Schizoid Personality Disorder

Schizoid personality disorder (SPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy. Affected individuals may simultaneously demonstrate a rich, elaborate and exclusively internal fantasy world.

SPD is not the same as schizophrenia, although they share such similar characteristics as detachment and blunted affect. There is, moreover, increased prevalence of the disorder in families with schizophrenia.

Some psychologists argue that the definition of SPD is flawed due to cultural bias: "One reason schizoid people are pathologized is because they are comparatively rare. People in majorities tend to assume that their own psychology is normative and to equate difference with inferiority". Therefore "[t]he so-called schizoid personality disorder is one of the more blatant examples of the APA’s pathologizing of normal human differences."

History

The term "schizoid" was coined in 1908 by Eugen Bleuler to designate a human tendency to direct attention toward one's inner life and away from the external world, a concept akin tointroversion in that it was not viewed in terms of psychopathology. Bleuler labeled the exaggeration of this tendency the “schizoid personality.”

Studies on the schizoid personality have developed along two distinct paths. The "descriptive psychiatry" tradition focuses on overtly observable, behavioral and describable symptoms and finds its clearest exposition in the DSM-IV revised. The dynamic psychiatry tradition includes the exploration of covert or unconscious motivations and character structure as elaborated by classic psychoanalysis and object-relations theory.

The descriptive tradition began in Ernst Kretschmer's 1925 description of observable schizoid behaviors, which he organized into three groups of characteristics:

1.    unsociability, quietness, reservedness, seriousness, eccentricity

2.    timidity, shyness with feelings, sensitivity, nervousness, excitability

3.    pliability, honesty, indifference, silence, cold emotional attitudes.

These characteristics were the precursors of the DSM-IV division of schizoid character into three distinct personality disorders, though 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 schizoids 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.

The second path, that of dynamic psychiatry, began in 1924 with observations by Eugen Bleuler, who observed that the schizoid person and schizoid pathology were not things to be set apart. W. R. D. Fairbairn's seminal work on the schizoid personality, from which most of what is known today about 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 asindifference, and (4) an overvaluation of the inner world at the expense of the outer world. Following Fairbairn, the dynamic psychiatry tradition has continued to produce rich explorations on the schizoid character, most notably from writers Nannarello (1953), Laing (1960), Winnicott (1965), Guntrip (1969), Khan (1974), Akhtar (1987), Seinfeld (1991), Manfield (1992) and Klein (1995).

Psychologist Nancy McWilliams argues that the definition of SPD is flawed due to cultural bias: "One reason schizoid people are pathologized is because they are comparatively rare. People in majorities tend to assume that their own psychology is normative and to equate difference with inferiority." Commentators have responded McWilliams is asking for an impossibility (norms as void as itself normative) and the more philosophically minded psychologists have pointed out, humans functioning well in the absence of norms realistically cannot exist and her argument represents a form of fallacious nihilism. In other words, the counter-argument is human beings have something like a teleological essence, and at least some underpinning of culturally transmitted ethics harmonious with the human telos (in Aristotelian terms), being a necessity inescapable for human beings striving after living well or Maslovian "flourishing", rejecting the predicted social anomie of the unspoken relativistic or nihilistic philosophical assumptions arguably underlying the views of McWilliams.

Largely unknown in contemporary psychological science, what modern psychologists understand as "schizoid" has, diagnostically, a "genealogical" and terminological antecedent in "schizothymia", an older term once erroneously dismissed but now increasingly reassessed in critical psycho-diagnostic research as of probable utility in managing resistant, exceedingly complex schizoid-like conditions or schizoid subcategories.

Sign 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 in a meaningful way. They may remain passive in the face of unfavorable situations. Their communication with other people may be indifferent and concise at times. Because of their lack of meaningful communication with other people, those who are diagnosed with SPD are not able to develop accurate images of how well they get along with others.

Such images are believed to be important for a person's self-awareness and ability to assess the impact of their own actions in social situations. R.D. Laing suggests that when one is not enriched by injections of interpersonal reality, the self-image becomes increasingly empty and volatilized, which leads the individual to feel unreal.

When the individual's personal space is violated, they feel suffocated and feel the need to free themselves and be independent. People who have SPD tend to be happiest when they are in a relationship in which the partner places few emotional or intimate demands on them. It is not people as such that they want to avoid, but emotions both negative and positive,emotional intimacy, and self disclosure.

This means that it is possible for schizoid individuals to form relationships with others based on intellectual, physical, familial, occupational, or recreational activities as long as these modes of relating do not require or force the need for emotional intimacy, which the affected individual will reject. Donald Winnicott explains this need to modulate emotional interaction by saying that 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.

The ‘Secret Schizoid’

Many fundamentally schizoid individuals present with an engaging, interactive personality style that contradicts the observable characteristic emphasized by the DSM-IV and ICD-10 definitions of the schizoid personality. Klein classifies these individuals as "secret schizoids", who present themselves as socially available, interested, engaged and involved in interacting yet remain emotionally withdrawn and sequestered within the safety of the internal world.

Withdrawal or detachment from the outer world is a characteristic feature of schizoid (alleged) 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-IV. It is however "just as often" a hidden internal state: that which meets the objective eye may not match the subjective, internal world of the patient. Klein therefore cautions that one should not miss identifying the schizoid patient because one cannot see the patient's withdrawal through the patient's defensive, compensatory interaction with external reality. He suggests that one need only ask the patient what his or her subjective experience is in order 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 as far back as 1940 with Fairbairn's 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 is only "playing a part," his own personality is not involved. According to Fairbairn, "the person disowns the part which he is playing and thus the schizoid individual seeks to preserve his own personality intact and immune from compromise."

Further references to the secret schizoid come from Masud Khan, Jeffrey Seinfeld and Philip Manfield, who gives a palpable description of an SPD individual who actually "enjoys" regular public speaking engagements but experiences great difficulty in the breaks when audience members would attempt to engage him emotionally. These references expose the problems involved in relying singularly on outer observable behavior for assessing the presence of personality disorders in certain individuals.

Schizoid sexuality

People with SPD are sometimes sexually apathetic, though they do not typically suffer from anorgasmia. Many schizoids have a healthy sex drive but some prefer to masturbate rather than deal with the social aspects of finding a sexual partner. Their preference to remain alone and detached may cause their need for sex to appear to be less than that of those who do not have SPD. Sex often causes individuals with SPD 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. Significantly broadening this picture are notable exceptions of SPD individuals who engage in occasional or even frequent sexual activities with others.

Harry Guntrip describes the "secret sexual affair" entered into by some married schizoid individuals as an attempt to reduce the quantity of emotional intimacy focused within a single relationship, a sentiment echoed by Karen Horney's "resigned personality" who may exclude sex as "too intimate for a permanent relationship, and instead satisfy his sexual needs with a stranger. Conversely he may more or less restrict a relationship to merely sexual contacts and not share other experiences with the partner." Jeffrey Seinfeld, professor of social work at New York University, has published a volume on SPD that details examples of "schizoid hunger" which may manifest as sexual promiscuity. Seinfeld provides an example of a schizoid woman who would covertly attend various bars to meet men for the purposes of gaining impersonal sexual gratification, an act which alleviated her feelings of hunger and emptiness.

Salman Akhtar describes this dynamic interplay of overt versus covert sexuality and motivations of some SPD individuals with greater accuracy. Rather than following the narrow proposition that schizoid individuals are either sexual or asexual, Akhtar suggests that these forces may both be present in an individual despite their rather contradictory aims. A clinically accurate picture of schizoid sexuality must therefore include the overt signs: "asexual, sometimes celibate; free of romantic interests; averse to sexual gossip andinnuendo," as well as possible covert manifestations of "secret voyeuristic and pornographic interests; vulnerable to erotomania; tendency towards compulsive masturbation andperversions," although none of these necessarily apply to all people with SPD.

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