Schizoid personality disorder (SPD) is a personality disorder Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, and emotional coldness.^[1] There is increased prevalence of the disorder in families with schizophrenia Schizophrenia is a serious mental illness characterized by a disintegration of the process of thinking and of emotional responsiveness. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. Onset of symptoms typically occurs in. SPD is not the same as schizophrenia, although they share some similar characteristics such as detachment or blunted affect Victims of post-traumatic stress syndrome are often said to display blunted affect. Veterans of intense combat have been described as having the thousand-yard stare . Some of these veterans suffer from a disorder once referred to as shell shock and may experience a number of symptoms, including recurring nightmares, hypervigilance, and avoidance.

History

The term schizoid was coined in 1908 by Eugen Bleuler Paul Eugen Bleuler was a Swiss psychiatrist most notable for his contributions to the understanding of mental illness and coining the term schizophrenia to designate a natural human tendency to direct attention toward one's inner life and away from the external world, a concept akin to introversion Extraverts tend to be gregarious, assertive, and interested in seeking out excitement. They tend to think out loud and cannot solve things in their heads as well as introverts. However, it should not necessarily be assumed that just because one has many friends that they are an extravert. Introverts, in contrast, tend to be more reserved, less in that it was not viewed in terms of psychopathology. Bleuler also labeled the exaggeration A caricature can refer to a portrait that exaggerates or distorts the essence of a person or thing to create an easily identifiable visual likeness.[citation needed] In literature, a caricature is a description of a person using exaggeration of some characteristics and oversimplification of others of this tendency the “schizoid personality”.^[2]

Since then, studies on the schizoid personality have developed along two separate paths; firstly, the descriptive psychiatry Descriptive psychiatry is based on the study of observable symptoms and behavioral phenomena rather than underlying psychodynamic processes. In descriptive psychiatry, the clinical psychiatrist focuses on empirically observable behaviors and conditions, such as words spoken or actions taken tradition which focuses on overtly observable, behavioral, and describable symptoms which finds its clearest exposition in the DSM-IV revised The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies,, and secondly, the dynamic psychiatry tradition which includes the exploration of covert or unconscious motivation and character structure as elaborated by classic psychoanalysis and object-relations theory.

The descriptive tradition began in Ernst Kretschmer Ernst Kretschmer (* October 8, 1888 in Wüstenrot near Heilbronn ; † February 8, 1964 in Tübingen) Prof. Dr. med. Dr. phil. h.c., was a psychiatrist who researched the human constitution and established a typology’s (1925)^[3] portrayal of observable schizoid behaviours which he organized into three groups of characteristics:

1. unsociability, quietness, reservedness, seriousness, and eccentricity
2. timidity, shyness with feelings, sensitivity, nervousness, excitability, and fondness of nature and books
3. pliability, kindliness, honesty, indifference, silence, and cold emotional attitudes.^[3]

In these characteristics one can see the precursors of the DSM-IV division of schizoid character into three distinct personality disorders, though Kretschmer himself did not conceive of separating these behaviours to the point of radical isolation, considering them instead as simultaneously present as varying potentials in schizoid individuals. For Kretschmer the majority of schizoids are not either oversensitive or cold, but they are oversensitive and cold “at the same time” in quite different relative proportions, with a tendency to move along these dimensions from one behavior to the other.^[3]

The second path, that of dynamic psychiatry, began with observations by Eugen Bleuler (1924) ^[4] who observed that the schizoid person, and schizoid pathology were not things to be set apart.^[5] In 1940 W. R. D. Fairbairn He was born in Edinburgh in 1889. Fairbairn was educated at Edinburgh University where he studied for three years in divinity and Hellenic Greek studies. He served with General Allenby in the Palestinian campaign, and when he returned he undertook medical training. He also taught psychology and practiced analysis presented his seminal work on the schizoid personality in which most of what is known today about schizoid phenomena can be found. Here Fairbairn delineated four central schizoid themes; firstly, the need to regulate interpersonal distance as a central focus of concern; secondly, the ability to mobilize self-preservative defenses and self-reliance; thirdly a pervasive tension between the anxiety-laden need for attachment, and the defensive need for distance, which manifests in observable behavior as indifference; and fourthly an overvaluation of the inner world at the expense of the outer world.^[6] Following Fairbairn, the dynamic psychiatry tradition has continued to produce rich explorations on the schizoid character, most notably from writers Nannarello (1953); Laing Ronald David Laing , was a Scottish psychiatrist who wrote extensively on mental illness – in particular, the experience of psychosis. Laing's views on the causes and treatment of serious mental dysfunction, greatly influenced by existential philosophy, ran counter to the psychiatric orthodoxy of the day by taking the expressed feelings of the (1960); Winnicott Donald Woods Winnicott was an English paediatrician, psychiatrist, sociologist and psychoanalyst (1965); Guntrip (1969); Khan (1974); Akhtar Salman Akhtar is a psychoanalyst who also holds a professorship at the Jefferson Medical College in Philadelphia (1987); Seinfeld (1991); Manfield (1992); and Klein (1995).^[7]

Diagnostic criteria (DSM-IV-TR = 301.20)

The Diagnostic and Statistical Manual of Mental Disorders The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders A mental disorder or mental illness is a psychological or behavioral pattern associated with distress or disability that occurs in an individual and is not a part of normal development or culture. The recognition and understanding of mental health conditions has changed over time and across cultures, and there are still variations in the, defines schizoid personality disorder (in Axis II Cluster A Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders) as:^[8]

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood (age eighteen or older) and present in a variety of contexts, as indicated by four (or more) of the following:

1. neither desires nor enjoys close relationships, including being part of a family
2. almost always chooses solitary activities
3. has little, if any, interest in having sexual experiences with another person
4. takes pleasure in few, if any, activities
5. lacks close friends or confidants other than first-degree relatives
6. appears indifferent to the praise In its common usage, praise is the act of making positive statements about a person, object or idea, either in public or privately. Praise is typically, but not exclusively, earned relative to achievement and accomplishment. Praise is often contrasted with criticism, where the latter is held to mean exclusively negative statements made about or criticism Criticism is the judgement of the merits and faults of the work or actions of one individual by another . To criticise does not necessarily imply to find fault, but the word is often taken to mean the simple expression of prejudice or disapproval of others
7. shows emotional coldness, detachment, or flattened affect

B. Does not occur exclusively during the course of schizophrenia Schizophrenia is a serious mental illness characterized by a disintegration of the process of thinking and of emotional responsiveness. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. Onset of symptoms typically occurs in, a mood disorder A mood disorder is the term given for a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature. The classification is known as mood (affective) disorders in ICD 10 with psychotic features, another psychotic disorder Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic, or a pervasive developmental disorder The diagnostic category pervasive developmental disorders , as opposed to specific developmental disorders (SDD), refers to a group of five disorders characterized by delays in the development of multiple basic functions including socialization and communication and is not due to the direct physiological effects of a general medical condition.

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders.

Diagnostic criteria (ICD-10)

The World Health Organization The World Health Organization is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the's ICD-10 The International Statistical Classification of Diseases and Related Health Problems 10th Revision is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization. (WHO). The code set allows more than 14,400 different codes lists schizoid personality disorder as (F The International Statistical Classification of Diseases and Related Health Problems 10th Revision is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO).. This page contains ICD-10 Chapter V: Mental and 60.1) Schizoid personality disorder.^[9]

It is characterized by at least three of the following criteria:

1. Emotional coldness, detachment or reduced affection Affection is a "disposition or state of mind or body" that is often associated with a feeling or type of love. It has given rise to a number of branches of philosophy and psychology concerning: emotion ; disease; influence; state of being (philosophy); and state of mind (psychology). "Affection" is popularly used to denote a.
2. Limited capacity to express either positive or negative emotions towards others.
3. Consistent preference for solitary activities.
4. Very few, if any, close friends or relationships An interpersonal relationship is an association between two or more people that may range from fleeting to enduring. This association may be based on limerence, love and liking, regular business interactions, or some other type of social commitment. Interpersonal relationships take place in a great variety of contexts, such as family, friends,, and a lack of desire for such.
5. Indifference to either praise In its common usage, praise is the act of making positive statements about a person, object or idea, either in public or privately. Praise is typically, but not exclusively, earned relative to achievement and accomplishment. Praise is often contrasted with criticism, where the latter is held to mean exclusively negative statements made about or criticism Criticism is the judgement of the merits and faults of the work or actions of one individual by another . To criticise does not necessarily imply to find fault, but the word is often taken to mean the simple expression of prejudice or disapproval.
6. Taking pleasure in few, if any, activities.
7. Indifference to social norms Social norms are the behavioral expectations and cues within a society or group. This sociological term has been defined as "the rules that a group uses for appropriate and inappropriate values, beliefs, attitudes and behaviors. These rules may be explicit or implicit. Failure to follow the rules can result in severe punishments, including and conventions.
8. Preoccupation with fantasy When used in psychoanalytic writings in the English language, "phantasy" generally refers to the unconscious psychic content of the drives. Fantasy with an 'f' spelling is used to refer to more conscious psychic content such as day dreaming and products of the imagination and introspection Introspection is the self-observation and reporting of conscious inner thoughts, desires and sensations. It is a conscious mental and usually purposive process relying on thinking, reasoning, and examining one's own thoughts, feelings, and, in more spiritual cases, one's soul. It can also be called contemplation of one's self, and is contrasted.
9. Lack of desire for sexual experiences with another person.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders.

Millon's subtypes

Theodore Millon Theodore Millon is an American psychologist known for his work on personality disorders identified four subtypes of schizoid ^[10][11]. Any individual schizoid may exhibit none or one of the following:

• languid schizoid - including depressive Depressive personality disorder is a controversial psychiatric diagnosis that denotes a personality disorder with depressive features features

• remote schizoid - including avoidant Avoidant personality disorder (or anxious personality disorder) is a personality disorder recognized in the DSM-IV TR handbook in a person over the age of eighteen years as characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social interaction, schizotypal Schizotypal personality disorder, or simply schizotypal disorder, is a personality disorder that is characterized by a need for social isolation, odd behavior and thinking, and often unconventional beliefs features

• depersonalised schizoid - including schizotypal Schizotypal personality disorder, or simply schizotypal disorder, is a personality disorder that is characterized by a need for social isolation, odd behavior and thinking, and often unconventional beliefs features

• affectless schizoid - including compulsive Obsessive–compulsive personality disorder is a personality disorder which involves an obsession with perfection, rules, and organization. People with OCPD may feel anxious when they perceive that things are not right. This can lead to routines and rules for ways of doing things, whether for themselves or their families features

Dynamic diagnostic criteria

Ralph Klein, 1995 brought new light into the commonly held beliefs about the schizoid which focus mainly on the schizoid’s apparent disinterest in relationship. Clarifying the causes and conditions underlying the characteristics listed above, Klein describes a ‘split’ in the object relations of the schizoid. This split involves: on the one hand, the ‘slave/master’ relationship, a relationship characterised by exploitation, appropriation, and dehumanisation, and on the other, the 'self in exile'. It is in aversion, or recoil from the exploitive relationship that the self goes into exile. It is this, the self in exile, that is the more commonly recognised aspect of the schizoid, as described in the DSM, - the distanced or unresponsive person. As Klein puts it: the..."seeming detachment from feelings should never be accepted as the real state of affairs" p.135. Of particular significance is the correlation between the Narcissistic disorder and the schizoid. For example the ‘over entitlement’ of the narcissist in a family can result in the ‘under-entitlement’ of the schizoid. It is also the disavowed shame of the narcissist that is often absorbed by, or projected into the schizoid, thus giving rise to the experience of psychic invasion, and the vulnerability to intrusiveness. Paradoxically, a schizoid may also be attracted to exploitive relationships, where they long to experience significance and recognition by serving a need of the other. Yet this same person may be highly aware of any forms of corruption or exploitation outside of this relationship. In this approach diagnosis is based on the dynamic of this split, and all its consequences, as opposed to diagnosis on the basis of a list of external behaviours.

Guntrip's analysis

Ralph Klein, Clinical Director of the Masterson Institute delineates the following nine characteristics of the schizoid personality as described by Harry Guntrip Harry Guntrip was a psychologist known for his major contributions to object relations theory. He was a Fellow of the British Psychological Society and a psychotherapist and lecturer at the Department of Psychiatry, Leeds University, and also a Methodist minister. He was described by John D. Sutherland as "one of the psychoanalytic immortals&: introversion The trait of extraversion-introversion is a central dimension of human personality. Extraverts tend to be gregarious, assertive, and interested in seeking out excitement. Introverts, in contrast, tend to be more reserved, less outgoing, and less sociable. They are not necessarily loners but they tend to have smaller circles of friends and are less, withdrawnness, narcissism Narcissism is the personality trait of egotism, vanity, conceit, or simple selfishness. Applied to a social group, it is sometimes used to denote elitism or an indifference to the plight of others, self-sufficiency, a sense of superiority, loss of affect Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect", loneliness, depersonalization, and regression Regression, according to psychoanalyst Sigmund Freud, is a defense mechanism leading to the temporary reversion of the ego to an earlier stage of development rather than handling unacceptable impulses in a more adult way. The defense mechanism of regression, in psychoanalytic theory, occurs when thoughts are temporarily pushed back out of our.^[12]

Introversion

According to Guntrip, "By the very meaning of the term the schizoid is described as cut off from the world of outer reality in an emotional sense. All this libidinal desire and striving is directed inward toward internal objects and he lives an intense inner life often revealed in an astonishing wealth and richness of fantasy When used in psychoanalytic writings in the English language, "phantasy" generally refers to the unconscious psychic content of the drives. Fantasy with an 'f' spelling is used to refer to more conscious psychic content such as day dreaming and products of the imagination and imaginative life whenever that becomes accessible to observation. Though mostly his varied fantasy life is carried on in secret, hidden away." The schizoid person is cut off from outer reality to such a degree that he or she experiences outer reality as dangerous. It is a natural human response to turn away from sources of danger and toward sources of safety. The schizoid individual, therefore, is primarily concerned with avoiding danger and ensuring safety.^[12]

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