SPD is not the same as schizophrenia or schizotypal personality disorder, but there is some evidence of links and shared genetic risk between SPD, other cluster A personality disorders, and schizophrenia. Thus, SPD is considered to be a "schizophrenia-like personality disorder".
Critics argue that the definition of SPD is flawed due to " >cultural biasand that it does not constitute a mental disorder but simply an avoidant attachment style requiring more distant emotional proximity. 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. However, impairment is mandatory for any behaviour to be diagnosed as a personality disorder. SPD seems to satisfy this criterion because it is linked to negative outcomes. These include 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"). Symptoms of SPD are also a risk factor for more severe suicidal behaviour.
SPD is a poorly studied disorder, and there is little clinical data on SPD because it is rarely encountered in clinical settings. The effectiveness of psychotherapeutic and pharmacologicaltreatments for the disorder have yet to be empirically and systematically investigated.
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 meaningfully. They may remain passive in the face of unfavorable situations. Their communication with other people may be indifferent and terse at times. Because of their lack of meaningful communication with other people, those who are diagnosed with SPD are not able to develop accurate impressions of how well they get along with others.
Schizoid personality types are challenged to achieve self-awareness and the ability to assess the impact of their own actions in social situations. It's suggests when injections of interpersonal reality fail to enrich an individual, his or her self-image becomes empty and volatilized, making the individual feel unreal. When someone violates the personal space of an individual with SPD, it suffocates them and they must free themselves to be independent. People who have SPD tend to be happiest when in relationships in which their partner places few emotional or intimate demands on them. It is not people they want to avoid, but negative and positive emotions, emotional intimacy, and self-disclosure.
" >Therefore, it is possible for individuals with SPD to form relationships with others based on intellectual, physical, familial, occupational, or recreational activities as long as there is no need for emotional intimacy.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.
Although there is the belief people with schizoid personality disorder are complacent and unaware of their feelings, many recognize their differences from others. Some individuals with SPD who are in treatment say "life passes them by" or they feel like living inside of a shell; they see themselves as "missing the bus" and complain of observing life from a distance.
It's report that people with SPD 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 or depersonalisation. If they do, schizoid people often experience feeling "like a robot" or "going through life in a dream."
It is speculated schizoid personality disorder may have ties to creativity.
Phenomenology
The 'secret schizoid'
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.Individuals who behave with socially available, interested, engaged, and involved interaction yet remain emotionally withdrawn and sequestered within the safety of the internal world.
Frequently, a schizoid individual's social functioning improves, sometimes dramatically, when the individual knows he or she is an anonymous participant in a real-time conversation or correspondence, . in an online chat-room or message-board. Indeed, it is often the case the individual's online correspondent will report nothing amiss in the individual's engagement and affect.
Withdrawal or detachment from the outer world is a characteristic feature of schizoid pathology, but may appear either in "classic" or in "secret" form. When classic, it matches the typical description of the schizoid personality offered in the DSM-5. It is "just as often" a hidden internal state: that which meets the objective eye may not match the subjective, internal world of the patient. A "cautions" one should not miss identifying the schizoid person because one cannot see the person's withdrawal through the patient's defensive, compensatory interaction with external reality. It's suggests one ask the person what his or her subjective experience is, 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 since 1940 with description of "schizoid exhibitionism," in which the schizoid individual is able to express a great deal of feeling and to make what appear to be impressive social contacts yet in reality gives nothing and loses nothing. Because he or she is "playing a part," his or her personality is not involved.The affected " > person disowns the part he is playing and the schizoid individual seeks to preserve his personality intact and immune from compromise.SPD individual who "enjoys" public speaking engagements but experiences great difficulty in the breaks when audience members would attempt to engage him emotionally. These references expose the problems in relying on outer observable behavior for assessing the presence of personality disorders in certain individuals.
CAUSES
Some evidence suggests the Cluster A personality disorders have shared genetic and environmental risk factors, and there is an increased prevalence of schizoid personality disorder in relatives of people with schizophrenia and schizotypal personality disorder. Twin studies with schizoid personality disorder traits (e.g. low sociability and low warmth) suggest these are inherited. Besides this indirect evidence, the direct heritability estimates of SPD range from 50 to 59%. An extensive research and clinical work with children and teenagers with schizoid symptoms, "schizoid personality has a constitutional, probably genetic, basis." The link between SPD and being underweight may also point to the involvement of biological factors.
In general, prenatal caloric malnutrition, premature birth and a low birth weight are risk factors for being afflicted by mental disorders and may contribute to the development of schizoid personality disorder as well. Those who have experienced traumatic brain injury may be also at risk of developing features reflective of schizoid personality disorder.
CRITERIA FOR THE SCHIZOID PERSONALITY
Introversion
Withdrawnness
Narcissism
Self-sufficiency
A sense of superiority
Loss of affect
Loneliness
Depersonalization
Regression
The description of nine characteristics should clarify some differences between the traditional DSM portrait of SPD and the traditional informed object relations view. All nine characteristics are consistent. Most, if not all, must be present to diagnose a schizoid disorder.
DIFFERENTIAL DIAGNOSIS
While SPD shares several symptoms with other mental disorders, here are some important differentiating features:
PSYCHOLOGICAL CONDITION FEATURES
Depression People who have SPD may also suffer from clinical depression. However, this is not always the case. Unlike depressed people, persons with SPD generally do not consider themselves inferior to others. They may recognize that they are "different."
Avoidant personality disorder (AvPD) While people affected with APD avoid social interactions due to anxiety or feelings of incompetence, those with SPD do so because they are genuinely indifferent to social relationships. A 1989 study, 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 SPD and AvPD (see schizoid-avoidant behavior). Several sources to date have confirmed the synonymy of SPD and avoidant attachment style. However, the distinction should be made that individuals with SPD 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.
Other personality disorders 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 intellectual hypertrophy which leads to a lack of rootedness in bodily existence. There are, nonetheless, important differences. The schizoid hides his need for dependency and is rather fatalistic, passive, cynical, overtly bland or vaguely mysterious. The narcissist is, in contrast, ambitious and competitive and exploits others for his dependency needs. There are also parallels between SPD 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.
Asperger syndrome There may be substantial difficulty in distinguishing Asperger syndrome (AS), sometimes called "schizoid disorder of childhood," from SPD. But while AS is an autism-spectrum disorder, SPD 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 (see imprinted brain theory). Although they may have been socially isolated from childhood onward, most people with schizoid personality disorder displayed well-adapted social behavior as children, along with apparently normal emotional function. SPD does also not involve impairments in nonverbal communication such as a lack of eye contact, unusual prosody or a pattern of restricted interests or repetitive behaviors. Compared to AS, SPD is characterized by prominent conduct disorder, better adult adjustment, less severely impaired social interaction and a slightly increased risk of schizophrenia.
Simple-type schizophrenia Both simple schizophrenia and SPD share many negative symptoms like avolition, impoverished thinking and flat affect. Although they may look almost identical, what distinguishes them is usually the severity. Also, SPD is characterized by a lifelong pattern without change whereas simple schizophrenia represents a deterioration.
TREATMENT
Treatment of avoidant personality disorder can employ various techniques, such as social skills training, psychotherapy, cognitive therapy, and exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy.
A key issue in treatment is gaining and keeping the patient's trust, since people with avoidant personality disorder will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.
Significant improvement in the symptoms of personality disorders is possible, with the help of treatment and individual effort Psychotherapy.
PSYCHOTHERAPY
Supportive psychotherapy is also used in an inpatient or outpatient setting by a trained professional that focuses on areas such as coping skills, improvement of social skills and social interactions, communication, and self-esteem issues. People with SPD may also have a perceptual tendency to miss subtle differences. That causes an inability to pick up hints from the environment because social cues from others that might normally provoke an emotional response are not perceived. That in turn limits their own emotional experience. The perception of varied events only increases their fear for intimacy and limits them in their interpersonal relationships. Their aloofness may limit their opportunities to refine the social skills and behavior necessary to effectively pursue relationships.[ clarification needed.
Besides psychodynamic therapy, CBT can be used. But because CBT generally begins with identifying the automatic thoughts one should be aware of the potential hazards that can happen when working with schizoid patients. People with SPD seem to be distinguished from those with other personality disorders in that they often report having few or no automatic thoughts at all. That poverty of thought may have to do with their apathetic lifestyle. But another possible explanation could be the paucity of emotion many schizoids display which would influence their thought patterns as well.
Socialization groups may help people with SPD. Educational strategies in which people who have SPD identify their positive and negative emotions also may be effective. Such identification helps them to learn about their own emotions and the emotions they draw out from others and to feel the common emotions with other people with whom they relate. This can help people with SPD create empathy with the outside world.
SHORT TERM TREATMENT
The concept of "closer compromise" means that the schizoid patient may be encouraged to experience intermediate positions between the extremes of emotional closeness and permanent exile. A lack of injections of interpersonal reality causes an impoverishment in which the schizoid individual's self-image becomes increasingly empty and volatilized and leads the individual to feel unreal. To create a more adaptive and self-enriching interaction with others in which one "feels real," the patient is encouraged to take risks through greater connection, communication, and sharing of ideas, feelings, and actions. Closer compromise means that while the patient's vulnerability to anxieties is not overcome, it is modified and managed more adaptively. Here the therapist repeatedly conveys to the patient that anxiety is inevitable but manageable, without any illusion that the vulnerability to such anxiety can be permanently dispensed with. The limiting factor is the point at which the dangers of intimacy become overwhelming and the patient must again retreat.
There is a suggests that patients must take the responsibility to place themselves at risk and to take the initiative for following through with treatment suggestions in their personal lives. It is emphasized that these are the therapist's impressions and that he or she is not reading the patient's mind or imposing an agenda but is simply stating a position that is an extension of the patient's therapeutic wish. Finally, the therapist directs attention to the need to employ these actions outside of the therapeutic settin
LONGER-TERM THERAPY
Klein suggests that "working through" is the second longer-term tier of psychotherapeutic work with schizoid patients. Its goals are to change fundamentally the old ways of feeling and thinking, and to rid oneself of the vulnerability to those emotions associated with old feelings and thoughts. A new therapeutic operation of "remembering with feeling" that draws on concepts of false self and true self is called for. The patient must remember with feeling the emergence of his or her false self through childhood, and remember the conditions and proscriptions that were imposed on the individual’s freedom to experience the self in company with others
Remembering with feeling ultimately leads the patient to understand that he or she had no opportunity to choose from a selection of possible ways of experiencing the self and of relating with others, and had few, if any, options other than to develop a schizoid stance toward others. The false self was simply the best way in which the patient could experience the repetitive predictable acknowledgment, affirmation, and approval necessary for emotional survival while warding off the effects associated with the abandonment depressio
If the goal of shorter-term therapy is for patients to understand that they are not the way they appear to be and can act differently, then the longer-term goal of working through is for patients to understand who and what they are as human beings, what they truly are like and what they truly contain. The goal of working through is not achieved by the patient’s sudden discovery of a hidden, fully formed talented and creative self living inside, but is a process of slowly freeing oneself from the confinement of abandonment depression in order to uncover a potential. It is a process of experimentation with the spontaneous, nonreactive elements that can be experienced in relationship with others.
Working through abandonment depression is a complicated, lengthy and conflicted process that can be an enormously painful experience in terms of what is remembered and what must be felt. It involves mourning and grieving for the loss of the illusion that the patient had adequate support for the emergence of the real self. There is also a mourning for the loss of an identity, the false self, which the person constructed and with which he or she has negotiated much of his or her life. The dismantling of the false self requires relinquishing the only way that the patient has ever known of how to interact with others. This interaction was better than not to have a stable, organized experience of the self, no matter how false, defensive.
The dismantling of the false self "leaves the impaired real self with the opportunity to convert its potential and its possibilities into actualities." Working through brings unique rewards, of which the most important element is the growing realization that the individual has a fundamental, internal need for relatedness that may be expressed in a variety of ways. "Only schizoid patients,who have worked through the abandonment depression ... ultimately will believe that the capacity for relatedness and the wish for relatedness are woven into the structure of their beings, that they are truly part of who the patients are and what they contain as human beings. It is this sense that finally allows the schizoid patient to feel the most intimate sense of being connected with humanity more generally, and with another person more personally. For the schizoid patient, this degree of certainty is the most gratifying revelation, and a profound new organizer of the self experience
DEVELOPMENT AND COURSE
SPD can be first apparent in childhood and adolescence with solitariness, poor peer relationships, and underachievement in school. This may mark these children as different and make them subject to teasing
Being a personality disorder, which are usually chronic and long-lasting mental conditions, schizoid personality disorder is not expected to improve with time without treatment; however, much remains unknown because it is rarely encountered in clinical settings.We end here.
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