Today’s topic is Schizoid Personality Disorder, and the first step with this one is explaining why both a Schizoid and a Schizotypal PD exist. Both names are derived from the Greek prefix skhizein, which means “split”. They are both part of the schizophrenia spectrum, and they are more common in people who have relatives with schizophrenia. However, their symptoms oppose each other.

A common way to explain symptoms of schizophrenia is by sorting them into “positive” and “negative”. Positive symptoms refer to when something atypical is added, such as when a person experiences hallucinations or delusions. Negative symptoms refer to when something typical is lost, such as when a person is unable to feel happy or unable to motivate themselves. (Think of positive and negative as representing plus and minus, rather than good and bad).

Schizotypal PD (SzPD)  lies inbetween a personality disorder and a schizophrenic disorder, as some people who have SzPD later develop schizophrenia while others only ever have SzPD. SzPD includes many positive symptoms of schizophrenia, including disordered thoughts, disordered speech, and near-psychotic experiences. However, it doesn’t feature any negative symptoms of schizophrenia.

Schizoid PD (SPD), in contrast, is solely a personality disorder. Its diagnostic criteria include many negative symptoms of schizophrenia, but none of the positive symptoms. To be diagnosed with Schizoid PD, a person needs to meet 4 of these criteria:

• They are emotionally cold and detached, and do not seem to experience strong emotions.
• They do not often express emotions towards others or react strongly to others.
• They consistently prefer to work alone and have solitary hobbies.
• They have few or no close friends or relationships (due to not wanting them rather than anxiety or fear).
• They don’t care about being praised or criticised.
• They find few or no activities pleasurable.
• They are indifferent to social norms and conventions.
• They are preoccupied with fantasy and introspection; they may seem “in their own world” or absent-minded.
• They do not desire or care about having sexual experiences with another person.

Before someone can be diagnosed with PPD, a psychiatrist must make sure the symptoms are not solely caused by schizophrenia, a psychotic disorder, a mood disorder, or an autism spectrum condition. The general personality disorder criteria also need to apply. “A person needs to have a collection of unusual behaviours and traits which affect a large portion of their everyday life. Those behaviours and traits must start before early adulthood. They need to cause negative consequences for the person, who should be upset by or annoyed at those behaviours.”

A person with SPD can be seen as a stereotypical loner or INTP turned up to eleven, someone detached from the world. People with SPD often describe themselves as observers of life, rather than participants in it.

SPD does not match many people’s understanding of mental health conditions; it goes against the stereotypical belief that people with mental illnesses are noticeably disconnected from reality, violent to others, or in severe distress (I’ve heard it summed up before as “mad, bad, or sad”). People with SPD fit none of those patterns, and they are rarely found in psychiatrists’ offices, prisons, hospitals, or any of the dramatic situations an untreated personality disorder can lead to.

Instead, most people with SPD will have an uneventful, quiet life and a steady job, albeit probably one they are over-qualified for. They may have hobbies, generally indoor activities which do not require social contact, and they may gain companionship through keeping pets. The boundary between SPD and extreme introversion is unclear. In theory it could be decided merely by whether or not someone has had the opportunities to find a life situation which works around their preferred isolation. This can be a frequent point of contention for critics of psychiatry.

Media characters with SPD are uncommon, probably because a character who is detached, indifferent to expectations, and unmotivated to go on adventures goes against what we expect of a protagonist. One possible example is Mersault from Camus’ The Stranger. Mersault expresses confusion over conventions and “the done thing”, and he cares little for his life’s direction or connections, living simply because he exists. Rather than choosing his actions, he drifts into them;  his apathy becomes his downfall.

SPD seems to be one of the rarest PDs, with an estimated lifetime prevalence of 1%. However, this could be because most people with SPD are unlikely to seek a diagnosis or to find themselves in situations which require one. Negative effects of SPD are usually a result of difficulties within the workplace, such as issues fitting in with social expectations or workplace conventions. Someone with SPD may find typical jobs difficult and may only maintain jobs which let them work in complete isolation. Another potential consequence of SPD is substance abuse, as people with SPD who feel frustrated at their outsider status can rely on substances to distract or comfort themselves.

There is no direct treatment for SPD. Talk therapy is little-used because clients with SPD may not wish to form a theraputic relationship or to share their personal experiences with a therapist. Although SPD is on the schizophrenia spectrum, antipsychotic medications are not helpful for people with SPD. However, people can be prescribed anti-depressants if they experience anhedonia (the inability to find activities pleasurable).

Psychological Criticisms of SPD

One principle of the medical model of psychiatry is that a trait can be classified as dysfunctional, or as a mental health issue, if it causes distress. Yet many people with SPD are not distressed about their experiences. Others can worry on their behalf, such as family members who are confused or concerned by the person’s lack of friendships disinterest in typical social milestones. However, few SPD symptoms fit the general personality disorder criteria even within the system which developed them. Because of this, critics commonly use SPD to support the argument that psychiatry has over-stepped its boundaries and moved from identifying genuine medical problems into creating them.

Western culture often sends out the message that people need to be extroverted, social, and hyper-connected to be successful or happy. As a result, a reserved and aloof person with SPD stands out as unusual. In cultures which value different personality traits and do not focus as heavily on social performance, someone with SPD would not appear to be so unusual, and their traits would not be seen as disordered.

The tools used to calculate the long-term effects of mental health conditions also fall prey to this cultural expectation. Functioning scales weigh up people’s ability to participate in various areas of life. On these scales, people with SPD recieve middling scores which indicate moderate life impairment. However, these scales measure life success through very Western metrics – status, wealth, and career progress. When SPD is partly defined by not desiring those things, then people with it can never score highly. This is one example of how psychiatric diagnoses and tools often need to rely on tautologies because of how much about the causes of and connections between mental health conditions is unknown.