Schizoid Personality Disorder

Schizoid Personality disorder

Schizoid personality disorder (SPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy. Affected individuals may also demonstrate a simultaneous rich, elaborate, and exclusively internal fantasy world, although this is often more suggestive of schizotypal personality disorder.
SPD is not the same as schizophrenia, although they share some similar characteristics, such as detachment or blunted affect. However, there is increased prevalence of the disorder in families with schizophrenia.
The psychologist Nancy McWilliams argues that the definition of SPD is flawed due to cultural bias: "One reason schizoid people are pathologized is because they are comparatively rare. People in majorities tend to assume that their own psychology is normative and to equate difference with inferiority

Signs and symptoms

People with SPD are often aloof, cold, and indifferent, which causes interpersonal difficulty. Most individuals diagnosed with SPD have trouble establishing personal relationships or expressing their feelings in a meaningful way, and may remain passive in the face of unfavorable situations. Their communication with other people may be indifferent and concise at times. Because of their lack of meaningful communication with other people, those who are diagnosed with SPD are not able to develop accurate reflections of themselves with respect to how well they are getting along with others.
Supposedly, such reflections are important for a person's self awareness and ability to assess the impact of their own actions in social situations. R.D. Laing suggests that without being enriched by injections of interpersonal reality, there occurs an impoverishment in which one's self image becomes increasingly empty and volatilized, leading the individual himself to feel unreal.
According to Gunderson, people with SPD "feel lost" without the people they are normally around because they require a sense of security and stability. However, when the patient's personal space is violated, they feel suffocated and feel the need to free themselves and be independent. People who have SPD tend to be happiest when they are in a relationship in which the partner places few emotional or intimate demands on them; it is not people as such that they want to avoid, but both negative and positive emotions, emotional intimacy, and self disclosure.
This means that it is possible for schizoid individuals to form relationships with others based on intellectual, physical, familial, occupational, or recreational activities as long as these modes of relating do not require or force the need for emotional intimacy, which the affected individual will reject.
Donald Winnicott summarizes the schizoid need to modulate emotional interaction with others with his comment that schizoid individuals "prefer to make relationships on their own terms and not in terms of the impulses of other people," and failing to attain that, they prefer isolation.[13]

The 'Secret schizoid'

According to Ralph Klein, there are many fundamentally schizoid individuals who present with an engaging, interactive personality style which contradicts the observable characteristic emphasized by the DSM-IV and ICD-10 definitions of the schizoid personality. Klein classifies these individuals as secret schizoids, presenting themselves as socially available, interested, engaged, and involved in interacting in the eyes of the observer, while at the same time remaining emotionally withdrawn and sequestered within the safety of the internal world.
While withdrawal or detachment from the outer world is a characteristic feature of schizoid pathology, it is sometimes classic and sometimes secret. When classic, it matches the typical description of the schizoid personality offered in the DSM-IV. However, according to Klein, it is "just as often" a secret, hidden internal state of the patient in which what meets the objective eye may not be what is present in the subjective, internal world of the patient. Klein therefore cautions that one should not miss identifying the schizoid patient because one cannot see the patient's withdrawal through the patient's defensive, compensatory, engaging interaction with external reality. Klein suggests that one need only ask the patient what his or her subjective experience is in order to detect the presence of the schizoid refusal of emotional intimacy.
Descriptions of the schizoid personality as "hidden" behind an outward appearance of emotional engagement have been recognized as far back as 1940 with Fairbairn's description of 'schizoid exhibitionism,' in which he remarked that the schizoid individual is able to express a great deal of feeling and to make what appear to be impressive social contacts while in reality giving nothing and losing nothing; because he is only "playing a part," his own personality is not involved. According to Fairbairn, "[the person] disowns the part which he is playing and thus the schizoid individual seeks to preserve his own personality intact and immune from compromise.
Further references to the secret schizoid come from Masud Khan, Jeffrey Seinfeld, and Philip Manfield, who gives a palpable description of an SPD individual who actually "enjoys" regular public speaking engagements, but experiences great difficulty in the breaks when audience members would attempt to engage him emotionally. These references expose the problems involved in relying singularly on outer observable behavior for assessing the presence of personality disorders in certain individuals.

Avoidant attachment style

The question of whether SPD qualifies as a full personality disorder or simply as an avoidant attachment style is a contentious one[citation needed]. If what has been known as schizoid personality disorder is no more than an attachment style requiring more distant emotional proximity, then many of the more problematic reactions these individuals show in interpersonal situations may be partly accounted for by the social judgments commonly imposed on those with this style. To date several sources have confirmed the synonymy of SPD and avoidant attachment style which leaves open the question of how researchers might best approach this subject in future diagnostic manuals, and in therapeutic practice. However, characteristically - and depending on the severity of the disorder - individuals do not seek social interactions merely due to lack of interest, as opposed to the avoidant personality type in which there is craving for interactions, but then fear of rejection.

Schizoid sexuality

People with SPD are sometimes sexually apathetic, though they do not typically suffer from anorgasmia. Many schizoids have a healthy sex drive but some prefer to masturbate rather than deal with the social aspects of finding a sexual partner. Therefore, their need for sex may appear to be less than those who do not have SPD, as individuals with SPD prefer to remain alone and detached. When having sex, individuals with SPD often feel that their personal space is being violated, and they commonly feel that masturbation or sexual abstinence is preferable to the emotional closeness they must tolerate when having sex. Significantly broadening this picture are notable exceptions of SPD individuals who engage in occasional or even frequent sexual activities with others.
Harry Guntrip describes the "secret sexual affair" entered into by some married schizoid individuals as an attempt to reduce the quantity of emotional intimacy focused within a single relationship, a sentiment echoed by Karen Horney's resigned personality who may exclude sex as being "too intimate for a permanent relationship, and instead satisfy his sexual needs with a stranger. Conversely he may more or less restrict a relationship to merely sexual contacts and not share other experiences with the partner. More recently, Jeffrey Seinfeld, professor of social work at New York University, has published a volume on SPD in which he details examples of "schizoid hunger" which may manifest as sexual promiscuity. Seinfeld provides an example of a schizoid woman who would covertly attend various bars to meet men for the purposes of gaining impersonal sexual gratification, an act, says Seinfeld, which alleviated her feelings of hunger and emptiness.
Salman Akhtar describes this dynamic interplay of overt versus covert sexuality and motivations of some SPD individuals with greater accuracy. Rather than following the narrow proposition that schizoid individuals are either sexual or asexual, Akhtar suggests that these forces may both be present in an individual despite their rather contradictory aims. For Akhtar, therefore, a clinically accurate picture of schizoid sexuality must include both the overt signs: "asexual, sometimes celibate; free of romantic interests; averse to sexual gossip and innuendo," along with possible covert manifestations of "secret voyeuristic and pornographic interests; vulnerable to erotomania; tendency towards compulsive masturbation and perversions, although none of these necessarily apply to all people with SPD.

Diagnosis

DSM

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, a widely used manual for diagnosing mental disorders, defines schizoid personality disorder (in Axis II Cluster A) as:
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:
Neither desires nor enjoys relationships or human interaction, including being part of a family
Almost always chooses solitary activities
Has little, if any, interest in having sexual experiences with another person
Takes pleasure in few, if any, activities
Lacks close friends or confidants other than first-degree relatives
Appears indifferent to praise or criticism by others
Shows emotional coldness, detachment, or flattened affect

World Health Organization

The World Health Organization's ICD-10 lists schizoid personality disorder as (F60.1) Schizoid personality disorder.
It is characterized by at least four of the following criteria:
Emotional coldness, detachment or reduced affect.
Limited capacity to express either positive or negative emotions towards others.
Consistent preference for solitary activities.
Very few, if any, close friends or relationships, and a lack of desire for such.
Indifference to either praise or criticism.
Taking pleasure in few, if any, activities.
Indifference to social norms and conventions.
Preoccupation with fantasy and introspection.
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.

Millon's subtypes

Theodore Millon identified four subtypes of schizoid. Any individual schizoid may exhibit none or one of the following:
Languid schizoid
including depressive features
Remote schizoid
including avoidant, schizotypal features
Depersonalized schizoid
including schizotypal features
Affectless

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 relationships. Clarifying the causes and conditions underlying the above characteristics, Klein describes a schism in the object of relations of the schizoid. This split involves: (1) the "slave/master" relationship: characterized by exploitation, appropriation, and dehumanization; and (2) the "self in exile:" the aversive recoiling from the exploitative relationship that the self goes into exile. The distanced or unresponsive self in exile is the more commonly recognized aspect of the schizoid. As Klein states: "[the] seeming detachment from feelings should never be accepted as the real state of affairs."[14]
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 sibling. It is also the disavowed shame of the narcissist that is often absorbed by, or projected onto the schizoid; thus giving rise to the experience of psychic invasion, and the development of sense of vulnerability to intrusiveness. Paradoxically, a schizoid may also be attracted to exploitative relationships in which 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 its consequences, as opposed to diagnosis on the basis of a list of external behaviors
including compulsive features

Guntrip criteria
Ralph Klein, Clinical Director of the Masterson Institute delineates the following nine characteristics of the schizoid personality as described by Harry Guntrip: introversion, withdrawnness, narcissism, self-sufficiency, a sense of superiority, loss of affect, loneliness, depersonalization, and regression.

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 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

Loneliness

According to Guntrip, "Loneliness is an inescapable result of schizoid introversion and abolition of external relationships. It reveals itself in the intense longing for friendship and love which repeatedly break through. Loneliness in the midst of a crowd is the experience of the schizoid cut off from affective rapport." This is a central experience of the schizoid that is often lost to the observer. Contrary to the familiar caricature of the schizoid as uncaring and cold, the vast majority of schizoid persons who become patients express at some point in their treatment their longing for friendship and love. This is not the schizoid patient as described in the DSMs. Such longing, however, may not break through except in the schizoid’s fantasy life, to which the therapist may not be allowed access for quite a long period in treatment. If longing is immediately present, however, it is more likely avoidant personality disorder.[citation needed]
There is a very narrow range of schizoid individuals, the classic DSM-defined schizoids, for whom the hope of establishing relationships is so minimal as to be almost extinct. The longing for closeness and attachment is almost unidentifiable to this type of schizoid. These individuals will not voluntarily become patients; the schizoid individual who becomes a patient does so often because of the twin motivations of loneliness and longing. This type of schizoid patient still believes that some kind of connection and attachment is possible, and is well suited to psychotherapy. Yet the irony of the DSMs is that they may lead the psychotherapist to approach the schizoid patient with a sense of therapeutic pessimism, if not nihilism, misreading the patient by believing that the patient’s wariness is indifference and that caution is coldness