Objectives

• What are the DSM-IV criteria for the schizoid personality?

• The solitary and retiring personalities are normal variants of the schizoid. Describe some of their characteristics and relate them to the more disordered criteria of the DSM-IV.

• List the several subtypes of the schizoid personality and indicate how each relates to other personality types.

• Summarize the genetic, neuroanatomical, and neurophysiological approaches to the schizoid personality.

• Could schizoidal tendencies in personality be due to prenatal insult to the fetus?

• Explain why the psychoanalytic tradition does not make a distinction between schizoid and avoidant personalities.

• Describe the varied attempts of the psychoanalytic tradition to explain the schizoid personality.

• What insights does the interpersonal perspective offer to the understanding of schizoid functioning?

• A sense of identity develops from interactions with others. How does social isolation of schizoids affect the content of their cognition?

• Schizoids share characteristics with other personality disorders. List these other disorders and explain the distinction between each and the schizoid.

• Schizoids generally do not experience anxiety. Explain why social overstimulation or un-derstimulation may trigger an anxiety reaction in them.

• List therapeutic goals for the schizoid personality.

Imagine, as you are walking to class, you spot an individual sitting on the campus lawn, back against a tree, textbook opened and inverted on his lap, gazing distantly to the sky.

You instantly recognize him from your classes, where rambunctious classmates often harangue and berate him, yet to no avail, as though he was emotionally detached and indifferent, appearing almost numb. He is also the one who seems so apathetic when the professor praises him for his academic performances. Nearing him, you glance his way with a nod and smile, acknowledging his presence and inviting a response. He reciprocates the nod and resumes his reading. As a friendly gesture, you invite him to join you at lunch. He declines, which is reminiscent of the many other offers he has rejected, saying, "I much prefer being by myself." Though in keeping with his past behavior, it puzzles you as to whether he is merely fearful of rejection or truly enjoys a life of solitude. Pondering this query, you realize you have never seen him with nor has he sought out friends. Could it be that he truly enjoys a life of solitude and lacks the need for interpersonal relationships? The answer is yes. As we see in this chapter, you have just encountered a schizoid personality.

Typically distant and viewed as introverted, these individuals keep to themselves. With the exception of minimal familial relations, schizoid personalities, or schizoids, feel no need for relationships, whether platonic or sexual. This is notably unlike the painfully shy avoidant, who desperately desires intimacy and acceptance but fears shame, humiliation, and embarrassment. Because schizoids choose to be by themselves, they go through life with markedly reduced interpersonal stress, as they are immune to the demands that others might put on them. Neither responding to praise nor criticism, the social dynamics typically held to most of us as important are merely incidental to schizoids. They almost seem incapable of experiencing emotional extremes of pleasure—as they rarely become excited about anything—and anger—as they hardly ever become heated or irate. Their emotional experience and expression may be so flattened that they seem detached from the world and even themselves. Perpetually untroubled and indifferent, they work silently and unobtrusively at their jobs and rarely get noticed by anyone, even by those with whom they have some routine contact. Left to their own doing, they would probably blend into the background indefinitely.

Our first case study, Leonard (see Case 11.1), provides a global illustration of a schizoid personality. Leonard's asocial disposition and the book checkout position proved incongruent. Leonard found it difficult to be friendly to others, to smile, to make small talk, or to follow the niceties of casual social encounters. In fact, the need for closeness is a notion confusing to him; the concept is simply beyond anything his life experience might incur. Rather than having a gregarious lifestyle, Leonard prefers to spend time alone watching television or working on his model airplanes (see criterion 2). It is not that he is hostile, but simply that he is indifferent. When others smile at him or try to develop a conversation, he probably senses that they want a response of some kind, but he either does not know what to say in return or just does not feel like saying much of anything. For this reason, people automatically conclude that Leonard is unlike most and view him as deliberately aloof and condescending, perhaps even too arrogant to speak. In reality, he is merely detached and without proclivity to engage others.

Detachment from human relationships is a central theme of all schizoid personalities. For Leonard, it extends even to his association with his family (see criterion 5). When he changes his residence, for example, Leonard has been known to delay notifying his family for months. Once he does, however, they continue to stay in touch with him, despite his lack of reciprocity. He just doesn't find such relationships rewarding, and he may even find them aversive, overstimulating, and confusing. For that

Leonard is a tall, slender man referred to the Employee Assistance Program at the university by his supervisor. When asked why he was being seen, Leonard replied, "Maybe he thought I'd do better by now." He offers no other explanation, cannot explain why his supervisor might be dissatisfied, and does not seem especially concerned.1 He has worked at the library for not quite a year. At first, he was assigned to book checkout, but was unable to engage the patrons interpersonally and was eventually reassigned to work alone in the stacks, a position he prefers.

The most notable aspect of his presentation is an absence of emotion. There is no restrained anger, nor even any sign of fear or annoyance. Nor is there any anxiety or curiosity about what he might experience. In fact, Leonard seems quite detached from the surrounding world, responding slowly but automatically, as if he were just going through the motions. Eye contact is minimal.

Gathering information from Leonard takes time. Sometimes, he seems to misunderstand the questions. Sentences loaded with emotional nuance take a long time for him to process. Even when he does understand, his responses are brief and nearly devoid of emotional content. The few facial expressions he uses seem inappropriate to the content of his words.

And yet, Leonard is not malicious. Rather, he is simply not connected to the interviewer, nor to the world. No mention is made of friends, coworkers, or any significant relationships, either past or present. Instead, he prefers to spend his free time alone, watching television or working on model airplanes, which are "all I need." Nevertheless, he cannot name a show or series he likes. He does not understand the idea of a "favorite." When asked if he is close to anyone in his family, he is confused by the idea of "closeness," but does mention that his older sister had suggested that work at the university would give him health insurance coverage. Further inquiry reveals that although his family lives in the area, it is they who stay in touch with him, while Leonard has been known to move without notifying anyone for months.

Leonard's conduct cannot be seen as insubordinate, because he has no understanding of what "insubordinate" might mean. When it is explained to him that if job improvements were not seen, termination might result, he seems to understand but is not perturbed by the possibility.

1 Numbers mark aspects of the case most consistent with DSM criteria, and do not necessarily indicate that the case "meets" diagnostic criteria in this respect.

Schizoid Personality Disorder DSM-IV Criteria

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1) neither desires nor enjoys close relationships, including being part of a family

(2) almost always chooses solitary activities

(3) has little, if any, interest in having sexual experiences with another person

(4) takes pleasure in few, if any, activities

(5) lacks close friends or confidants other than first-degree relatives

(6) appears indifferent to the praise or criticism of others

(7) shows emotional coldness, detachment, or flattened affectivity

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder with Psychotic Features, or another Psychotic Disorder, and is not due to the direct physiological effects of a general medical condition.

Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g. "Paranoid Personality Disorder (Premorbid)."

Reproduced with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

same reason, he avoids making friends. Leonard finds that he neither wants nor needs social affiliation. Friends contribute seemingly nothing to his quality of life. When others try to strike up a conversation with him in the library, he may reply only briefly, perhaps bordering rudeness, thus bringing the interaction to a conclusion or otherwise exposing his indifference. In fact, he appears to be much more comfortable in the world of inanimate objects, which is probably why he prefers working in the stacks to working at the checkout. To Leonard, model airplanes are all he needs.

Although Leonard has now found a more comfortable place for himself, it is likely that his detachment from the world of human affairs will continue to create problems for him vocationally. Such difficulties are not limited to simply engaging others but also concern his ability to profit from feedback from coworkers and supervisors. In addition, because he receives so little reinforcement from the social world, he has little incentive to change his behavior in any way. Accordingly, he does not truly grasp why his job performance is perceived as unusual and why others are dissatisfied with it, and he finds no reason to change based on the assessment of his supervisor. He is indifferent to both praise and criticism (see criterion 6). If terminated, he is not likely to feel angry or disturbed. Instead, he will simply go through the motions of getting another job that supports his existence in a basic way.

Why is Leonard so detached? To those unfamiliar with the schizoid personality, he might be characterized as an extreme introvert. To the trained professional, however, Leonard's clinical interview revealed distinct signs of the personality disorder. The similarity between introverts and schizoids extends only to their asocial nature, as introverts are able to experience and express emotion. On the other hand, schizoids are most recognized for flattened affectivity (see criterion 7), and Leonard shows this limited capacity for expression of emotion. In fact, he has a restricted ability to experience pleasure of any kind. Additionally, he has no fear, annoyance, anxiety, or curiosity— just an unwavering absence of feeling (see criterion 4). This was observed by his inability to comprehend the concept of "favorite," his paucity of interests and hobbies, and his monotone speech with unvarying facial expression. Like other schizoids, Leonard's life typically lacks fascination, immersion, intimacy, and perhaps even joy. It is also without transcendental or peak experiences because they require the ability to fuse with something more ultimate than self. To most, humans are commonly regarded as innately expressive, emotional, and social creatures. As such, persons like Leonard, who lack these typically human characteristics, may be perceived as robotic and somewhat mechanical. It is this anomaly that leads us to pursue a greater understanding of this personality disorder.

With the illustration of Leonard, we are now in a position to consider other issues, some of which are preliminary to any further discussion. Although the term schizoid has been in constant use for over half a century, its meaning has never really stabilized. As the case of Leonard shows, the DSM diagnostic criteria focus almost exclusively on what is absent from the schizoid personality that might be present in normals. Rather than give the construct its own intrinsic traits, the DSM tells us what it lacks, namely, any capacity for emotional experience, motivation, sexuality, or interpersonal sensitivity and relatedness. Defining a personality disorder through what it lacks is highly questionable. Take everything away, and nothing substantive remains. The DSM schizoid is somewhat of a contradiction: the ineffective exercise of describing what exists when all qualities have been removed. Who can offer a rich description of a vacuum? For this reason, the various perspectives on the construct do not synthesize as harmoniously as for other personality disorders. Likewise, many experienced clinicians claim never to have seen a true schizoid personality (e.g., Benjamin, 1996).

To clarify the disorder, certain accommodations must be made. First, because the nature of the construct is uncertain, we do not focus on issues of development. The developmental pathways sketched in the biological perspective are too uncertain, and those of the psychodynamic perspective are too tangled by obscure metapsychological formulations. Only the interpersonal perspective offers a straightforward, easily understood account, which is briefly reviewed. Second, the chapter draws certain important theoretical contrasts, giving the disorder a measure of content by putting it on a continuum with constructs that are both more common and more familiar. In the evolutionary theory, the schizoid and avoidant are viewed as interpersonally detached patterns existing at opposite ends of a continuum. The schizoid is passively detached; the avoidant is actively detached. In its prototypal form, the schizoid appears behaviorally inert, inter-personally unengaged, remote, and indifferent; cognitively impoverished or even vacant; and temperamentally unexcitable. In contrast, the avoidant appears behaviorally fretful and hesitant, interpersonally fearful, cognitively distracted, and temperamentally anguished and tense.

Both personalities can be put on a continuum with normal introversion. The distinction between them disappears as they merge near the threshold of normality, where we find individuals with both schizoid and avoidant traits but also a capacity for near-normal adjustment. Thus, although the total schizoid typically lacks the avoidant's fear of social humiliation, many nevertheless possess a degree of emotional capacity and enjoy a well-developed fantasy life, while still preferring a solitary lifestyle. Moving toward higher overall levels of pathology, the continuum between the schizoid and avoidant personalities gradually becomes defined into their DSM expressions. Finally, both may be seen as merging into the more unusual and eccentric schizotypal personality, and beyond this, with the more deteriorated schizophrenic syndromes (Millon, 1981). The relationship of the schizoid and avoidant personalities to the schizotypal personality and schizophrenia is considered in depth in the next chapter. Consult Figure 12.2 in the schizotypal chapter to clarify the preceding theoretical contrasts.

With the preceding qualifications, the plan of this chapter is the same as that for the other personality disorders. First, we compare normality and abnormality; then we move on to variations of the basic schizoid theme. After that, biological, psychodynamic, interpersonal, and cognitive perspectives on the schizoid personality are described. These sections form the core of what is scientific in personality. By seeking to explain what we observe in character sketches like Leonard's, the goal is to move beyond literary anecdote and enter the domain of theory. As always, we present history and description side by side, noting the contributions of past thinkers, each of whom tends to bring into focus a different aspect of the disorder. Developmental hypotheses are also reviewed but are tentative for all personality disorders. Next, the section "Evolutionary Neurodevelopmental Perspective" shows how the existence of the personality disorder follows from the laws of evolution. Also included are a comparison between the schizoid and other theory-derived constructs and a discussion of how schizoid personalities tend to develop Axis I disorders. Finally, we survey how the disorder might be treated through psychotherapy, again organizing our material in terms of classical approaches to the field: the interpersonal, cognitive, and psychodynamic perspectives.

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