached and not socially sensitive, schizoids are not callous or harsh toward other
people. Their communication style tends to be dry and impersonal, and because they
fail to attach to others, they never experience the pleasure of being part of a family or
being loved by a friend or mate.
Cognitively, more normal schizoids may give free reign to their intellectual endeavors,
becoming mathematicians or philosophers, but more severe schizoids appear to develop
some cognitive eccentricities akin to the schizotypal. The more isolated the schizoid be-
comes, the more unlikely he or she is to have a coherent and rich sense of self. Schizoids
are often unaware of any goals or drives that motivate them and, in the most severe cases,
are incapable of introspection. Beck and Freeman describe schizoids as observers of life,
not participants.
The evolutionary neurodevelopmental perspective describes the schizoid as one of the
pleasure-deficient personalities, insensitive to both pleasure and pain. They passively ac-
commodate to life’s circumstances and rarely take the initiative to change things. This
perspective also espouses multiple pathways to development of the schizoid personality,
as all domains (biological, interpersonal, dynamic) interact to form the whole person.
Although the schizoid may appear to share some surface qualities with other disor-
ders, such as avoidant, depressive, and compulsive, schizoids are identifiable by their
lack of emotion or desire for human interaction. Schizoids appear relatively immune to
anxiety and mood disorders but may be vulnerable to developing dissociative disorders,
schizophrenic symptoms, and psychotic disorders.
The therapeutic outlook for the schizoid is fairly bleak. It is important to not expect
too much change and to not get frustrated and give up too early on the schizoid. Some
change can be effected by finding something the schizoid enjoys or derives pleasure
from, increasing interpersonal contact, and engaging in a vocation or education. These
goals can be achieved through interpersonal means as well as cognitive modalities
focusing on a hierarchy of social interaction goals. Group therapy can be instrumental
in affecting a substantiated differential diagnosis, thereby determining a more realistic
prognosis. Role playing and in vivo exposure can help ensure that the changes extend
beyond the walls of the clinic or hospital and help schizoids learn to broaden their in-
terpersonal experiences.