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Schizoid personality disorder (, often abbreviated as SzPD or ScPD) is a
personality disorder Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's cultu ...
characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment and
apathy Apathy is a lack of feeling, emotion, interest, or concern about something. It is a state of indifference, or the suppression of emotions such as concern, excitement, motivation, or passion. An apathetic individual has an absence of inter ...
. Affected individuals may be unable to form intimate attachments to others and simultaneously possess a rich and elaborate but exclusively internal fantasy world. Other associated features include
stilted speech In psychiatry, stilted speech or pedantic speech is communication characterized by situationally-inappropriate formality. This formality can be expressed both through abnormal prosody as well as speech content that is "inappropriately pompous, leg ...
, a lack of deriving enjoyment from most activities, feeling as though one is an "observer" rather than a participant in life, an inability to tolerate emotional expectations of others, apparent indifference when praised or criticized, a degree of asexuality and idiosyncratic moral or political beliefs. Symptoms typically start in late childhood or adolescence. The cause of SzPD is uncertain, but there is some evidence of links and shared genetic risk between SzPD, other
cluster A personality disorders Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture ...
(such as schizotypal personality disorder) and
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...
. Thus, SzPD is considered to be a "schizophrenia-like personality disorder".
Dennis S. Charney Dennis S. Charney is an American biological psychiatrist and researcher, with expertise in the neurobiology and treatment of mood and anxiety disorders. He is the author of ''Neurobiology of Mental Illness'', ''The Physician's Guide to Depressi ...
, Eric J. Nestler ''(2005)
Neurobiology of Mental Illness
'. Oxford Press. . Schizophrenia-like Personality Disorders. p. 240.
It is diagnosed by clinical observation, and it can be very difficult to distinguish SzPD from other mental disorders or conditions (such as
autism spectrum The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
disorders, with which it may sometimes overlap). The effectiveness of
psychotherapeutic Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome prob ...
and pharmacological treatments for SzPD has yet to be empirically and systematically investigated. There is little clinical data on SzPD because it is rarely encountered in clinical settings. It is not general practice to treat SzPD with medications, other than for the short-term treatment of associated disorders such as depression or anhedonia. Talk therapies such as
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
(CBT) may not be effective, because people with SzPD may have a hard time forming a good working relationship with a therapist. SzPD is a poorly studied disorder. Studies have generally reported a prevalence of less than 1%. It is more commonly diagnosed in males than in females. SzPD is linked to negative outcomes, including a significantly compromised
quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...
, 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").Paul Emmelkamp (2013):
Personality Disorders
'' p.54. Se
Cramer (2006)
an
Hong (2005)
for details.
*
Bullying Bullying is the use of force, coercion, hurtful teasing or threat, to abuse, aggressively dominate or intimidate. The behavior is often repeated and habitual. One essential prerequisite is the perception (by the bully or by others) of an ...
is particularly common towards schizoid individuals.
Suicide Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and ...
may be a running mental theme for schizoid individuals, though they are not likely to actually attempt it. Some symptoms of SzPD (e.g. solitary lifestyle, emotional detachment, loneliness and impaired communication), however, have been stated as general risk factors for serious suicidal behaviour.


Signs and symptoms

People with SzPD are often aloof, cold and indifferent, which causes interpersonal difficulty. Most individuals diagnosed with SzPD 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. Schizoid personality types often lack the ability to assess the impact of their own actions in social situations. According to Guntrip, Klein and others, people with SzPD may possess a hidden sense of superiority and lack dependence on other people's opinions.
Aaron Beck Aaron Temkin Beck (July 18, 1921 – November 1, 2021) was an American psychiatrist who was a professor in the department of psychiatry at the University of Pennsylvania.
and his colleagues report that people with SzPD 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 depersonalization. If they do, schizoid people often experience feeling "like a robot" or "going through life in a dream". Although there is the belief that people with SzPD are complacent and unaware of their feelings, many recognize their differences from others. Some individuals in treatment say "life passes them by" or they feel like living inside a shell; they see themselves as "missing the bus" and speak of observing life from a distance.


Relationships

People with SzPD tend to be happiest in relationships without the expectation of phatic or social niceties. It is not necessarily people they want to avoid, but negative ''or'' positive emotional expectations, emotional intimacy and
self-disclosure Self-disclosure is a process of communication by which one person reveals information about themselves to another. The information can be descriptive or evaluative, and can include thoughts, feelings, aspirations, goals, failures, successes, fears, ...
. Therefore, it is possible for individuals with SzPD to form relationships around intellectual, physical, familial, occupational or recreational activities, as long as there is no need for emotional intimacy. Donald Winnicott explains that 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. In general, friendship among schizoids is usually limited to one person, often also schizoid, forming what has been called a union of two eccentrics; "within it – the ecstatic cult of personality, outside it – everything is sharply rejected and despised". Ronald Fairbairn notes that schizoids can fear that in a relationship, their needs will weaken and exhaust their partner, so they feel forced to disown them and move to satisfy solely the needs of the partner. The net result of this is a loss of dignity and sense of self within any relationship they enter, eventually leading to intolerable frustration and friction. Appel notes that these fears result in the schizoid's negativism, stubbornness and reluctance to love. Thus, a central conflict of the schizoid is between an immense longing for relationships but a deep anxiety and avoidance of relationships, manifested by choosing to abandon others as the "lesser evil". A person with SzPD may feel suffocated when their personal space is violated and take actions to avoid this feeling.


Secret schizoids

Many schizoid individuals display an engaging, interactive personality, contradicting the observable characteristic emphasized by the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
and
ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms ...
definitions of the schizoid personality. Guntrip (using ideas of Klein, Fairbairn and Winnicott) classifies these individuals as "secret schizoids", who behave with socially available, interested, engaged and involved interaction yet remain emotionally withdrawn and sequestered within the safety of the internal world. Klein distinguishes between a "classic" SzPD and a "secret" SzPD, which occur "just as often" as each other. Klein cautions one should not misidentify the schizoid person as a result of the patient's defensive, compensatory interaction with the external world. He suggests one ask the person what their subjective experience is, to detect the presence of the schizoid refusal of emotional intimacy and preference for objective fact. Frequently, a schizoid individual's social functioning improves, sometimes dramatically, when the individual knows they are an anonymous participant in a real-time conversation or correspondence, e.g. in an online chatroom or message board. It is often the case the individual's online correspondent will report nothing amiss in the individual's engagement and affect. A 2013 study looking at personality disorders and Internet use found that being online more hours per day predicted signs of SzPD. Additionally, SzPD correlated with lower phone call use and fewer Facebook friends. Descriptions of the schizoid personality as "hidden" behind an outward appearance of emotional engagement have been recognized since 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 they are "playing a part", their personality is not involved. According to Fairbairn, ''the person'' disowns the part they are playing, and the schizoid individual seeks to preserve their personality intact and immune from compromise. The schizoid's false persona is based around what those around them define as normal or good behaviour, as a form of compliance. Further references to the secret schizoid come from Masud Khan, Jeffrey Seinfeld and Philip Manfield, who give a description of an SzPD 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.


Schizoid fantasy

A pathological reliance on fantasizing and preoccupation with inner experience is often part of the schizoid withdrawal from the world. Fantasy thus becomes a core component of the ''self in exile'', though fantasizing in schizoid individuals is far more complicated than a means of facilitating withdrawal. The related schizotypal personality disorder and
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...
are reported to have ties to creative thinking, and it is speculated that the internal fantasy aspect of SzPD may also be reflective of this thinking. Fantasy is also a relationship with the world and with others by proxy. It is a substitute relationship, but a relationship nonetheless, characterized by idealized, defensive and compensatory mechanisms. This is self-contained and free from the dangers and anxieties associated with emotional connection to real persons and situations. Klein explains it as "an expression of the self struggling to connect to objects, albeit internal objects. Fantasy permits schizoid patients to feel connected, and yet still free from the imprisonment in relationships. In short, in fantasy one can be attached (to internal objects) and still be free." This aspect of schizoid pathology has been generously elaborated in works by R. D. Laing, Donald Winnicott and Ralph Klein.


Sexuality

People with SzPD are sometimes sexually apathetic, though they do not typically experience
anorgasmia Anorgasmia is a type of sexual dysfunction in which a person cannot achieve orgasm despite adequate stimulation. Anorgasmia is far more common in females (4.6 percent) than in males and is especially rare in younger men. The problem is greater in ...
. 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 SzPD. The schizoid is often labelled asexual or presents with "a lack of sexual identity". Kernberg states that this apparent lack of a sexuality does not represent a lack of sexual definition but rather a combination of several strong fixations to cope with the same conflicts. Significantly broadening this picture are notable exceptions of SzPD individuals who engage in occasional or even frequent sexual activities with others. Sex often causes individuals with SzPD to feel that their personal space is being violated, and they commonly feel that
masturbation Masturbation is the sexual stimulation of one's own genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. The stimulation may involve hands, fingers, everyday objects, sex toys such as vibrators, or combinat ...
or sexual abstinence is preferable to the emotional closeness that they must tolerate when having sex. Individuals with SzPD have long been noted to have an increased rate of unconventional sexual tendencies, though if present, these are rarely acted upon. People with SzPD are often able to pursue any fantasies with content on the Internet while remaining completely unengaged with the outside world.


Clinical classifications


Akhtar's profile

Salman Akhtar provided a comprehensive phenomenological profile of SzPD in which classic and contemporary descriptive views are synthesized with psychoanalytic observations. Akhtar states that his profile has several advantages over the DSM in terms of maintaining historical continuity of the use of the word ''schizoid'', valuing depth and complexity over descriptive oversimplification and helping to provide a more meaningful
differential diagnosis In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...
of SzPD from other personality disorders. This profile is summarized in the table reproduced below that lists clinical features that involve six areas of psychosocial functioning and are organized by "overt" and "covert" manifestations, intended to denote seemingly contradictory aspects that may simultaneously be present in an individual. These designations do not necessarily imply their conscious or unconscious existence. The covert characteristics are not immediately apparent by definition and difficult to discern. Additionally, the lack of data on the frequency of many of the features makes their relative diagnostic weight difficult to distinguish at this time.


Millon's subtypes

Theodore Millon Theodore Millon () (August 18, 1928 – January 29, 2014) was an American psychologist known for his work on personality disorders. He founded the '' Journal of Personality Disorders'' and was the inaugural president of the International Society ...
restricted the term "schizoid" to those personalities who lack the capacity to form social relationships. He characterizes their way of thinking as being vague and void of thoughts and as sometimes having a "defective perceptual scanning". Because they often do not perceive cues that trigger
affective Affect, in psychology, refers to the underlying experience of feeling, emotion or mood. History The modern conception of affect developed in the 19th century with Wilhelm Wundt. The word comes from the German ''Gefühl'', meaning "feeling ...
responses, they experience fewer emotional reactions. For Millon, SzPD is distinguished from other personality disorders in that it is "the personality disorder that lacks a personality." He criticizes that this may be due to the current diagnostic criteria: They describe SzPD only by an absence of certain traits, which results in a "deficit syndrome" or "vacuum". Instead of delineating the presence of something, they mention solely what is lacking. Therefore, it is hard to describe and research such a concept. He identified four subtypes of SzPD. Any individual schizoid may exhibit none or one of the following:


Causes

Some evidence suggests the cluster A personality disorders have shared genetic and environmental risk factors, and there is an increased prevalence of SzPD in relatives of people with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...
and schizotypal personality disorder. Twin studies with SzPD traits (e.g. low sociability and low warmth) suggest these are inherited. Besides this indirect evidence, the direct heritability estimates of SzPD range from 50 to 59%. To
Sula Wolff Sulammith (Sula) Wolff FRCP FRCPysch (1 March 1924 – 21 September 2009) was a prominent and pioneering British child psychiatrist. She was amongst the first in her field to identify and define the characteristics of children on the autisti ...
, who did extensive research and clinical work with children and teenagers with schizoid symptoms, "schizoid personality has a constitutional, probably genetic, basis." The link between SzPD and being underweight may also point to the involvement of biological factors. In general, prenatal caloric
malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
,
premature birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between ...
and a low birth weight are risk factors for having a
mental disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
and may contribute to the development of SzPD as well. Those who have experienced traumatic brain injury may be also at risk of developing features reflective of SzPD. Other historical researchers had hypothesized excessively perfectionist, unloving or neglectful parenting could play a role.


Diagnosis


DSM-5 criteria

The '' Diagnostic and Statistical Manual of Mental Disorders'' is a widely used manual for diagnosing mental disorders.
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
includes SzPD with the same criteria as in DSM-IV. In the DSM-5, SzPD is described as 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 at least four of the following: # Neither desires nor enjoys close relationships, including being part of a family. # Almost always chooses solitary activities. # Has little, if any, interest in having sexual experiences with another person. # Takes pleasure in few, if any, activities. # Lacks close friends or confidants other than first-degree relatives. # Appears indifferent to the praise or criticism of others. # Shows emotional coldness, detachment, or flattened affectivity. According to the DSM, those with SzPD may often be unable to, or will rarely express aggressiveness or hostility, even when provoked directly. These individuals can seem vague or drifting about their goals and their lives may appear directionless. Others view them as indecisive in their actions, self-absorbed, absent-minded and detached from their surroundings. Excessive daydreaming is often present. In cases with severe defects in the capacity to form social relationships, dating and marriage may not be possible.Descriptions from DSM-III (1980) and
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
(2013)
Schizoid PD, Associated features (p. 310)
an
"Schizoid PD (p. 652–655)
.


ICD-10 criteria

The Classification of Mental and Behavioural Disorders of
ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms ...
lists SzPD under
F60.1
. The general criteria of personality disorder (F60) should be met first. In addition, at least four of the following criteria must be present: * Few, if any, activities provide pleasure. * Displays emotional coldness, detachment, or flattened affectivity. * Limited capacity to express warm, tender feelings for others as well as anger. * Appears indifferent to either praise or criticism from others. * Little interest in having sexual experiences with another person (taking into account age). * Almost always chooses solitary activities. * Excessive preoccupation with
fantasy Fantasy is a genre of speculative fiction involving magical elements, typically set in a fictional universe and sometimes inspired by mythology and folklore. Its roots are in oral traditions, which then became fantasy literature and d ...
and introspection. * Neither desires, nor has, any close friends or confiding relationships (or only one). * Marked insensitivity to prevailing
social norm Social norms are shared standards of acceptable behavior by groups. Social norms can both be informal understandings that govern the behavior of members of a society, as well as be codified into rules and laws. Social normative influences or soci ...
s and conventions; if these are not followed, this is unintentional.


Guntrip criteria

Ralph Klein, Clinical Director of the Masterson Institute, delineates the following nine characteristics of the schizoid personality as described by
Harry Guntrip Henry James Samuel Guntrip (29 May 1901 – 1975) was a British psychologist known for his major contributions to object relations theory or school of Freudian thought. He was a Fellow of the British Psychological Society and a psychotherapist a ...
: *
Introversion The traits of extraversion (also spelled extroversion Retrieved 2018-02-21.) and introversion are a central dimension in some human personality theories. The terms ''introversion'' and ''extraversion'' were introduced into psychology by Carl ...
* Withdrawnness *
Narcissism Narcissism is a self-centered personality style characterized as having an excessive interest in one's physical appearance or image and an excessive preoccupation with one's own needs, often at the expense of others. Narcissism exists on a co ...
*
Self-sufficiency Self-sustainability and self-sufficiency are overlapping states of being in which a person or organization needs little or no help from, or interaction with, others. Self-sufficiency entails the self being enough (to fulfill needs), and a self-s ...
* Sense of superiority * Loss of affect * Loneliness * Depersonalization * Regression The description of Guntrip's nine characteristics should clarify some differences between the traditional DSM portrait of SzPD and the traditional informed
object relations Object relations theory is a school of thought in psychoanalytic theory centered around theories of stages of ego development. Its concerns include the relation of the psyche to others in childhood and the exploration of relationships between ...
view. All nine characteristics are consistent. Most, if not all, must be present to diagnose a schizoid disorder.


Differential diagnosis

While SzPD shares several symptoms with other
mental disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
s, there are some important differentiating features.


Comorbidity

SzPD is often found to be comorbid with several disorders or pathologies. Persons with SzPD may meet criteria for an additional personality disorder, most often
avoidant personality disorder Avoidant personality disorder (AvPD) is a Cluster C personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy (despite an intense desire for it), severe feelings of inadequacy and inferiority, and an over ...
, schizotypal personality disorder or paranoid personality disorder. Alexithymia (the inability to identify and describe emotions) is often present in SzPD. Sharon Ekleberry suggests that some people with schizoid personality features may occasionally experience instances of
brief reactive psychosis Brief psychotic disorder ⁠— according to the classifications of mental disorders DSM-IV-TR and DSM-5 ⁠— is a psychotic condition involving the sudden onset of at least one psychotic symptom (such as disorganized thought/speech, delusions, ...
when under stress.


Substance use disorder

Very little data exists for rates of substance use disorder among people with SzPD, but existing studies suggest they are less likely to have substance abuse problems than the general population. One study found that significantly fewer boys with SzPD had alcohol problems than a control group of non-schizoids. Another study evaluating personality disorder profiles in substance abusers found that substance abusers who showed schizoid symptoms were more likely to abuse one substance rather than many, in contrast to other personality disorders such as borderline, antisocial or
histrionic Histrionic may refer to: * related to or reminiscent of (theatrical) acting, or acting out * Histrionic personality disorder, a Cluster B personality disorder * ''Histrionics'' (album), by The Higher * ''Histrionicus The harlequin duck (''Hi ...
, which were more likely to abuse many. American psychotherapist Sharon Ekleberry states that the impoverished social connections experienced by people with SzPD limit their exposure to the drug culture and that they have limited inclination to learn how to do narcotics. Describing them as "highly resistant to influence", she additionally states that even if they could access illegal drugs, they would be disinclined to use them in public or social settings, and because they would be more likely to use alcohol or cannabis alone than for social disinhibition, they would not be particularly susceptible to negative consequences in early use.


Suicide

Suicide Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and ...
may be a running theme for schizoid individuals, in part due to the knowledge of the large-scale ostracism that would result if their idiosyncratic views were revealed and their experience that most, if not all people, are unrelatable or have polar opposite reactions to them on societally sensitive issues, though they are not likely to actually attempt it. They might be down and depressed when all possible connections have been cut off, but as long as there is some relationship or even hope for one the risk will be low. The idea of suicide is a driving force against the person's schizoid defenses. Often among people with SzPD, there is a rationally grounded and reasoned position on why they want to die, and this "suicidal construct" takes a stable position in the mind. The characteristics of the premorbidities (
schizothymia Schizothymia is a temperament related to schizophrenia in a way analogous to cyclothymia's relationship with bipolar disorder. Schizothymia was proposed by Ernst Kretschmer when examining body types of schizophrenic patients. Schizothymia is defin ...
,
autism The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
,
anhedonia Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers ...
) also affected suicidal behaviour. Suicide attempts were always genuine in nature, well-planned, and it was only by chance that patients survived (usually the fatal outcome was prevented by the sudden appearance of others). They denied the existence of suicidal experiences earlier, but argued that in the current circumstances, suicide seemed to them the most appropriate way out. Important in all these cases was the absence of any significant anti-suicidal factors (most were found in a situation of relative social isolation; there were no professional and personal interests). The high ability to introspect in these cases only increased the isolation from reality, rendering the choice of suicide more reasonable. A mini-review indicates that SzPD or schizoid traits are a major risk factor for both suicide attempts and suicide, but schizoids tend to hide their suicidal thoughts and intentions. Demonstrative suicides or suicide blackmail, as seen in cluster B personality disorders such as borderline, histrionic or antisocial, are extremely rare among schizoid individuals. As in other clinical mental health settings, among suicidal inpatients, individuals with SzPD are not as well-represented as some other groups. A 2011 study on suicidal inpatients at a Moscow hospital found that schizoids were the least common patients, while those with cluster B personality disorders were the most common.


Low weight

A study which looked at the body mass index (BMI) of a sample of both male adolescents diagnosed with SzPD and those diagnosed with Asperger syndrome found that the BMI of all patients was significantly below normal. Clinical records indicated abnormal eating behaviour by some patients. Some patients would only eat when alone and refused to eat out. Restrictive diets and fears of disease were also found. It was suggested that the anhedonia of SzPD may also cover eating, leading schizoid individuals to not enjoy it. Alternatively, it was suggested that schizoid individuals may not feel hunger as strongly as others or not respond to it, a certain withdrawal "from themselves".


Anti-social conduct

Another study looked at rates of anti-social conduct in boys with either SzPD or Asperger syndrome compared with a control group of non-schizoid individuals and found the incidence of anti-social conduct to be the same in both groups. However, the schizoid boys stole significantly less. Upon follow-up in adulthood, out of a matched group of 19 boys with SzPD and 19 boys without, four of the schizoid boys reported having exclusively internal violent fantasies (concerned with Zulu wars, abattoirs,
fascists Fascism is a far-right, authoritarian, ultra-nationalist political ideology and movement,: "extreme militaristic nationalism, contempt for electoral democracy and political and cultural liberalism, a belief in natural social hierarchy and the ...
and communists and a collection of knives, respectively), which were pursued entirely by themselves, while the only non-schizoid subject to report a violent fantasy life shared his with a group of young men (dressing up and riding motorcycles as a self-styled "
panzer This article deals with the tanks (german: panzer) serving in the German Army (''Deutsches Heer'') throughout history, such as the World War I tanks of the Imperial German Army, the interwar and World War II tanks of the Nazi German Wehrma ...
" group). An absent parent or socio-economic disadvantage did not seem to affect the risk of anti-social conduct in schizoid individuals as much as it did in non-schizoid individuals. Absent parents and parental socio-economic disadvantage were also less common in the schizoid group.


Distinction from autism spectrum disorders

Several studies have reported an overlap with Asperger syndrome which had traditionally been called "schizoid disorder of childhood".
Eugen Bleuler Paul Eugen Bleuler (; ; 30 April 1857 – 15 July 1939) was a Swiss psychiatrist and humanist most notable for his contributions to the understanding of mental illness. He coined several psychiatric terms including " schizophrenia", "schizoid" ...
coined both the terms "autism" and "schizoid" to describe withdrawal to an internal fantasy, against which any influence from outside becomes an intolerable disturbance. Tantam suggested that Asperger syndrome may confer an increased risk of developing SzPD. A study from 2012 found that in a sample of 54 young adults with Asperger syndrome, 26% of them also met criteria for SzPD, the highest comorbidity out of any personality disorder in the sample (the other comorbidities were 19% for obsessive–compulsive personality disorder, 13% for
avoidant personality disorder Avoidant personality disorder (AvPD) is a Cluster C personality disorder characterized by excessive social anxiety and inhibition, fear of intimacy (despite an intense desire for it), severe feelings of inadequacy and inferiority, and an over ...
and one female with schizotypal personality disorder). Additionally, twice as many men with Asperger syndrome met criteria for SzPD than women. While 41% of the whole sample were unemployed with no occupation, this rose to 62% for the Asperger's and SzPD comorbid group. It noted that the DSM may complicate diagnosis by requiring the exclusion of a
pervasive developmental disorder The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), is a group of disorders characterized by delays in the development of multiple basic functions including socialization and ...
(PDD) before establishing a diagnosis of SzPD. The study found that social interaction impairments, stereotyped behaviours and specific interests were more severe in the individuals with Asperger syndrome also fulfilling SzPD criteria, against the notion that social interaction skills are unimpaired in SzPD. The authors believe that a substantial subgroup of people with autism spectrum disorder or PDD have clear "schizoid traits" and correspond largely to the "loners" in Lorna Wing's classification ''The autism spectrum'' ( Lancet 1997), described by
Sula Wolff Sulammith (Sula) Wolff FRCP FRCPysch (1 March 1924 – 21 September 2009) was a prominent and pioneering British child psychiatrist. She was amongst the first in her field to identify and define the characteristics of children on the autisti ...
. A study from 2019 found that 54% of a group of males aged 11 to 25 with Asperger syndrome showed significant SzPD traits, with 6% meeting full diagnostic criteria for SzPD, compared to 0% of a control group. The authors of the study hypothesised that it is extremely likely that historic cohorts of adults diagnosed with SzPD were either misdiagnosed, or they also had childhood-onset autistic syndromes. They stressed that further research to clarify overlap and distinctions between these two syndromes was strongly warranted, especially given that high-functioning
autism spectrum The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
disorders are now recognised in around 1% of the population.


Treatment

People with SzPD rarely seek treatment for their condition. This issue is found in many
personality disorders Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's cultur ...
, which prevents many people with these conditions from seeking treatment: they tend to view their condition as not conflicting with their self-image and their abnormal perceptions and behaviors as rational and appropriate. There is little data on the effectiveness of various treatments on this personality disorder because it is seldom seen in clinical settings.


Medication

No medications are indicated for directly treating SzPD, but certain medications may reduce the symptoms of SzPD and treat co-occurring mental disorders. However, it is not general practice to treat SzPD with medications, other than for the short-term treatment of acute co-occurring axis I conditions such as depression. The
substituted amphetamine Substituted amphetamines are a class of compounds based upon the amphetamine structure; it includes all derivative compounds which are formed by replacing, or substituting, one or more hydrogen atoms in the amphetamine core structure with s ...
bupropion Bupropion, sold under the brand names Wellbutrin and Zyban among others, is an atypical antidepressant primarily used to treat major depressive disorder and to support smoking cessation. It is also popular as an add-on medication in the cas ...
may be used to treat anhedonia.
Lamotrigine Lamotrigine, sold under the brand name Lamictal among others, is a medication used to treat epilepsy and stabilize mood in bipolar disorder. For epilepsy, this includes focal seizures, tonic-clonic seizures, and seizures in Lennox-Gastaut sy ...
,
SSRIs Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions. SSRIs increase the extracellu ...
, TCAs, MAOIs and hydroxyzine may help counter
social anxiety Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disor ...
if it is a concern for people who have SzPD. The symptoms of SzPD mirror the negative symptoms of schizophrenia, such as
anhedonia Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers ...
, blunted affect and low energy. SzPD is thought to be part of the "
schizophrenia spectrum A spectrum disorder is a mental disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be cause ...
" of disorders, thus it may benefit from the medications that treat those disorders such as
modafinil Modafinil, sold under the brand name Provigil among others, is a central nervous system (CNS) stimulant medication used to treat sleepiness due to narcolepsy, shift work sleep disorder, and obstructive sleep apnea. While it has seen off-la ...
. Originally, low doses of atypical antipsychotics like risperidone or olanzapine were used to alleviate social deficits and blunted affect. However, a 2012 review concluded that atypical antipsychotics were ineffective for treating personality disorders.


Psychotherapy

Despite the relative emotional comfort, psychoanalytic therapy of schizoid individuals takes a long time and causes many difficulties. Schizoids are generally poorly involved in psychotherapy due to difficulties in establishing empathic relations with a psychotherapist and low motivation for treatment. Supportive psychotherapy is 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 SzPD may also have a perceptual tendency to miss subtle differences in expression. 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. Besides psychodynamic therapy,
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
(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 SzPD 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 SzPD. Educational strategies in which people who have SzPD 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 SzPD create empathy with the outside world.


Shorter-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. Klein 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 setting.


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
D. W. Winnicott Donald Woods Winnicott (7 April 1896 – 25 January 1971) was an English paediatrician and psychoanalyst who was especially influential in the field of object relations theory and developmental psychology. He was a leading member of the Briti ...
's 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 acknowledgement, affirmation and approval necessary for emotional survival while warding off the effects associated with the abandonment depression. 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 or destructive that identity may be. 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", suggests Klein, "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

SzPD 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, SzPD is not expected to improve with time without treatment; however, much remains unknown because it is rarely encountered in clinical settings. There has been an especially large contribution of people with schizoid symptoms to science and theoretical areas of knowledge, including maths, physics, economics, etc. At the same time, people with SzPD are helpless at many practical activities because of their symptoms.


Epidemiology

SzPD is uncommon in clinical settings (about 2.2%) and occurs more commonly in males. It is rare compared with other personality disorders, with a prevalence estimated at less than 1% of the general population. Philip Manfield suggests that the "schizoid condition", which roughly includes the DSM schizoid, avoidant and schizotypal personality disorders, is represented by "as many as forty percent of all personality disorders." Manfield adds "This huge discrepancy rom the ten percent reported by therapists for the conditionis probably largely because someone with a schizoid disorder is less likely to seek treatment than someone with other axis II disorders." A 2008 study assessing personality and mood disorder prevalence among homeless people at New York City drop-in centres reported an SzPD rate of 65% among this sample. The study did not assess homeless people who did not show up at drop-in centres, and the rates of most other personality and mood disorders within the drop-in centres was lower than that of SzPD. The authors noted the limitations of the study, including the higher male-to-female ratio in the sample and the absence of subjects outside the support system or receiving other support (e.g., shelters) as well as the absence of subjects in geographical settings outside New York City, a large city often considered a magnet for disenfranchised people. A
University of Colorado Colorado Springs The University of Colorado Colorado Springs (UCCS) is a public research university in Colorado Springs, Colorado. It is one of four campuses that make up the University of Colorado system. As of Fall 2017, UCCS had over 12,400 undergraduate an ...
study comparing personality disorders and
Myers–Briggs Type Indicator In personality typology, the Myers–Briggs Type Indicator (MBTI) is an introspective self-report questionnaire indicating differing psychological preferences in how people perceive the world and make decisions. The test attempts to assign ...
types found that the disorder had a significant correlation with the Introverted (I) and Thinking (T) preferences.


Criticism

Nancy McWilliams of
Rutgers University Rutgers University (; RU), officially Rutgers, The State University of New Jersey, is a public land-grant research university consisting of four campuses in New Jersey. Chartered in 1766, Rutgers was originally called Queen's College, and was ...
and Parpottas Panagiotis of
European University Cyprus , image = Euc-logo-en.png , established = 1961 , type = Private University , faculty = , president = Dr. Christoforos Hadjikyprianou , rector = Dr. Andreas Efstathiou , students = 7,500+ , undergrad = , postgrad = , doctoral = , prof ...
have argued that the definition of SzPD is flawed due to
cultural bias Cultural bias is the phenomenon of interpreting and judging phenomena by standards inherent to one's own culture. The phenomenon is sometimes considered a problem central to social and human sciences, such as economics, psychology, anthropology, ...
and that it does not constitute a mental disorder but simply an avoidant attachment style requiring more emotional distance. If that is true, then many of the more problematic reactions these individuals show in social situations may be partly accounted for by the judgements commonly imposed on people with this style. However, impairment is mandatory for classification as a personality disorder. SzPD seems to satisfy this criterion because it is linked to negative outcomes, including reduced overall functioning even after 15 years and among the lowest levels of
quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...
and "life success" for all personality disorders (measured as "status, wealth and successful relationships"). However, determination of what qualify as "impairments" or as "negative outcomes" is itself potentially subject to cultural bias. People with SzPD may not regard a lack of social-status or successful relationships, for example, as a harm. Furthermore, correlation with negative outcomes does not necessarily demonstrate that these outcomes were directly caused by the schizoid traits. Rather, it may be that these outcomes are the result of discrimination against people with SzPD, who may be viewed as abnormal. Due to the poor consistency and efficiency of diagnosis due to overlapping traits, it has been argued that SzPD should be removed altogether from the DSM. In 2012, an article called for the replacement of the SzPD category with a dimensional model which would allow for the description of schizoid traits on an individual basis, suggesting that two different disorders may better represent SzPD: one affect-constricted disorder (belonging to schizotypal PD, see also "emotional detachment" in 6D11.1 of ) and a seclusive disorder (belonging to avoidant PD, see also "social detachment" in 6D11.1 of ).


Origin and historical definition

The term "schizoid" was coined in 1908 by
Eugen Bleuler Paul Eugen Bleuler (; ; 30 April 1857 – 15 July 1939) was a Swiss psychiatrist and humanist most notable for his contributions to the understanding of mental illness. He coined several psychiatric terms including " schizophrenia", "schizoid" ...
to designate a human tendency to direct attention toward one's inner life and away from the external world as a concept akin to
introversion The traits of extraversion (also spelled extroversion Retrieved 2018-02-21.) and introversion are a central dimension in some human personality theories. The terms ''introversion'' and ''extraversion'' were introduced into psychology by Carl ...
, not viewed in terms of psychopathology. Bleuler labeled the exaggeration of this tendency the "schizoid personality". He described these personalities as "comfortably dull and at the same time sensitive, people who in a narrow manner pursue vague purposes". In 1910, August Hoch introduced a very similar concept called the "shut-in" personality, characterised by reticence, seclusiveness, shyness and a preference for living in fantasy worlds, among others. In 1925, Russian psychiatrist Grunya Sukhareva described a "schizoid psychopathy" in a group of children, resembling today's SzPD and ASD. About a decade later Pyotr Gannushkin also included ''Schizoids'' and ''Dreamers'' in his detailed typology of personality types.


Clinical studies

Studies on the schizoid personality have developed along two distinct paths.


Descriptive psychiatry tradition

The descriptive psychiatry tradition focuses on overtly observable, behavioral and describable symptoms and finds its clearest exposition in the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
. The descriptive psychiatry tradition began in 1925 with the description of observable schizoid behaviors by Ernst Kretschmer. He organized those into three groups of characteristics: # Unsociability, quietness, reservedness, seriousness and eccentricity. # Timidity, shyness with feelings, sensitivity, nervousness, excitability, fondness of nature and books. # Pliability, kindliness, honesty, indifference, silence and cold emotional attitudes. These characteristics were the precursors of the DSM-III division of the schizoid character into three distinct personality disorders: schizotypal, avoidant and schizoid. Kretschmer himself, however, 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.


Dynamic psychiatry tradition

The
dynamic psychiatry Dynamic psychiatry is based on the study of emotional processes, their origins, and the mental mechanisms underlying them. It is in direct contrast with descriptive psychiatry, which is based on the study of observable symptoms and behavioral ph ...
tradition includes the exploration of covert or unconscious motivations and character structure as elaborated by classic
psychoanalysis PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might ...
and object-relations theory. The dynamic psychiatry tradition began in 1924 with observations by
Eugen Bleuler Paul Eugen Bleuler (; ; 30 April 1857 – 15 July 1939) was a Swiss psychiatrist and humanist most notable for his contributions to the understanding of mental illness. He coined several psychiatric terms including " schizophrenia", "schizoid" ...
, who observed that the schizoid person and schizoid pathology were not things to be set apart. Ronald 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: # The need to regulate interpersonal distance as a central focus of concern. # The ability to mobilize self-preservative defenses and self-reliance. # A pervasive tension between the anxiety-laden need for attachment and the defensive need for distance that manifests in observable behavior as ''indifference''. # 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 (1965), Winnicott (1965),Donald Winnicott (1965):
The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development
'. Karnac Books. .
Guntrip (1969),
Khan Khan may refer to: *Khan (inn), from Persian, a caravanserai or resting-place for a travelling caravan *Khan (surname), including a list of people with the name *Khan (title), a royal title for a ruler in Mongol and Turkic languages and used by ...
(1974), Akhtar (1987), Seinfeld (1991), Manfield (1992) and Klein (1995).


Controversy

The original concept of the schizoid character developed by Kretschmer in the 1920s comprised an amalgamation of avoidant, schizotypal and schizoid traits. The work of Millon in the 1980s led to this concept being split into three distinct disorders. This caused debate about whether this was accurate or if these traits were different expressions of a single personality disorder.


See also

*
Asociality Asociality refers to the lack of motivation to engage in social interaction, or a preference for solitary activities. Asociality may be associated with avolition, but it can, moreover, be a manifestation of limited opportunities for social relat ...
* Counterphobic attitude * Dissociation (psychology) * Distrust *
Hermit A hermit, also known as an eremite ( adjectival form: hermitic or eremitic) or solitary, is a person who lives in seclusion. Eremitism plays a role in a variety of religions. Description In Christianity, the term was originally applied to a C ...
*
Recluse A recluse is a person who lives in voluntary seclusion from the public and society. The word is from the Latin ''recludere'', which means "shut up" or "sequester". Historically, the word referred to a Christian hermit's total isolation from th ...
*
Schizothymia Schizothymia is a temperament related to schizophrenia in a way analogous to cyclothymia's relationship with bipolar disorder. Schizothymia was proposed by Ernst Kretschmer when examining body types of schizophrenic patients. Schizothymia is defin ...
*
Schizotypy In psychology, schizotypy is a theoretical concept that posits a continuum of personality characteristics and experiences, ranging from normal dissociative, imaginative states to extreme states of mind related to psychosis, especially schizophr ...
*
Sluggish cognitive tempo Sluggish cognitive tempo (SCT) is a syndrome related to attention deficit hyperactivity disorder (ADHD) but distinct from it. Typical symptoms include prominent dreaminess, mental fogginess, hypoactivity, sluggishness, staring frequently, incons ...
*
Social alienation Social alienation is a person's feeling of disconnection from a group whether friends, family, or wider society to which the individual has an affinity. Such alienation has been described as "a condition in social relationships reflected by (1) ...
* Social isolation


References


External links


The biological foundations of the schizoid process
* * {{Authority control Cluster A personality disorders Schizophrenia