Personality Disorders: Toward the DSM-V
Chapter 4
Schizoid personality disorder

Introduction

Schizoid personality disorder (SCPD) is distinguished from the other two personality disorders in the ‘odd/eccentric’ cluster by the prominence of social, interpersonal and affective deficits in the absence of psychotic-like cognitive/perceptual distortions.

The diagnosis of schizoid personality disorder

Prevalence

Schizoid personality disorder is among the least frequently observed of the personality disorders. This may be due to the uncommon appearance of schizoid individuals in clinical settings.

Schizoid personality disorder may be first apparent in late childhood. This is a period in which cooperative play is in ascendance, and the social isolation becomes more salient.

The disorder is more common in men.

DSM-IV-TR criteria for schizoid personality disorder

The DSM-criteria for schizoid personality disorder are: a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four of the following: 1) neither desires nor enjoys close relationships 2) almost always chooses solitary activities 3) has little, if any, interest in having sexual experiences with another persons 4) takes pleasure in few, if any, activities 5) lacks close friends or confidants other than first-degree relatives 6) appears indifferent to praise or criticism from others 7) behaviour or appearance that is odd, eccentric or peculiar.

Psychometric properties

The internal consistency of measures of schizoid personality disorder is poor.

Comorbidity

The highest co-occurrence of schizoid personality disorder is with schizotypal personality disorder. This might be due to the high overlap between the two criteria sets. Another high comorbid disorder is avoidant personality disorder. Lesser degrees of comorbidity are demonstrated with paranoid, antisocial, and borderline personality disorder.

Schizoid and avoidant personality disorder

Some studies suggest that schizoid personality disorder can be distinguished from avoidant personality disorder on the basis of intimacy needs and sensitivity to rejection. But, anxiety and clinical symptoms occur in both disorders.

Research literature has demonstrated poor discriminant validity between schizoid personality disorder and avoidant personality disorder.

Schizoid personality disorder and Asperger’s syndrome

There is significant overlap in the phenomenological criteria for schizoid personality disorder and asperger’s syndrome.

The clinical presentation of the two disorders is different. Autism becomes evident between two and three years of age when imaginative play is in ascendance. Schizoid children do not appear to be lacking in fantasy proneness. They appear to have trouble distinguishing make-believe from reality. Schizoid traits are usually first apparent in middle childhood.

Dimensions and boundaries in the schizophrenia spectrum

Schizoid personality disorder shares deficit symptoms with schizotypal personality disorder, specifically those contributing to an asociality due to deficits in interpersonal skills and affect expression.

The two disorders can be distinguished by the absence of positive symptoms in schizoid personality disorder.

The boundaries of schizophrenia-related disorders may extend beyond schizotypal personality disorder to include  schizoid and paranoid personality disorders. It may not extend to schizoid personality disorder.

Treatment

Few schizoid individuals see indifference to interpersonal contact and avoidance of others as problematic. When they do seek help, it is rarely for prolonged periods of time.

There are no controlled trials.