Schizoid personality disorder is a persistent pattern of emotional and social detachment from interpersonal relationships that typically begins in early adulthood. This indifference to interactions and connections often extends to immediate family members. People with schizoid personality disorder are often described as loners and recluses. They have a restricted range of emotional expression, speak in monotone, and are often described as cold and apathetic.1
What Is Schizoid Personality Disorder?
Schizoid personality disorder is categorized in the Diagnostic and Statistical Manual-5 (DSM-5) as a Cluster A personality disorder along with schizotypal personality disorder and paranoid personality disorder. They are categorized together due to shared symptom presentation — difficulty connecting with others and peculiar, eccentric behavior (based on cultural norms).
Schizoid personality disorder along with schizotypal personality disorder, brief psychotic disorder, and delusional disorder are all conceptualized as being a part of the schizophrenia spectrum disorders. In this perspective, schizoid personality disorder and these psychotic disorders are viewed along a continuum or dimension in severity and functional impairment.
One primary difference with schizoid personality disorder is that the individual doesn’t experience psychosis but has many of the other features typical of schizophrenia spectrum disorder such as restricted emotional expression and odd/eccentric behaviors. People diagnosed with schizoid personality disorder are at an increased risk to later develop schizophrenia or other psychotic disorders.1
Within clinical samples, schizoid personality disorder is rare. The DSM-5 states that the disorder is more often diagnosed in men than women and that their presentation may be more severe. Risk factors include having relatives with schizophrenia or schizotypal personality disorder.1
Symptoms of Schizoid Personality Disorder
For a diagnosis of schizoid personality disorder, at least four of seven symptoms must be present since early adulthood and persistent in a variety of contexts.
The symptoms of schizoid personality disorder include:1
- No enjoyment in close relationships or lack of desire for close relationships, including family
- Preference almost exclusively for solitary activities
- Little to no interest in sexual activities with people
- Little to no pleasure in activities
- Has very few if any friends or confidants other than first-degree relatives.
- Indifferent to praise and criticism
- Flat affect, monotone voice, emotionally distant
Symptoms of schizoid personality disorder do not occur exclusively during episodes of other mental health disorders such as schizophrenia, bipolar disorder, depressive disorder with psychotic features, other psychotic disorders, or autism spectrum disorder. To be diagnosed with an additional psychotic disorder the person must have expressed symptoms of the personality disorder prior to onset of the psychotic disorder and presentation must persist when psychosis from the disorder is ceased. Personality disorders such as schizoid personality disorder are somewhat consistent and stable in presentation as are most personality traits.1
Signs of Schizoid Personality Disorder
In Children
While personality disorder diagnoses are not given to children under 18 years of age, schizoid personality disorder symptoms will often emerge during childhood and adolescence.1 Children with schizoid personality disorder prefer solitary activities, exhibit unusual interests and fantasies, and may have developmental delays, most commonly language-specific. Autism spectrum disorder will often be considered by healthcare providers due to similar symptom presentation.1,2,3
In Adolescents
Teenagers with schizoid personality disorder may not be aware that their personality is different from a typical individual their age. Much like adults with the disorder, they will prefer to be alone and not engage in many, if any social activities with their peers. They often will exhibit a rigidity in their thinking and behaviors, making it difficult for parents or teachers to get them to adapt or change. According to research on prodromal schizophrenia, meaning the period before diagnosis, teens exhibiting schizoid symptoms are at a 30% increased risk for developing schizophrenia.2,3
In Adults
Adults with schizoid personality disorder will often seek employment in solitary environments even if the job is below their skill level. It is also common for them to develop emotional attachments with animals and objects. Research has found evidence supporting a connection between under stimulation from lack of social contact to an increased risk for depression and anxiety related disorder. Some adults with schizoid personality disorder may be more likely to disconnect from reality and be drawn into preoccupations with fantasy. Schizoid personality disorder can worsen with age and individuals often do not seek treatment that may help with worsening symptoms.3,4
Causes of Schizoid Personality Disorder
There is no singular cause of schizoid personality disorder. Personality forms early in life and is shaped by an interaction of genetic predispositions and environmental factors. Research has indicated heritability of schizoid personality disorder to be about 30%. Known risk factors to developing schizoid personality disorder include having a first-degree relative with schizotypal personality disorder and/or schizophrenia and having a parent who is neglectful and unresponsive.1,5
Treatment of Schizoid Personality Disorder
This disorder often goes untreated as the person may not have insight into their symptoms, particularly if they avoid situations such as work or school environments that force unwanted social engagement. This avoidance may also extend to medical and mental health providers.
Many people with schizoid personality disorder only seek treatment at the urging of loved ones or when situations pressure them to engage in services. They often live in a detached world, but this retreat from reality offers clinical opportunities to use imagination and play-psychotherapy to engage the person and build rapport.1,6,7
Common Types of Therapy
Forms of cognitive-behavioral therapy (CBT) that focus on socialization and interpersonal skills may reduce symptoms of schizoid personality disorder. Finding common interests is a common therapeutic tactic to establish a relationship with the person that otherwise avoids making personal connections. Individuals with schizoid personality disorder may also seek treatment for co-occurring depression and related disorders drawing clinical attention to their personality disorder.
In addition to individual therapy services, group therapy can be an effective form of treatment for schizoid personality disorder as it provides an environment to practice interpersonal skills. Some may also find validation when meeting other people with similar behavioral health challenges, particularly with a disorder as rare as schizoid personality disorder.7
Medication
There are no Food and Drug Administration (FDA) medications for treating schizoid personality disorder. However, medications that treat comorbid disorders such as depression or anxiety may improve functioning. There is also evidence from research on individuals with autism spectrum disorder and psychosis that medications such as atypical antipsychotics may improve symptoms of inflexible thinking and overly rigid behaviors.7,8,9
Lifestyle Changes
With proper treatment many people experience some improvement in their symptoms but personality disorders are considered generally stable throughout one’s lifetime. As with all mental health disorders, exercise and a balanced-diet may prove beneficial in treating schizoid personality disorder, along with proper treatment of any comorbid medical, mental health and substance abuse disorders. In addition, having a support system of people that encourage positive change and personal growth rather than enable maladaptive behaviors is also enormously advantageous to people with schizoid personality disorder.1,4
How to Get Help for Schizoid Personality Disorder
To diagnose schizoid personality disorder, a mental health provider or medical provider will generally look at symptoms across the lifespan and exclude other possible causes of the disordered personality. This is done by reviewing medical history and performing semi-structured interviews.
Assessment measures include:1,10
- Minnesota Multiphasic Personality Inventory (MMPI)
- Inventory of Interpersonal Problems (IIP)
- The Iowa Personality Disorder Screen (IPDS)
- The self-directedness scale of the Temperament and Character Inventory (TCI)
Consulting with a primary care provider may be an important first step in seeking mental health treatment. The provider will often refer to a psychiatric or behavioral health specialist if it’s indicated. Insurance companies will typically provide a list of available and in-network providers when requested. For those in rural areas or difficulty traveling, telehealth appointments have become more widely-available and covered under most insurance plans since COVID-19 pandemic.7
How to Get Help for a Loved One
Finding help for a loved one with schizoid personality disorder may prove difficult, but encouraging treatment and having patience goes a long way. They will commonly avoid medical and mental health providers, prefer solitude, and have a limited insight into how the disorder impacts their quality of life. Avoid making judgments; find common concerns to discuss in an effort to get them to seek help.5,7
How to Get Help for a Child
If the individual is a child or teen, additional information from teachers will provide information and context for their behaviors and social challenges. DSM-5 personality disorders such as schizoid personality disorder are not diagnosed in people under the age of 18 years old; however, if you have reason to believe your child or teen is exhibiting symptoms, consult with your child’s primary care provider (PCP).2,7
Schizoid Personality Disorder Facts & Statistics
Here are five statistics and facts on schizoid personality disorder:
- Schizoid personality disorder is relatively rare with prevalence estimates in the United States ranging from 3.13% in the general population to 4.69% in clinical samples1,11
- The disorder is slightly more common in males than females in most literature including the DSM-5; however, prevalence estimates by gender are unknown and findings of differences by gender are inconsistent1,12
- The disorder is more common in those with family history of schizophrenia or schizotypal personality disorder1
- Individuals with schizoid personality disorder have high rates of co-morbid depression with estimates ranging around 50% comorbidity1
- People with schizoid personality disorder do experience feelings and emotions but rather have difficult expressing them verbally and through by body language1,5
Coping With Schizoid Personality Disorder
Living with schizoid personality disorder causes difficulty maintaining relationships and emotional ties with people. Interestingly, the desire to avoid connection typically does not extend to animals. When forced into social situations, the person may come across as eccentric and aloof, causing significant functional impairment and disability across vocational, educational, and social aspects of life.
People with schizoid personality disorder may go their entire life without being properly diagnosed. The relative obscurity of the disorder and related resources can make getting treatment even more challenging. It is common for people with the disorder to first obtain treatment for depression or other mental health conditions prior to being diagnosed. Some people may not recognize their disposition or temperament as disordered due to its persistence and their avoidance of social situations.1,5
Schizoid Personality Disorder vs. Other Disorders
While schizoid personality disorder may present similarly to other disorders, it’s important to know the difference.
Schizoid Personality Disorder vs. Schizophrenia
Schizoid personality disorder is often conceptualized as being on the schizophrenia spectrum; however, the primary feature that sets the disorder apart is the lack of psychotic features such as delusions (false beliefs) and auditory, visual, or sensory hallucinations. Psychosis is a common feature in schizotypal personality disorder, delusional disorder, and schizophrenia.
Flat affect or emotional blunting, social avoidance, and culturally bizarre behaviors are commonly seen in all of these disorders including schizoid personality disorder. Those with schizoid personality disorder are more susceptible to later developing schizophrenia and other psychotic disorders.1
Schizoid Personality Disorder vs. Avoidant Personality Disorder
These two disorders may outwardly appear similar with regards to extreme social aversion; however, they are experienced quite differently. Individuals with avoidant personality disorder are preoccupied by avoiding feelings of being judged and situations they feel may cause embarrassment, whereas someone with schizoid personality disorder is indifferent with regards to being around people or what other people may think of them.1
Schizoid Personality Disorder vs. Autism Spectrum Disorder
The emotional detachment and preference for solitude can make distinguishing schizoid personality disorder from autism spectrum disorder difficult; however, those with autism have symptoms that extend beyond social and emotional difficulties, including ritualistic/perseverative behaviors and language and learning disabilities that vary in severity. Additionally, the inability to recognize emotion in others tends to be more severe in autism than in schizoid personality disorder.1,9
Common Co-Occurring Disorders
Research has found an increased risk for major depressive disorder in those with schizoid personality disorder. As many as 50% may have another personality disorder, most commonly another Cluster A personality disorder such as schizotypal and paranoid personality disorders. These three disorders share commonalities such as detachment from social relationships, flat or restricted emotional affect, and odd/eccentric behaviors. Avoidant personality disorder is also commonly diagnosed in those with schizoid personality disorder.1,7
Final Thoughts on Schizoid Personality Disorder
If you or a loved one are dealing with schizoid personality disorder, remember that you are not alone. There are resources available such as Mental Health America where you can find support groups and links to various clinical resources. National Alliance on Mental Illness also provides information nationwide for caregivers and family members of people struggling with mental illness.
