Flawed Hearts

Schizoid personality disorder is a pattern of indifference to social relationships, with a limited range of emotional expression and experience. The disorder manifests itself by early adulthood through social and emotional detachments that prevent people from having close relationships. People with it are able to function in everyday life, but will not develop meaningful relationships with others. They are typically loners and may be prone to excessive daydreaming as well as forming attachments to animals. They may do well at solitary jobs others would find intolerable. There is evidence indicating the disorder may be the start of schizophrenia or just a very mild form of it. People with schizoid personality disorder are in touch with reality unless they develop schizophrenia.

Those with schizoid personality disorder do not have schizophrenia, but it is thought that many of the same risk factors in schizophrenia may cause schizoid personality disorder.

SYMPTOMS

Takes pleasure in few, if any, activities.

Does not desire or enjoy close relationships, including family.

Appears aloof and detached.

Avoids social activities that involve significant contact with other people.

Almost always chooses solitary activities.

Little or no interest in sexual experiences with another person.

Lacks close relationships other than with immediate relatives.

Indifferent to praise or criticism.

Shows emotional coldness, detachment or flattened affect.

Exhibits little observable change in mood.

People with schizoid personality disorder maintain contact with reality.

TREATMENT

Little research has been done on the treatment of SPD. This is partly because people with this diagnosis typically do not experience loneliness or compete with or envy people who enjoy close relationships.

People with this disorder rarely seek treatment, and little is known about which treatments work. Talk therapy may not be effective, because people with schizoid personality disorder have difficulty relating well to others. Therefore, treatment can be difficult because of initial reduced capacity or desire to form a relationship with a health professional. A non-intrusive support group can alleviate feelings of solitude, and fears of social interactions and close relationships. Individual therapy, in most cases, has proven relatively ineffective and often temporarily addresses immediate conditions instead of seeking to eliminate the disorder entirely.

MEDICATION

Medications are not usually recommended for SPD. However, they are sometimes used for short-term treatment of extreme anxiety states associated with the disorder. The presence of anxiety, usually caused by fear of other people, may mean that a diagnosis of the related schizotypal personality disorder is more appropriate.

PSYCHOTHERAPY

Individual therapy that successfully attains a long-term level of trust may be useful in certain cases of schizoid personality disorder by giving patients an outlet to transform their false perceptions of friendships into authentic relationships. As a therapist-client relationship develops, a patient can start to reveal imaginary friendships and terrors of dependency. Individual psychotherapy can gradually affect the formation of a true relationship between the patient and therapist.

Long-term psychotherapy should not be pursued because of its poor treatment outcomes and the costs inherent in lengthy therapy. Instead, therapy should focus on simple treatment goals to alleviate current pressing concerns or stressors within the individual's life.

Cognitive-restructuring may be proper to address certain types of clear, irrational thoughts that are negatively influencing the patient's behaviors. This therapeutic plan should be clearly defined at the onset of treatment. Stability and support are the keys to good treatment with someone who suffers from schizoid personality disorder. Care should be taken not to "smother" the person with schizoid personality disorder and be able to tolerate possible "acting out" behaviors.

Group therapy is another potentially effective form of treatment but it generally is not a good initial treatment.

Although patients may initially withdraw from the therapy group, they often grow participatory as the level of comfort is gradually established. Protected by the therapist, who must safeguard people with this diagnosis from criticism by others in the group, patients have the chance to conquer fears of intimacy by making social contact in a supportive environment.

Social consequences of serious mental disorders ; family disruption, loss of employment and housing are sometimes calamitous. Comprehensive treatment, including services existing beyond the formal treatment system, is crucial to ameliorate symptoms, assist recovery, and redress stigma.

Self-help programs, family self-help, advocacy and services for housing and vocational assistance complement and supplement the formal treatment system.

REFERENCE

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Center for Substance Abuse Treatment

Psychology Network-UK

Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735-743.

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"Like a mollusk without a shell--that is the surface. Or else the surface is just nothing; we see a man who stands in our way like a question mark [...] there are schizoid men, with whom we can live for ten years and yet we may not say for certain we know them."

-E. Kretschmer (1925, From Physique and Character, pp. 146).

*When a schizoid person is aggressive, the hate is cold and unfeeling, destructive and paranoid.

*The markedly schizoid person comes into treatment complaining about feeling cut off, out of touch, and shut off; things do not feel real. Feeling almost robotic and futile.

*Many people fear their over-dependence will overwhelm the other, but it is when that fear makes the person withdraw into their internal world as a result that it is schizoid.

*The extremely schizoid person fears good and loving relationships. As soon as he gets close to someone, he experiences an unaccountable loss of interest.

*The fundamental cause of the development of the schizoid condition is the experience of isolation resulting from the loss of mental rapport.

*In summary, schizoid phenomena are on a continuum, but when the schizoid position is dominant in a patient, the analyst has to manage the patient’s unwillingness to make a commitment to the treatment and refusal to admit being effected by the analyst. Maintaining boundaries and not giving advice is extremely important to reassure the patient that you are not trying to take them over. But when the schizoid patient wants to be in another treatment at the same time; go on vacation for two months; or do his laundry instead of coming to his session, BE CALM but STAND STRONG.