Schizoid psychopathy (Schizoid personality disorder)

Schizoid personality disorder (from Ancient Greek σχίζω - “splitting” + -oid, from Ancient Greek εἶδος - “similarity”) (outdated names - personality disorder of the schizoid type, schizoid psychopathy) - a personality disorder characterized by a tendency to avoid emotionally rich relationships through excessive theorizing, withdrawing into oneself, and retreating into fantasy. In addition, schizoid individuals often tend to disregard prevailing social norms. Schizophrenia often develops in schizoid individuals. Included in ICD-10 and DSM-5.

Description

There are two main features of schizoid personality disorder: a lack of interpersonal relationships and a lack of desire to establish such relationships. Other people are viewed as intrusive and unhelpful, and relationships with them are viewed as messy and undesirable. As a result, these people are often described as introverted, reclusive, and lonely. In accordance with this, they react little to both negative and positive feedback from others.

As you might expect, they get little satisfaction from relationships with people.

In addition, schizoid people are affectively limited and exhibit neither strong negative nor strong positive emotional reactions. According to this, Millon (1981) suggests that they are unable to recognize subtle emotions in both themselves and others. As a result, they often appear and feel uncaring. For many of these people, life is, at best, an unexciting endeavor.

Although schizoid individuals can be productive, they organize their lives to limit interaction with other people and usually choose professions that require minimal social contact. In addition, they act alone and outside the professional sphere.

Paranoid schizophrenia being treated in a clinic

At the Moscow center of psychiatry and psychotherapy “Preobrazhenie Clinic” you will receive everything you need for complete treatment of paranoid schizophrenia. The clinic’s specialists provide comprehensive treatment using the most effective methods. Both patients and loved ones receive assistance. You can find out the cost of services here.

Why should paranoid schizophrenia be treated?

The specialists of our clinic are attentive to each patient and are ready to help you in the fight against mental illness. Here you will receive all the necessary medical and psychological assistance, the patient will be prescribed medication and supportive psychotherapy. “Transfiguration Clinic” works so that you and your loved ones can return to a full life and forget about mental illness.

With us you will receive:

• rapid treatment with accurate diagnosis;
• attentiveness and understanding;
• psychological support for the patient’s loved ones;
• a full range of services for the rehabilitation of a patient with schizophrenia;
• anonymity of treatment and compliance with confidentiality conditions.

Specialists at the Transfiguration Clinic of psychiatry and psychotherapy in Moscow are ready to help your loved one and you at any time.

Diagnosis

ICD-10

According to ICD-10, this mental disorder is diagnosed if the general diagnostic criteria for personality disorder are met, plus three or more of the following:

• little or nothing is enjoyable;
• emotional coldness, alienated or flattened affectivity;
• inability to show warm, tender feelings towards other people, as well as anger;
• weak response to both praise and criticism;
• little interest in sexual contact with another person (taking into account age);
• increased preoccupation with fantasy and introspection;
• almost constant preference for solitary activities;
• a noticeable insensitivity to prevailing social norms and conditions;
• lack of close friends or trusted connections (or the existence of only one) and lack of desire to have such connections.

Included:

• an autistic personality with a predominance of sensitive traits (“mimosa-like” with a hypersensitive internal organization and susceptibility to psychogenia with an asthenic-depressive type of reactions);
• sthenic schizoid with high performance in narrow areas of activity, combined with formal (dry) pragmatism and certain features of despotism that characterize interpersonal relationships.

Excluded:

• schizophrenia (F20.);
• schizotypal disorder (F21.);
• Asperger's syndrome (F84.5);
• schizoid disorder of childhood (F84.5);
• delusional disorder (F22.0).

DSM-IV and DSM-5

According to DSM-IV and DSM-5, schizoid personality disorder is classified as Cluster A (unusual or eccentric disorders). A person with this disorder is characterized by a general withdrawal from social relationships and a limited way of expressing emotions in interpersonal situations. To make a diagnosis, four or more of the following characteristics must begin in early adulthood (age eighteen years or older) in a variety of settings, and the disorder must meet the general criteria for a personality disorder.

1. Does not want to have and does not enjoy close relationships, including family ones.
2. Almost always prefers solitary activities.
3. Has little, if any, interest in sexual relations.
4. Enjoys only a few activities or does not enjoy any activities at all.
5. Has no close friends or comrades other than immediate family.
6. Appears indifferent to praise or criticism.
7. Shows emotional coldness, detachment, or flattened affectivity.

To make a diagnosis, these manifestations must not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic symptoms, another psychotic disorder, or autism spectrum disorder, and must not be a direct consequence of any other illness or general physical condition.

Differential diagnosis

Schizotypal personality disorder differs from schizoid personality disorder by the presence of cognitive or perceptual distortions in addition to social withdrawal. In schizotypal disorder (F21), there are more severe thinking and sensory disturbances, lower social functioning, and subpsychotic-level episodes.

Paranoid personality disorder is characterized by suspiciousness and paranoid thinking. In addition, patients with paranoid personality disorder are able to engage in emotionally rich and stable relationships with others, and are more likely to use projection.

Emotionally unstable personality disorder and anxious (avoidant) personality disorder are characterized by a richer social and emotional life; patients with these personality disorders are more interested in establishing contacts, are sensitive to their loneliness, and are less prone to autistic fantasizing. If patients, in conversation with a doctor, express fantasies about imaginary close relationships, which are accompanied by a fear of dependence on others, then a diagnosis of avoidant personality disorder is more likely.

What is paranoid schizophrenia

Paranoid schizophrenia is the most common type of illness. Sometimes mistakenly called paranoid schizophrenia. It is manifested by the presence of delusions of persecution, obsessions, conversations with non-existent interlocutors, and problems with self-identification are observed. Sometimes paranoid schizophrenia is accompanied by hallucinations and catatonic symptoms (in a mild form).

The exact causes of the disease have not yet been fully determined. Possible reasons that can provoke hereditary mental disorders are: the influence of the environment, family upbringing, prenatal and stress factors, alcoholism, drug addiction and disorders in the brain (neurobiological factors), age crisis.

Prevention of paranoid (paranoid) schizophrenia

Schizophrenia affects about 10% of the population. The first, pronounced attack often occurs before the age of 30. But early signs and symptoms of paranoid (paranoid) schizophrenia can occur as early as adolescence and young adulthood. Anyone can develop schizophrenia during their lifetime. As the disease progresses, social aspects of life and a person’s functioning in society suffer, which causes the person severe mental discomfort.

Etiology and pathogenesis

Psychoanalytic interpretation

In psychoanalysis, schizoid personality disorder is understood as the condition of a person with a schizoid personality type, located at the borderline level of development of personality organization. Psychoanalysts believe that a person with this type of personality can also be on a neurotic (which corresponds to accentuations in Russian psychology) and psychotic levels, but the personal characteristics characteristic of this type will be preserved.

It is believed that the schizoid personality organization is characterized by reliance on defensive fantasy - withdrawal into the inner world, fantasies. In addition, one of the most characteristic defenses for a schizoid is intellectualization, which allows one to reduce the emotional significance of what is happening without losing touch with it. In addition, schizoid personalities often rely on sublimation, which can rely on the fruits of the schizoid’s rich imagination.

It is assumed that the primary conflict that forms the schizoid personality lies in the area of ​​relationships and concerns problems of approaching/distanced. The schizoid constantly maintains a significant distance from people, which is why he always craves intimacy. At the same time, he associates intimacy with violation of boundaries and absorption, which forces the schizoid to maintain distance to ensure his own safety. Schizoid individuals are often characterized by eccentricity and disregard for social norms. One explanation for this feature is that schizoids understand “similarity” to others as a state of “absorption.” A schizoid person can make significant efforts to not fit into any framework.

The hypothesis about the influence of contradictory double messages on the formation of a schizoid personality type in a child is quite popular.

Schizoid character traits in adolescents

Schizoid accentuation manifests itself at its worst during puberty, and it is during adolescence that it brings many problems. At this age, the child’s communication with other peers and teenagers is very important. And it is quite difficult for schizoids to find that same contact with society and the world around them in general.

The main value of such teenagers lies in their own uniqueness, and their biggest fear is the possibility of losing themselves in such a big world. In their hearts, such children want to be in society and want to be accepted by them, but despite this desire, schizoids do not leave their protective shell so as not to stumble again.

As a result, such a lifestyle without any communication begins to become a habit that burdens the teenager. This leads to the fact that the child simply chooses between communication and a possible mistake, non-acceptance of society, his unique individuality.

Schizoids are never distinguished by a large number of friends, and those friends whom he managed to find must respect the personal space of the schizoid. Otherwise, he leaves his social circle. Difficulties also develop when communicating with members of the opposite sex.

Schizoids often avoid physical contact, especially with the opposite sex, and may not tolerate loud and harsh sounds and smells.

Therefore, when communicating with a schizoid teenager, it is important to take into account his individuality, trying to understand this approach, principles and aspirations. It is important to support the desire to develop in a creative direction and respect the personal space of such a teenager.

Story

The term “schizoid” was first used by Bleuler (1924), who described a “closed,” suspicious, sad person whose energy is directed inward rather than outward. This individual also demonstrated social withdrawal and odd thinking, but was not psychotic (Siever & Gunderson, 1983). A few years earlier, Hoch (1909) also described a “closed” personality that preceded the development of schizophrenia. The personality of these patients in the premorbid period was characterized by a tendency to solitude, shyness, stubbornness and rich imagination. Hoch and Polatin (1939) later described this group of nonpsychotics predisposed to developing schizophrenia as “pseudoneurotic schizophrenics.” Nannarello (1953) reported that the term was later popularized by Kretschmer (1925), who described “affective impairment” in two types of schizoid personality, “hyperaesthetic” and “anesthetic.” Kretschmer described the anesthetic schizoid personality as a dull, colorless, quiet, withdrawn person who rarely or does not show his emotions and interests.

In contrast, hyperaesthetic people are shy and so sensitive to external stimuli that they try to avoid them at all costs. From Kretschmer's point of view, a schizoid diagnosis does not necessarily equate to disability. Millon (1981) suggests that in modern terminology, the hyperaesthetic type would correspond to avoidant personality disorder, and the anesthetic type would correspond to schizoid personality disorder.

As noted by Siever & Gunderson (1983), the term "schizoid" has expanded from its original meaning to include people who avoid relationships and social interactions and tend to be eccentric. Widespread use of the term has overshadowed its original meaning as a non-psychotic form of schizophrenia. But it was not until 1953 that Raido coined the term "schizotypal" as short for "schizophrenic genotype." He was referring to people who he believed were genetically predisposed to schizophrenia but did not exhibit psychotic behavior. Rado's description of a schizotypal person included complete indifference to the joys of life, emotional coldness, impaired empathy and dependence. Although Raido intended to describe a non-psychotic form of schizophrenia, his description (apart from addiction) is very similar to the modern diagnosis of schizoid personality disorder.

Meehl (1962) later described a personality type similar to schizotypal personality disorder, which he believed was genetically related to schizophrenia. This group was characterized by cognitive decline, withdrawal from social contacts, complete indifference to the joys of life and ambivalence. This personality type typically showed low levels of adjustment, but eccentricity in thinking, behavior, and emotions, as described by Meehl, were not the main characteristics of this disorder. Kety, Rosenthal, Wender, & Schulsinger (1968) described “borderline schizophrenia,” also similar to schizotypal personality disorder, as a nonpsychotic personality disorder involving cognitive distortions, complete indifference to the joys of life, emotional coldness and lack of interpersonal skills. Siever and Gunderson (1983) note that this personality type is characterized by a paucity of interpersonal relationships rather than by social isolation and withdrawal (consistent with modern diagnoses of avoidant and schizoid personality disorders).

Because of the vagueness of these disorders and the changes in views on them over the years, the corresponding diagnoses have changed over time. In the DSM-I, schizoid personality was characterized by avoidance of relationships with others, an inability to express hostility or aggressive feelings, and autistic thinking. This description of a cold, emotionally detached, timid personality who could exhibit eccentricities appears to fit modern diagnoses of avoidant, schizoid, and schizotypal personality disorders. It was only in DSM-III that these disorders were separated. When developing new criteria, Millon (1969) emphasized the difference between the two personality types. He labeled them the “passive-avoidant” and “active-lonely” types or the “asocial” and “avoidant” types, which correspond to the modern diagnoses of schizoid and avoidant personality disorders (Millon, 1981). Although the term "schizoid" has a complicated history, it has remained a label for "asociality." This was supposed to be different from antisocial personality disorder. The schizotypal pattern, also included in the DSM-I and DSM-II descriptions of schizoid personality, was considered a separate personality type. Schizotypal and borderline personality types were then distinguished (Spitzer, Endicott, & Gibbon, 1979).

While early theorists such as Bleuler and Kretschmer believed that schizoid personality was due to constitutional problems, later psychoanalytic theorists hypothesized that schizoid character structure resulted from serious disturbances in the mother-child relationship. In psychoanalytic terms, as a result of these early disturbances, the schizoid person developed a primary defense structure in which relationships were avoided due to an inability to give or receive love. Moreover, this type of patient was thought to be so vulnerable to rejection that the value of relationships with people was suppressed (Arieti, 1955). Fairbairn (1940) reported that the result of these unsatisfying maternal relationships was the development of depersonalization and an artificial self in which feelings were repressed. The schizoid personality is unable to experience love and intimacy. Klein (1952) viewed the schizoid process as a developmental stage that all children go through. During this stage, oral and sadistic urges, experienced as dangerous, are separated and projected onto the caregiver. In this case, the caregiver is considered dangerous, and various defenses are formed to overcome the anxiety that arises in this regard. The schizoid adult, retaining some of these early defenses, maintains distance in interpersonal relationships due to anxiety caused by interpersonal contacts. Guntrip (1969) also described developmental delays in early life when children avoid an unsatisfying relationship with their mother. These people subsequently develop a primitive fear of consuming people or being consumed by a caregiver. This leads them to develop a reserved and aloof interpersonal style as a defense against primary horror and anger.

Psychoanalytic theorists, in addition to distance in interpersonal relationships, also pay attention to the defensive, detached, “observer” style seen in schizoid individuals. Deutsch (1942) reported that an “as if” personality is formed, so it is impossible to feel emotions. The observer may see that the life of schizoids “seems” to be fulfilling, but upon closer examination, a lack of emotional reactivity will be obvious.

In contrast to the complex intrapsychic mechanisms proposed in psychoanalysis, Millon (1981) stated that the schizoid personality has a relatively simple defense structure. He believes that schizoid people suffer from a lack of ability to form relationships and experience emotions. As a result of this insensitivity to interpersonal contacts and emotional stress, there is no need to develop defenses.

Schizoid accentuation in children

Unlike other accentuations, schizoid symptoms appear quite early, and from the very first years, a child can show them. For example, he may try to be alone in games; other children will not attract or interest him; instead of noisy games and companies, he will give preference to quiet and calm activities.

In this case, children usually try to avoid communicating with peers, and being in the company of the older generation will be more pleasant and interesting for them. Moreover, in such a society, schizoid children do not attract the attention of adults in any way; rather, on the contrary, they behave as calmly and quietly as possible, carefully listening to the conversations of adults, and thinking about these words as much as possible.

Treatment and therapy

Psychoanalytic

Therapy for schizoid personalities, in general, is relatively comfortable for psychoanalytically oriented therapists. One of the possible difficulties that can be expected is the transition of the dialogue with the client to an abstract-theoretical level, too divorced from reality. Schizoids themselves are prone to this, and the therapist can also become carried away by this manner of communication. Meanwhile, persistently demanding from a schizoid client that he “explain himself normally” is unacceptable, since a therapist who is unable to accept the client’s extraordinary way of thinking is perceived by the schizoid as not empathic and not interested in him.

Common problems that arise when working with a schizoid client relate, predictably, to issues of distance between the client and the therapist.

Despite the relative emotional comfort, psychoanalytic therapy for schizoid individuals takes a long time and causes many difficulties.

Subtypes according to Theodore Millon

American psychologist Theodore Millon identified four subtypes of schizoid personality disorder. A person suffering from this disorder may exhibit the following traits: