Schizoid personality disorder

Template:Short description Template:RedirectTemplate:Not to be confused Template:Cs1 config Template:Infobox medical condition (new) Template:Personality disorders sidebar Schizoid personality disorder (Template:IPAc-en, often abbreviated as SzPD or ScPD) is a personality disorder characterized by a lack of interest in social relationships,<ref>Template:Cite journal</ref> a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy.<ref name="Medline">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Affected individuals may be unable to form intimate attachments to others and simultaneously possess a rich and elaborate but exclusively internal fantasy world.<ref>Template:Cite book</ref> Other associated features include stilted speech, a lack of deriving enjoyment from most activities, feeling as though one is an "observer" rather than a participant in life, an inability to tolerate emotional expectations of others, apparent indifference when praised or criticized, being on the asexual spectrum, and idiosyncratic moral or political beliefs.<ref name="Akhtar2">Template:Cite book</ref>

Symptoms typically start in late childhood or adolescence.<ref name="Medline" /> The cause of SzPD is uncertain, but there is some evidence of links and shared genetic risk between SzPD, other cluster A personality disorders, and schizophrenia.<ref name=":272">Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Thus, SzPD is considered to be a "schizophrenia-like personality disorder".<ref name="ClusterA2">Template:Cite journal</ref><ref name="CharneyNestler2005">Template:Cite book</ref> It is diagnosed by clinical observation, and it can be very difficult to distinguish SzPD from other mental disorders or conditions (such as autism spectrum disorder, with which it may sometimes overlap).<ref name=":172">Template:Cite journal</ref><ref name="Cook_2020">Template:Cite journal</ref>

The effectiveness of psychotherapeutic and pharmacological treatments for the disorder has yet to be empirically and systematically investigated. This is largely because people with SzPD rarely seek treatment for their condition.<ref name="Medline" /> Originally, low doses of atypical antipsychotics were used to treat some symptoms of SzPD, but their use is no longer recommended.<ref name=":152">Template:Cite journal</ref> The substituted amphetamine bupropion may be used to treat associated anhedonia.<ref name="SonnyJoseph2">Template:Cite book</ref> However, it is not general practice to treat SzPD with medications, other than for the short-term treatment of acute co-occurring disorders (e.g. depression).<ref name=":282">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Talk therapies such as cognitive behavioral therapy (CBT) may not be effective, because people with SzPD may have a hard time forming a good working relationship with a therapist.<ref name="Medline" />

SzPD is a poorly studied disorder, and there is little clinical data on SzPD because it is rarely encountered in clinical settings. Studies have generally reported a prevalence of less than 1%.<ref name="ClusterA2"/><ref name=":10">Template:Cite journal</ref><ref>Template:Cite book</ref> It is more commonly diagnosed in males than in females.<ref name=":10" /> SzPD is linked to negative outcomes, including a significantly compromised quality of life, reduced overall functioning even after 15 years, and one of the lowest levels of "life success" of all personality disorders (measured as "status, wealth and successful relationships").<ref name=":92">Template:Cite book</ref><ref name=":1222">Template:Cite journal</ref><ref>Template:Cite journal</ref> Bullying is particularly common towards schizoid individuals.<ref name=":163">Template:Cite book</ref><ref name=":113">Descriptions from DSM-III (1980) and DSM-5 (2013):"Schizoid PD, Associated features (p. 310)" and "Schizoid PD (p. 652–655)".</ref> Suicide may be a running mental theme for schizoid individuals, though they are not likely to attempt it.<ref name="Klein62">Template:Cite book Alt URL</ref> Some symptoms of SzPD (e.g. solitary lifestyle, emotional detachment, loneliness, and impaired communication), however, have been stated as general risk factors for serious suicidal behavior.<ref name=":142">Template:Cite journal</ref><ref name="PsychiatriaDanubina">Template:Cite journal</ref>

History

The term schizoid was coined in 1908 by Eugen Bleuler to describe a human tendency to direct attention toward one's inner life and away from the external world.<ref name="Akhtar2"/> Bleuler describes these personalities as "comfortably dull and at the same time sensitive, people who in a narrow manner pursue vague purposes".<ref name=":132">Template:Cite journal</ref> This description echoes Bleuler's 1911 description of a personality pathology functionally related to schizophrenia, as described in his seminal work, Dementia Praecox or the Group of Schizophrenias.

August Hoch in 1910 introduced a very similar concept called the "shut-in" personality. Characteristics of it were reticence, reclusiveness, shyness and a preference for living in fantasy worlds, among others. In 1925, Russian psychiatrist Grunya Sukhareva described a "schizoid psychopathy" in a group of children, resembling today's SzPD and ASD.Template:Cn About a decade later Pyotr Gannushkin also included Schizoids and Dreamers in his detailed typology of personality types.<ref>Both types shared a detachment from the world but Schizoids also showed eccentricity and paradoxicality of emotional life and behavior, emotional coldness and dryness, unpredictability combined with lack of intuition and ambivalence (e.g., simultaneous presence of both stubbornness and submissiveness). Characteristic of Dreamers were tenderness and fragility, receptiveness to beauty, weak-willedness and listlessness, luxuriant imagination, dereism and usually an inflated self-concept. (From: Gannushkin, P.B (1933). Manifestations of psychopathies: statics, dynamics, systematic aspects.)</ref>

It has been argued that descriptive tradition began in 1925 with the description of observable schizoid behaviors by Kretschmer. However, various theorist prior to Kretschmer described observable behaviours characteristic of schizoid personality as conceptualized by the early descriptive tradition, including Karl Kahlbaum in 1890, Emil Kraepelin in 1902 and 1919, Bleuler in 1911 and 1920, and Adolf Meyer in 1906, 1908, and 1912. Nevertheless, Kretschmer's seminal work involving schizoid personality, Physique and Character, was highly influential and constituted the most robust description of observable schizoid behaviours, and was notably descriptive for setting forth classifications based on these observable behaviours. However, it would be in error to claim that Kretschmer was operating solely from the descriptive tradition.

In Physique and Character, and under a specific influence of the Bleuler school, which Kretschmer failed to properly credit, the schizoid is organized into three characteristic groups:<ref name=":29">Template:Cite book</ref>

1. Unsociability, quietness, reservedness, seriousness and eccentricity.
2. Timidity, shyness with feelings, sensitivity, nervousness, excitability, fondness of nature and books.
3. Pliability, kindliness, honesty, indifference, silence and cold emotional attitudes.<ref name=":29" />

These characteristics are thought to be precursors of the DSM-III subcategorization of the schizoid character into three distinct personality disorders: schizotypal, avoidant and schizoid. However, Kretschmer's divisions were dimensional, and Kretschmer himself did not conceive of separating these behaviors to the point of radical isolation but considered them to be simultaneously present as varying potentials in schizoid individuals. For Kretschmer, the majority of schizoid people 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.<ref name=":29" /> Though Krestchmer notes that as a schizoid individual ages, she tends to become more anaclitic. Moreover, as per Bleuler's various works on the fundamental features of schizophrenia, this "split" in temperamental characteristics was thought by Kretschmer to be a fundamental, defining feature of schizoid personality.

The second path to schizoid personality, that of dynamic psychiatry, began in 1924 with the influence of observations by descriptive psychiatrist Eugen Bleuler,<ref>Eugen Bleuler – Textbook of Psychiatry, New York: Macmillan (1924)</ref> who observed that the schizoid person and schizoid pathology were not things to be set apart, though Bleuler argued for this earlier, on schizophrenic diseases more generally, in Dementia Praecox or the Group of Schizophrenias. In addition, Bleuler himself was strongly influenced by earlier dynamic theorists, such as Sigmund Freud on the "day-dreamer" in 1908 and on secondary narcissism in 1914, and Carl Jung on introversion in 1917. Later, under the influence of Bleuler and others, Ronald Fairbairn's seminal work on the schizoid condition, which was divided into schizophrenia proper; the schizoid personality type, the schizoid character; and transient schizoid episodes, and from which most of what is known today about psychodynamic schizoid phenomena is derived, was presented in 1940. Here, Fairbairn delineated four central schizoid themes:

1. The need to regulate interpersonal distance as a central focus of concern.
2. The ability to mobilize self-preservative defenses and self-reliance.
3. A pervasive tension between the anxiety-laden need for attachment and the defensive need for distance that manifests in observable behavior as indifference.
4. An overvaluation of the inner world at the expense of the outer world.

Following Fairbairn's derivation of SzPD from a combination of derealization, depersonalization, splitting, the oral stage of making all subjects into partial objects, and intellectualization;<ref>Template:Cite book</ref> the dynamic psychiatry tradition has continued to produce rich explorations on the schizoid character, most notably from writers Nannarello (1953), Laing (1965), Winnicott (1965),<ref>Donald Winnicott (1965): The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development. Karnac Books. Template:ISBN.</ref> Guntrip (1969), Khan (1974), Akhtar (1987), Seinfeld (1991), Manfield (1992) and Klein (1995).

The DSM-I had the diagnosis of schizoid personality, which was defined by avoidance of close relationships, inability to express aggressive feelings, and autistic thinking (thinking which is preoccupied with one's inner experience).<ref>Template:Cite book</ref> The DSM-II later updated the definition to include daydreaming, detachment from reality, and sensitivity.<ref>Template:Cite book</ref> It was incorporated into the DSM-III as schizoid personality disorder to describe difficulties forming meaningful social relationships and a persistent pattern of disconnection and apathy.<ref name=":0">Template:Cite book</ref><ref>Template:Cite book</ref> The diagnosis of SzPD made it to the DSM-IV and DSM-V.<ref>Template:Cite book</ref>

Epidemiology

It remains unclear how prevalent the disorder is. It may be present in anywhere from 0.5% to 7% of the population and possibly 14% of the homeless population.<ref name=":1">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Gender differences in this disorder are also unclear.<ref name=":0" /><ref>Template:Cite journal</ref> Some research has suggested that this disorder may occur more frequently in men than women.<ref name=":2">Template:Cite thesis</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> SzPD is uncommon in clinical settings (about 2.2%) and occurs more commonly in males. It is rare compared with other personality disorders.<ref name="ClusterA2"/><ref name=":92"/><ref name=":102">Template:Cite journal</ref> Philip Manfield suggests that the "schizoid condition", which roughly includes the DSM schizoid, avoidant and schizotypal personality disorders, is represented by "as many as forty percent of all personality disorders." Manfield adds: "This huge discrepancy [from the ten percent reported by therapists for the condition] is probably largely because someone with a schizoid disorder is less likely to seek treatment than someone with other axis-II disorders."<ref name=":03">Template:Cite book</ref><ref name=":5">Template:Cite journal</ref> A 2008 study assessing personality and mood disorder prevalence among homeless people at New York City drop-in centers reported an SzPD rate of 65% among this sample. The study did not assess homeless people who did not show up at drop-in centers, and the rates of most other personality and mood disorders within the drop-in centers were lower than that of SzPD. The authors noted the limitations of the study, including the higher male-to-female ratio in the sample and the absence of subjects outside the support system or receiving other support (e.g., shelters) as well as the absence of subjects in geographical settings outside New York City, a large city often considered a magnet for disenfranchised people.<ref>Template:Cite journal</ref>

Etiology

Environmental

Perfectionist and hypercritical parenting or cold,<ref>Template:Cite journal</ref> neglectful, and distant parenting contribute to the onset of SzPD.<ref name=":1" /><ref name=":2" /><ref>Template:Cite journal</ref> For a person with SzPD, their parents likely were intolerant of their emotional experiences.<ref>Template:Cite journal</ref> They may have been forced to repress and compartmentalize their emotions, possibly resulting in the onset of difficulties expressing and processing emotional experiences.<ref>Template:Cite journal</ref> These difficulties lead to the child feeling rejected and developing the belief that the only safe environment is one where they are alone and inexpressive.<ref>Template:Cite journal</ref><ref name=":24">Template:Cite journal</ref><ref>Template:Cite journal</ref><ref name=":18">Template:Cite thesis</ref> People with SzPD may also have internalized the belief that their emotions are dangerous to themselves and others due to the negative responses received from others.<ref name=":Yontef">Template:Cite journal</ref><ref name=":25">Template:Cite journal</ref><ref>Template:Cite journal</ref> In their status of isolation and emotional bluntness they can be self-sufficient and safe.<ref>Template:Cite journal</ref><ref>Template:Cite book</ref>Template:Self-published source Childhood trauma can also contribute to feelings of emptiness in adulthood.<ref name=":3">Template:Cite journal</ref> Alcoholism in parents is associated with a heightened risk of developing SzPD.<ref>Template:Cite journal</ref>

Genetic

Sula Wolff, who did extensive research and clinical work with children and teenagers with schizoid symptoms, stated that "schizoid personality has a constitutional, probably genetic, basis."<ref>Template:Cite book</ref> Research on heritability and this disorder is lacking.<ref name=":0" /> Twin studies with SzPD traits (e.g., low sociability and low warmth) suggest that these traits are inherited. Besides this indirect evidence, the direct heritability estimates of SzPD range from 50% to 59%.<ref name=":272"/><ref>Template:Cite book</ref> Earlier, less methodologically rigorous research had found the heritability rate to be 29%.<ref>Template:Cite journal</ref>

The pathophysiology of SzPD remains unclear. Genetic relationships with people who have schizophrenia spectrum disorders increase the risk of developing schizoid personality disorder.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> People with SzPD can have a history of schizotypy before developing the disorder.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> SzPD symptoms can be premorbid to schizophrenia.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

Neurological

Prenatal malnutrition,<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> premature birth, and low birth weight are all thought to play a role in the development of SzPD.<ref name=":163"/><ref>Template:Cite journal</ref><ref name=":4">Template:Cite conference</ref><ref>Template:Cite journal</ref> SzPD is associated with reduced serotonergic and dopaminergic pathways in areas such as the frontal lobe, amygdala, and striatum.<ref>Template:Cite journal</ref><ref name=":22">Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Traumatic brain injuries to the frontal lobe may also contribute to the onset of SzPD as that area of the brain controls areas such as emotion and socialization.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name=":3" /><ref>Template:Cite journal</ref> Deficits in the right hemisphere of the brain may also be associated with SzPD.<ref>Template:Cite journal</ref> Lower levels of low-density lipoprotein cholesterol may be correlated with the presence of schizoid traits in women.<ref>Template:Cite journal</ref> Excess indices in the left hemisphere may also be related to SzPD.<ref>Template:Cite journal</ref>

Prognosis

Traits of schizoid personality disorder appear in childhood and adolescence. Children with this disorder usually have poor relationships with others,<ref>Template:Cite book</ref><ref>Template:Cite journal</ref> social anxiety, internal fantasies, strange behavior, and hyperactivity. These behaviors can result in teasing and bullying at the hands of others.<ref>Template:Cite thesis</ref><ref>Template:Cite journal</ref> It is common for people with SzPD to have had major depressive disorder in childhood.<ref name=":102" /><ref>Template:Cite journal</ref> SzPD is associated with lower levels of achievement, a compromised quality of life,<ref name=":102" /><ref>Template:Cite journal</ref> and a worse outcome of treatment.<ref>Template:Cite journal</ref> Treatment for this disorder is under-studied and poorly understood.<ref>Template:Cite journal</ref> There is no widely accepted and approved psychotherapy or medication for this disorder. It is one of the most poorly researched psychiatric disorders.<ref name=":22" /> Professionals may misunderstand the disorder and the client, potentially reinforcing a feeling of failure and negatively impacting their willingness to continue to commit to treatment.<ref name=":4" /> Clinicians tend to worry that they are incapable of properly treating the patient.<ref>Template:Cite journal</ref> It is rare for someone with this disorder to voluntarily seek treatment without a comorbid disorder or pressure from family or friends.<ref>Template:Cite journal</ref> In treatment, people with SzPD are usually disinterested and often minimize symptoms. Patients with SzPD may fear losing their independence through therapy. Many schizoid individuals will avoid making the efforts required to establish a proper relationship with the therapist. It can be difficult for them to open up or discuss their emotions in therapy.<ref name=":18" /> Although people with this disorder can still improve, it is unlikely they will ever experience significant joy through social interaction.<ref name=":0" />

Signs and symptoms

Social isolation

File:Thoma Loneliness.jpg

People with SzPD are often socially isolated.

SzPD is associated with a dismissive-avoidant attachment style.<ref name=":18" /><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite book</ref> People with this disorder will rarely maintain close relationships and often exclusively choose to participate in solitary activities.<ref>Template:Cite journal</ref><ref name = "Carvalho_2020">Template:Cite journal</ref><ref>Template:Cite journal</ref> People with schizoid personality disorder typically have no close friends or confidants, except for a close relative on occasions.

They usually prefer hobbies and activities that do not require interaction with others.<ref>Template:Cite book</ref><ref>Template:Cite journal</ref> People with SzPD may be averse to social situations due to difficulties deriving pleasure from physical or emotional sensations, rather than social anhedonia.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

One potential motivation for avoiding social situations is that they feel that it intrudes on their freedom.<ref name=":3" /><ref name=":13">Template:Cite book</ref> Relationships can feel suffocating for people with SzPD,<ref>Template:Cite book</ref> and they may think of them as opportunities for entrapment.<ref name=":92" /><ref>Template:Cite journal</ref>

Patients with this disorder are often independent and turn to themselves as sources of validation. They tend to be the happiest when in relationships in which their partner places few emotional or intimate demands on them and does not expect phatic or social niceties. It is not necessarily people they want to avoid, but negative or positive emotional expectations, emotional intimacy, and self-disclosure.<ref name=":4" /><ref name=":02">Template:Cite book</ref>

Patients with SzPD can feel as if close emotional bonds are dangerous to themselves and others.<ref name=":25" /><ref name=":13" /><ref>Template:Cite journal</ref> They may have feelings of inadequacy or shame.<ref>Template:Cite journal</ref> Some people with SzPD may experience a deep desire to connect with others, yet will be terrified by the dangers inherent in doing so.<ref name=":13" /><ref name="McWilliams">Template:Cite journal</ref> Avoidance of social situations may be a method of avoiding being hurt or rejected.<ref name=":8">Template:Cite journal</ref><ref>Template:Cite journal</ref>

Individuals with SzPD can form relationships with others based on intellectual, physical, familial, occupational, or recreational activities, as long as there is no need for emotional intimacy. Donald Winnicott explains this is because schizoid individuals "prefer to make relationships on their own terms and not in terms of the impulses of other people." Failing to attain that, they prefer isolation.<ref>Template:Cite book</ref>

In general, friendship for schizoid individuals is usually limited to one other person, who is often also schizoid, forming what has been called a union of two eccentrics; "within it – the ecstatic cult of personality, outside it – everything is sharply rejected and despised".<ref>Template:Cite book</ref> Their unique lifestyle can lead to social rejection and people with SzPD are at a higher risk of facing bullying or homelessness.<ref name=":113" /><ref>Template:Cite journal</ref> This social rejection can reinforce their asocial behavior.

Sexuality

People with this disorder usually have little to no interest in sexual or romantic relationships; it is rare for people with SzPD to date or marry.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Sex often causes individuals with SzPD to 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.<ref name=":26">Template:Cite journal</ref> Significantly broadening this picture are notable exceptions of SzPD individuals who engage in occasional or even frequent sexual activities with others.<ref name=":26" /> Individuals with SzPD have long been noted to have an increased rate of unconventional sexual tendencies, though if present, these are rarely acted upon. Schizoid people are often labeled asexual or present with "a lack of sexual identity". Kernberg states that this apparent lack of sexuality does not represent a lack of sexual definition but rather a combination of several strong fixations to cope with the same conflicts. People with SzPD are often able to pursue any fantasies with content on the internet while remaining completely unengaged with the outside world.<ref name=":18" />

Emotions

Sensory or emotional experiences typically provide little enjoyment for people with SzPD.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> They rarely display strong emotions or react to anything.<ref>Template:Cite journal</ref> People with SzPD can have difficulty expressing themselves and seem to be directionless or passive.<ref name=":1" /> Individuals with SzPD can also experience anhedonia.<ref>Template:Cite journal</ref> They can also have difficulty understanding others' emotions and social cues.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> It can be hard for people with SzPD to assess the impact of their actions in social situations.<ref name="Laing1960">Template:Cite book</ref><ref>Template:Cite book</ref> People with this condition are often indifferent towards criticism or praise and can appear distant, aloof, or uncaring to others.<ref>Template:Cite journal</ref> They may avoid others and expressing themselves as a method of keeping others distant and preventing themselves from being hurt.<ref>Template:Cite journal</ref><ref name=":24" /><ref name=":8" /> Remaining alone and expressionless can feel safe and comfortable for people with SzPD.<ref>Template:Cite journal</ref> Expressing themselves can make them feel shame or discomfort.<ref name=":1" /> People with SzPD may feel inadequate and can be sensitive,<ref>Template:Cite journal</ref> although they have difficulty expressing it.<ref name=":152"/><ref name=":18" /> Alexithymia, or difficulties understanding one's own emotions, is common amongst people with SzPD.<ref>Template:Cite book</ref><ref>Template:Cite book</ref><ref>Template:Cite journal</ref> This leads to them isolating themselves to avoid the discomfort and stimulation that emotional experiences offer.<ref name=":18" /> According to Guntrip, Klein, and others, people with SzPD may possess a hidden sense of superiority and lack dependence on other people's opinions. This is very different from the grandiosity seen in narcissistic personality disorder, which is described as "burdened with envy" and with a desire to destroy or put down others. Additionally, schizoid individuals do not go out of their way to achieve social validation. Unlike narcissists, schizoid people will often keep their creations private to avoid unwelcome attention or the feeling that their ideas and thoughts are being appropriated by the public.<ref name=":18" /> When forced to rely on others, a person with SzPD may feel panic or terror.<ref name=":18" />

Feelings of unreality

Patients with SzPD often feel unreal, empty,<ref name=":4" /><ref name="McWilliams" /> and separate from their own emotions.<ref>Template:Cite thesis</ref> They tend to perceive themselves as fundamentally different from others and can believe that they are fundamentally unlikeable.<ref name=":13" /><ref>Template:Cite journal</ref> Other people often seem strange and incomprehensible to a person with SzPD. Reality can feel unenjoyable and uninteresting to people with SzPD. They have difficulty finding motivation and lack ambition.<ref name = "Carvalho_2020" /><ref>Template:Cite thesis</ref><ref>Template:Cite journal</ref> Patients with SzPD often feel as if they are "going through the motions" or that "life passes them by."<ref name=":12">Template:Cite journal</ref><ref>Template:Cite book</ref><ref>Template:Cite journal</ref> Many describe feeling as if they are observing life from a distance.<ref>Template:Cite book</ref> Aaron Beck and his colleagues report that people with SzPD seem comfortable with their aloof lifestyle and consider themselves observers, rather than participants in the world around them. But they also mention that many of their schizoid patients recognize themselves as socially deviant (or even defective) when confronted with the different lives of ordinary people – especially when they read books or see movies focusing on relationships. Even when schizoid individuals may not long for closeness, they can become weary of being "on the outside, looking in". These feelings may lead to depression, depersonalization, or derealization.<ref name=":13" /><ref name=":12" /><ref name=":18" /> If they do, schizoid people often experience feeling "like a robot" or "going through life in a dream".<ref name="beckfreeman2">Template:Cite book</ref> People with SzPD may try to avoid all physical activity in order to become nobody and disconnect from reality. This can lead to the patient spending a large quantity of time sleeping and ignoring bodily functions such as hygiene.<ref name=":18" />

Internal fantasy

Although this disorder does not affect the patient's capacity to understand reality, they may engage in excessive daydreaming and introspection.<ref name=":2" /><ref>Template:Cite book</ref><ref>Template:Cite journal</ref> Their daydreams can grow to consume most of their lives. Real life can become secondary to their fantasy,<ref name=":7">Template:Cite journal</ref> and they can have complex lives and relationships which exist entirely inside of their internal fantasy. These daydreams may constitute a defense mechanism to protect the patient from the outside world and its difficulties.<ref name=":25" /><ref name=":13" /><ref>Template:Cite journal</ref> Common themes in their internal fantasies are omnipotence and grandiosity.<ref name=":18" /> The related schizotypal personality disorder and schizophrenia are reported to have ties to creative thinking, and it is speculated that the internal fantasy aspect of SzPD may also be reflective of this thinking.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Alternatively, there has been an especially large contribution of people with schizoid symptoms to science and theoretical areas of knowledge, including mathematics, physics, economics, etc. At the same time, people with SzPD are helpless at many practical activities because of their symptoms.<ref>Template:Cite book</ref>

Suicide and self-harm

Symptoms of SzPD such as isolation and the blunted affect put people with schizoid personality disorder at a higher risk of suicide and non-suicidal self-harm.<ref name="PsychiatriaDanubina"/><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> This may be because their reduced capacities for emotion prevent them from properly dealing with strife. Their solitary nature may contribute by preventing them from finding relief in relationships.<ref name=":142"/> Demonstrative suicides or suicide blackmail, as seen in cluster B personality disorders such as borderline, histrionic, or antisocial, are extremely rare among schizoid individuals.<ref name=":20">Template:Cite journal</ref> As in other clinical mental health settings, among suicidal inpatients, individuals with SzPD are not as well represented as some other groups. A 2011 study on suicidal inpatients at a Moscow hospital found that schizoid individuals were the least common patients, while those with cluster B personality disorders were the most common.<ref name=":20" />

Low weight

A study that looked at the body mass index (BMI) of a sample of male adolescents diagnosed with either SzPD or Asperger syndrome<ref>Template:Cite journal</ref> found that the BMI of all patients was significantly below normal. Clinical records indicated abnormal eating behavior by some patients. Some patients would only eat when alone and refused to eat out. Restrictive diets and fears of disease were also found. It was suggested that the anhedonia of SzPD may also affect eating, leading schizoid individuals to not enjoy it.<ref>Template:Cite journal</ref> Alternatively, it was suggested that schizoid individuals may not feel hunger as strongly as others or not respond to it, a certain withdrawal "from themselves".<ref name=":163"/>

Substance abuse

Very little data exists for rates of substance use disorder among people with SzPD, but existing studies suggest they are less likely to have substance abuse problems than the general population. One study found that significantly fewer boys with SzPD had alcohol problems than a control group of non-schizoid people.<ref name=":182">Template:Cite journal</ref> Another study evaluating personality disorder profiles in substance abusers found that substance abusers who showed schizoid symptoms were more likely to abuse one substance rather than many, in contrast to other personality disorders such as borderline, antisocial, or histrionic, which were more likely to abuse many.<ref>Template:Cite journal</ref> American psychotherapist Sharon Ekleberry states that the impoverished social connections experienced by people with SzPD limit their exposure to the drug culture and that they have limited inclination to learn how to do illegal drugs. Describing them as "highly resistant to influence", she additionally states that even if they could access illegal drugs, they would be disinclined to use them in public or social settings, and because they would be more likely to use alcohol or cannabis alone than for social disinhibition, they would not be particularly vulnerable to negative consequences in early use.<ref name=":52">Template:Cite book</ref> People with SzPD are at a lower risk of substance abuse issues than people with other personality disorders.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> They may form relationships with their substances as a substitute for human contact or to cope with emotional issues.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> People with SzPD may desire psychedelic drugs more than other kinds.<ref>Template:Cite book</ref>

Secret schizoids

Many schizoid individuals display an engaging, interactive personality, contradicting the observable characteristic emphasized by the DSM-5 and ICD-10 definitions of the schizoid personality. Guntrip (using ideas of Klein, Fairbairn, and Winnicott) classifies these individuals as "secret schizoids", who behave with socially available, interested, engaged, and involved interaction yet remain emotionally withdrawn and sequestered within the safety of the internal world.<ref name="Klein62"/><ref name="Falk2008">Template:Cite book</ref> Klein distinguishes between a "classic" SzPD and a "secret" SzPD, which occur "just as often" as each other. Klein cautions one should not misidentify the schizoid person as a result of the patient's defensive, compensatory interaction with the external world. He suggests one ask the person what their subjective experience is, to detect the presence of the schizoid refusal of emotional intimacy and preference for objective fact.<ref name="Klein62" /> A 2013 study looking at personality disorders and Internet use found that being online more hours per day predicted signs of SzPD. Additionally, SzPD correlated with lower phone call use and fewer Facebook friends.<ref>Template:Cite journal</ref>

Descriptions of the schizoid personality as "hidden" behind an outward appearance of emotional engagement have been recognized since 1940, with Fairbairn's description of "schizoid exhibitionism", in which the schizoid individual can express a great deal of feeling and make what appear to be impressive social contacts yet, in reality, gives nothing and loses nothing. Because they are "playing a part", their personality is not involved. According to Fairbairn, the person disowns the part they are playing, and the schizoid individual seeks to preserve their personality intact and immune from compromise.<ref>Template:Cite book</ref> The schizoid person's false persona is based on what those around them define as normal or good behavior, as a form of compliance.<ref name=":18" /> Further references to the secret schizoid come from Masud Khan,<ref name=":110">Template:Cite book</ref> Jeffrey Seinfeld,<ref name=":23">Template:Cite book</ref> and Philip Manfield.<ref name=":5" /> These scholars described secret schizoids as people who enjoy public speaking engagements but experience great difficulty during the breaks when audience members would attempt to engage them emotionally. These references expose the problems in relying on outer observable behavior for assessing the presence of personality disorders in certain individuals.

Comorbid disorders

• Agoraphobia<ref>Template:Cite journal</ref>
• Avoidant personality disorder<ref name=":1" />
• Antisocial personality disorderTemplate:Citation needed
• Borderline personality disorder<ref name=":1" /><ref name=":6">Template:Cite journal</ref>
• Post-traumatic stress disorder<ref>Template:Cite journal</ref><ref name=":6" />
• Major depressive disorder<ref>Template:Cite journal</ref><ref name=":1" />
• Generalized anxiety disorder<ref name="ClusterA2" />
• Panic disorder<ref>Template:Citation</ref>
• Paranoid personality disorder<ref name=":1" />
• Social anxiety disorder<ref name="ClusterA2" />
• Schizotypal personality disorder<ref name=":1" /><ref>Template:Cite journal</ref>
• Obsessive–compulsive disorder<ref name=":6" />

Autism spectrum disorder

Several studies have reported an overlap or comorbidity with autism spectrum disorder and Asperger syndrome.<ref name=":172"/><ref name="Cook_2020" /><ref name=":163"/><ref name=":222">Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Asperger syndrome had traditionally been called "schizoid disorder of childhood",<ref>Template:Cite journal</ref><ref>Template:Cite book</ref><ref>Template:Cite journal</ref> and Eugen Bleuler coined both the terms "autism" and "schizoid" to describe withdrawal to an internal fantasy, against which any influence from outside becomes an intolerable disturbance.<ref>Template:Cite journal The quote is a translation of Bleuler's 1910 original.</ref> In a 2012 study of a sample of 54 young adults with Asperger syndrome, it was found that 26% of them also met the criteria for SzPD, the highest comorbidity out of any personality disorder in the sample (the other comorbidities were 19% for obsessive–compulsive personality disorder, 13% for avoidant personality disorder and one female with schizotypal personality disorder). Additionally, twice as many men with Asperger syndrome met the criteria for SzPD than women. While 41% of the whole sample were unemployed with no occupation, this rose to 62% for the Asperger's and SzPD comorbid group.<ref name=":172" /> Tantam suggested that Asperger syndrome may confer an increased risk of developing SzPD.<ref name=":163"/> A 2019 study found that 54% of a group of males aged 11 to 25 with Asperger syndrome showed significant SzPD traits, with 6% meeting full diagnostic criteria for SzPD, compared to 0% of a control group.<ref name="Cook_2020" />

In the 2012 study, it was noted that the DSM may complicate diagnosis by requiring the exclusion of a pervasive developmental disorder (PDD) before establishing a diagnosis of SzPD. The study found that social interaction impairments, stereotyped behaviors, and specific interests were more severe in the individuals with Asperger syndrome also fulfilling SzPD criteria, against the notion that social interaction skills are unimpaired in SzPD. The authors believe that a substantial subgroup of people with autism spectrum disorder or PDD have clear "schizoid traits" and correspond largely to the "loners" in Lorna Wing's classification The autism spectrum (Lancet 1997), described by Sula Wolff.<ref name=":172" /> The authors of the 2019 study hypothesized that it is extremely likely that historic cohorts of adults diagnosed with SzPD either also had childhood-onset autistic syndromes or were misdiagnosed. They stressed that further research to clarify overlap and distinctions between these two syndromes was strongly warranted, especially given that high-functioning autism spectrum disorders are now recognized in around 1% of the population.<ref name=":19">Template:Cite journal</ref>

Treatment

Medication

There are no effective medications for schizoid personality disorder. However, certain medications may reduce the symptoms of SzPD and treat co-occurring mental disorders. Since the symptoms of SzPD mirror the negative symptoms of schizophrenia, antipsychotics have been suggested as a potentially effective medication for SzPD.<ref name=":282"/><ref name=":7" /><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Originally, low doses of atypical antipsychotics like risperidone or olanzapine were used to alleviate social deficits and blunted affect.<ref>Template:Cite book</ref><ref>Template:Cite book</ref><ref name="SonnyJoseph2"/><ref>Template:Cite journal</ref> However, a 2012 review concluded that atypical antipsychotics were ineffective for treating personality disorders.<ref name=":152" /> Antidepressants,<ref name=":4" /> SSRIs,<ref>Template:Cite book</ref> anxiolytics,<ref name=":18" /> bupropion,<ref name="SonnyJoseph2" /> modafinil,<ref>Template:Cite journal</ref> benzodiazepines,<ref>Template:Cite book</ref><ref>Template:Cite journal</ref> and biofeedback<ref>Template:Cite journal</ref> may also be effective treatments.

File:Cognitive behavioral therapy - basic tenets.svg

Basic tenets of Cognitive-Behavioral Therapy, a kind of Psychotherapy used to treat SzPD

Psychotherapy

Treatment for this disorder uses a combination of cognitive-behavioral therapy and psychodynamic psychotherapy.<ref name=":4" /><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> These techniques can be used to help patients identify their defense mechanisms and change them.<ref name=":92" /><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Therapists attempt to establish healthy relationships with their clients,<ref>Template:Cite journal</ref> helping to combat their internalized belief that relationships are harmful and unhelpful. Relationships with a therapist can seem terrifying and intrusive to a person with SzPD.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> They may feel as if they need to alter or hide their feelings to meet the therapist's demands or expectations. To combat this, therapists try to gradually increase their patient's emotional expression. Expressing too much too early can lead to their ending therapy. Treatment must be person centered, with clients feeling understood and well regarded.<ref name=":8" /><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> This can allow them to connect with and understand their emotions.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> When people with SzPD do not have their feelings validated, this will confirm their belief that expressing themselves is dangerous.<ref name=":18" /> Therapists attempt to avoid intruding on their patients' lives or restricting their freedoms,<ref name=":18" /> so as to prevent them from feeling as if therapy is intolerable.<ref name=":12" /> Because of this, therapy is usually less structured than treatment programs for other disorders.<ref name=":18" /> Patients may benefit from long-term treatment lasting several years.<ref>Template:Cite journal</ref><ref name=":152" /> Inpatient care may be effective for treating SzPD and other Cluster A disorders.<ref>Template:Cite journal</ref>

Controversy

The original concept of the schizoid character developed by Ernst Kretschmer in the 1920s comprised a mix of avoidant, schizotypal, and schizoid traits. It was not until 1980 and the work of Theodore Millon that led to splitting this concept into three personality disorders (now schizoid, schizotypal, and avoidant). This caused debate about whether this was accurate or if these traits were different expressions of a single personality disorder.<ref name=":132" /> It has also been argued due to the poor consistency and efficiency of diagnosis due to overlapping traits that SzPD should be removed altogether from the DSM.<ref name=":222" /> A 2012 article suggested that two different disorders may better represent SzPD: one affect-constricted disorder (belonging to schizotypal PD) and a seclusive disorder (belonging to avoidant PD). They called for the replacement of the SzPD category from future editions of the DSM with a dimensional model which would allow for the description of schizoid traits on an individual basis.<ref name=":102" />

Some critics such as Nancy McWilliams of Rutgers University and Panagiotis Parpottas of European University Cyprus argue that the definition of SzPD is flawed due to cultural bias and that it does not constitute a mental disorder but simply an avoidant attachment style requiring a more distant emotional proximity.<ref name=":8" /><ref>Template:Cite book</ref> If that is true, then many of the more problematic reactions these individuals show in social situations may be partly accounted for by the judgments commonly imposed on people with this style.

Similarly, John Oldham, using a dimensional approach, thinks that most people with schizoid character features do not have a full-blown personality disorder.<ref name="Discover">Template:Cite journal</ref> Impairment is mandatory for any behavior to be diagnosed as a personality disorder.

Diagnosis

Diagnostic manuals

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, namely the DSM-5-TR, defines SzPD as "a pattern of detachment from social relationships and a restricted range of emotional expression" in the section II chapter on personality disorders.<ref name=":9">Template:Cite book</ref> The diagnosis is based on at least four out of seven diagnostic criteria being met.<ref name=":11">Template:Cite book</ref> The criteria have been retained from the DSM-IV-TR.<ref name=":9" /> In addition to the aforementioned criteria, a diagnosis requires that the condition is not merely a part of the manifestation of a disorder causing psychosis, such as schizophrenia, nor of autism spectrum disorder or "the physiological effects of another medical condition".<ref name=":11" />

The Alternative DSM-5 Model for Personality Disorders (AMPD) does not list schizoid personality disorder as its own diagnostic entity.<ref>Template:Cite book</ref> However, it is stated in the AMPD that what is conceptualized as SzPD can instead be diagnosed as Personality Disorder - Trait Specified,<ref>Template:Cite book</ref> which is a dimensional diagnosis for personality disorders found in the alternative model.

Personality disorder can also be diagnosed in accordance with the International Classification of Diseases, the latest edition of which is the ICD-11. The ICD-11 personality disorder section differs substantially from the previous edition, ICD-10. All distinct PDs have been merged into one: personality disorder (6D10), which can be coded as mild (6D10.0), moderate (6D10.1), severe (6D10.2), or severity unspecified (6D10.Z).<ref>Template:Cite journal</ref> Thus, there is no diagnosis specifically for SzPD. On the other hand, the ICD-10 has a diagnostic category specifically for schizoid personality disorder, with the code (F60.1).<ref>Template:Cite journal</ref>

Guntrip criteria

Ralph Klein, Clinical Director of the Masterson Institute, delineates the following nine characteristics of the schizoid personality as described by Harry Guntrip:<ref name=":13" />Template:Rp

• Introversion
• Withdrawnness
• Narcissism
• Self-sufficiency
• A sense of superiority
• Loss of affect
• Loneliness
• Depersonalization
• Regression

The description of Guntrip's nine characteristics should clarify some differences between the traditional DSM portrait of SzPD and the traditional informed object relations view. All nine characteristics are consistent. Most, if not all, must be present to diagnose a schizoid disorder.<ref name=":13" />

Millon's subtypes

Theodore Millon restricted the term "schizoid" to those personalities who lack the capacity to form social relationships. He characterizes their way of thinking as being vague and void of thoughts and as sometimes having a "defective perceptual scanning". Because they often do not perceive cues that trigger affective responses, they experience fewer emotional reactions.<ref>Aaron T. Beck; Arthur Freeman (1990). "Chapter 7 Schizoid and Schizotypal PD (p.120-146)". Cognitive Therapy of Personality Disorders (1st ed.). The Guilford Press. pp. 125 (Millon), 127–129 (cognitive therapy conceptualization). Template:Isbn. Template:Oclc</ref><ref>Template:Cite book</ref>

For Millon, SzPD is distinguished from other personality disorders in that it is "the personality disorder that lacks a personality." He criticizes that this may be due to the current diagnostic criteria: They describe SzPD only by an absence of certain traits, which results in a "deficit syndrome" or "vacuum". Instead of delineating the presence of something, they mention solely what is lacking. Therefore, it is hard to describe and research such a concept.<ref name=":163"/>

He identified four subtypes of SzPD. Any schizoid individual may exhibit none or one of the following:<ref name=":163" /><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Subtype	Features	Personality Traits
Languid schizoid	Including dependent and depressive features	Marked inertia; deficient activation level; intrinsically phlegmatic, lethargic, weary, leaden, lackadaisical, exhausted, enfeebled. Unable to act with spontaneity or seeks simplest pleasures, may experience profound angst, yet lack the vitality to express it strongly.
Remote schizoid	Including avoidant features	Distant and removed; inaccessible, solitary, isolated, homeless, disconnected, secluded, aimlessly drifting; peripherally occupied. Seen among people who would have been otherwise capable of developing normal emotional life but having been subjected to intense hostility lost their innate capability to form bonds. Some residual anxiety is present.
Depersonalized schizoid	Including schizotypal features	Disengaged from others and self; self is disembodied or distant object; body and mind sundered, cleaved, dissociated, disjoined, eliminated. Often seen as simply staring into the empty space or being occupied with something substantial while actually being occupied with nothing at all.
Affectless schizoid	Including compulsive features	Passionless, unresponsive, unaffectionate, chilly, uncaring, unstirred, spiritless, lackluster, unexcitable, unperturbed, cold; all emotions diminished. Combines the preference for rigid schedule (obsessive–compulsive feature) with the coldness of the schizoid.

Akhtar's profile

American psychoanalyst Salman Akhtar provided a comprehensive phenomenological profile of SzPD in which classic and contemporary descriptive views are synthesized with psychoanalytic observations. This profile is summarized in the table reproduced below that lists clinical features that involve six areas of psychosocial functioning and are organized by "overt" and "covert" manifestations.

"Overt" and "covert" are intended to denote seemingly contradictory aspects that may both simultaneously be present in an individual.<ref name="Akhtar2"/> These designations do not necessarily imply their conscious or unconscious existence. The covert characteristics are by definition difficult to discern and not immediately apparent. Additionally, the lack of data on the frequency of many of the features makes their relative diagnostic weight difficult to distinguish at this time. However, Akhtar states that his profile has several advantages over the DSM in terms of maintaining historical continuity of the use of the word schizoid, valuing depth and complexity over descriptive oversimplification and helping provide a more meaningful differential diagnosis of SzPD from other personality disorders.<ref name="Akhtar2" />

Clinical features of schizoid personality disorder<ref name="Akhtar3">Template:Cite journal</ref>

Area	Overt characteristics	Covert characteristics
Self-concept	compliant stoic noncompetitive self-sufficient lacking assertiveness feeling inferior and an outsider in life	cynical inauthentic depersonalized alternately feeling empty, robot-like and full of omnipotent, vengeful fantasies hidden grandiosity
Interpersonal relations	withdrawn aloof have few close friends impervious to others' emotions afraid of intimacy	exquisitely sensitive deeply curious about others hungry for love envious of others' spontaneity intensely needy of involvement with others capable of excitement with carefully selected intimates
Social adaptation	prefer solitary occupational and recreational activities marginal or eclectically sociable in groups vulnerable to esoteric movements owing to a strong need to belong tend to be lazy and indolent	lack clarity of goals weak ethnic affiliation usually capable of steady work quite creative and may make unique and original contributions capable of passionate endurance in certain spheres of interest
Love and sexuality	asexual, sometimes celibate free of romantic interests averse to sexual gossip and innuendo	secret voyeuristic interests vulnerable to erotomania tendency towards compulsive perversions
Ethics, standards, and ideals	idiosyncratic moral and political beliefs tendency towards spiritual, mystical and para-psychological interests	moral unevenness occasionally strikingly amoral and vulnerable to odd crimes, at other times altruistically self-sacrificing
Cognitive style	absent-minded engrossed in fantasy vague and stilted speech alternations between eloquence and inarticulateness	autistic thinking fluctuations between sharp contact with external reality and hyperreflectiveness about the self autocentric use of language

Differential diagnosis

Psychological condition	Features
Other mental disorders with psychotic symptoms	Symptoms of SzPD can appear during the course of disorder with psychotic features such as delusional disorder. However, SzPD does not require the presence of any psychotic symptoms such as hallucinations or delusions.<ref name=":62">Template:Cite book</ref>
Depression	People who have SzPD may also have clinical depression. However, this is not always the case. Unlike people with depression, persons with SzPD generally do not consider themselves inferior to others. They may recognize instead that they are "different".
Autism spectrum disorder	There may be substantial difficulty in distinguishing Asperger syndrome (AS), sometimes called "schizoid disorder of childhood", from SzPD. But while AS is an autism spectrum disorder, SzPD is classified as a "schizophrenia-like" personality disorder. There is some overlap, as some people with autism also qualify for a diagnosis of schizotypal or schizoid PD. However, one of the distinguishing features of schizoid PD is a restricted affect and an impaired capacity for emotional experience and expression. Persons with AS are "hypo-mentalizers", i.e., they fail to recognize social cues such as verbal hints, body language and gesticulation, but those with schizophrenia-like personality disorders tend to be "hyper-mentalizers", overinterpreting such cues in a generally suspicious way.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Although they may have been socially isolated from childhood onward, most people with SzPD displayed well-adapted social behavior as children, along with apparently normal emotional function. SzPD also does not require impairments in nonverbal communication such as a lack of eye contact, unusual prosody or a pattern of restricted interests or repetitive behaviors.<ref name="PMID24290364">Template:Cite journal</ref>
Personality change due to another medical condition	Traits of SzPD can appear due to damage to the central nervous system.<ref name=":62"/>
Substance use disorders	Traits of SzPD can appear due to substance abuse.<ref name=":62"/>
Other personality disorders and personality traits	Schizoid and narcissistic personality disorders can seem similar in some respects (e.g. both show identity confusion, may lack warmth and spontaneity, avoid deep relationships with intimacy). Another commonality observed by Akhtar is preferring ideas over people and displaying "intellectual hypertrophy", with a corresponding lack of rootedness in bodily existence. There are, nonetheless, important differences. A schizoid person hides their need for dependency and is rather fatalistic, passive, cynical, overtly bland or vaguely mysterious. A narcissist is, in contrast, ambitious and competitive and exploits others for their dependency needs.<ref>Template:Cite book</ref> There are also parallels between SzPD and obsessive–compulsive personality disorder (OCPD), such as detachment, restricted emotional expression and rigidity. However, in OCPD the capacity to develop intimate relationships is usually intact, but deep contacts may be avoided because of an unease with emotions and a devotion to work.<ref name=":113"/><ref name="Akhtar22">Template:Cite journal</ref> While people affected with avoidant personality disorder (AvPD) avoid social interactions due to anxiety or feelings of incompetence, those with SzPD do so because they are genuinely indifferent to social relationships. A 1989 study,<ref>Template:Cite journal</ref> however, found that "schizoid and avoidant personalities were found to display equivalent levels of anxiety, depression, and psychotic tendencies as compared to psychiatric control patients." There also seems to be some shared genetic risk between SzPD and AvPD (see schizoid avoidant behavior). Several sources have confirmed the synonymy of SzPD and avoidant attachment style.<ref>Template:Cite book</ref> However, the distinction should be made that individuals with SzPD characteristically do not seek social interactions merely due to lack of interest, while those with avoidant attachment style can in fact be interested in interacting with others but without establishing connections of much depth or length due to having little tolerance for any kind of intimacy.

See also

• Alexithymia
• Asociality
• Cognitive disengagement syndrome
• Counterphobic attitude
• Dissociation (psychology)
• Hermit
• Hikikomori
• Recluse
• Schizothymia
• Schizotypy
• Social disorder
• Social isolation
• Schizoid avoidant behavior
• Schizotypal personality disorder

External links

• David Kishik, "Self Study: Notes on the Schizoid Condition"
• The Biological foundations of the Schizoid Process
• NY Times article "Like a Fish Needs a Bicycle: For Some People, Intimacy Is Toxic"
• Psychology Today (2017): The Disappearance of the Schizoid Personality