Schizoid personality disorder: symptoms, treatment

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Reason and emotions... They write a lot about them and often talk about them. Mismatch between the intellectual and emotional spheres at the personal level, the destruction of their delicate balance is a real threat to health. Psychiatrists and psychologists call inconsistency (disconnection) of a person’s inner “I” schizoid personality disorder (SPD). The schizoid organization of the psyche is full of contrasts: a person’s external emotionlessness turns into internal creativity, the desire to protect personal boundaries correlates with the desire to violate the boundaries of another person. How does the disease manifest? Is it a death sentence or treatable?

Specialists at Dr. Isaev’s psychiatric clinic provide treatment for schizoid personality disorder in Moscow, invariably achieving stable results in remission. If you suspect that your subtle psycho-emotional world is disturbed and are trying to understand the causes of this condition, call us at the phone number listed on the website. The psychologist on duty will advise you free of charge and invite you to attend an appointment with a specialized doctor. Don’t refuse to get help, because correction in the early stages gives lasting results in a short time.

General information

Schizoid personality disorder is a relatively total and stable mental disease, in which there is a weakness of attachments, various social and other contacts, a tendency to fantasize and self-examine, and a hermit lifestyle.
With this disorder, it is difficult for individuals to express their feelings, and signs of an autistic personality appear: they are limited in emotional manifestations and the ability to receive pleasure, for example, to feel happiness. This mental disorder is also called schizoid psychopathy . This is due to its similarity to schizoid splitting of the mental state as in the case of schizophrenia .
Patients constantly avoid emotionally rich communication, giving relationships an overly theoretical color. Shutting off and withdrawing into themselves, people almost constantly spend their lives in loneliness and fantasy. Such “introverts” do not need close friends or sexual contacts, or even basic social interactions; they are very selective in communication. But the main difference from schizophrenics is that the ability to recognize reality is not lost.

Causes of the disease

According to statistics, 5% of the planet's population suffers from pathology. The tendency to develop the disease manifests itself in childhood. Hyperactive children are usually hypersensitive. While studying psychopathology, scientists noticed that already in infancy such children clearly define their personal boundaries, reacting rather strangely to the touch of adults. They instinctively deviate when their parents approach.

Schizoid personality organization does not mean that it is the beginning of the schizophrenic process and will contribute to the development of schizophrenia. Moreover, a large percentage of schizophrenics are people who previously had pronounced signs of SPD syndrome. A person with schizoid personality disorder is capable of self-identification: he experiences shame, guilt and perceives the world in its real manifestation. Concern for safety is the main manifestation of the disease.

There are several theories explaining the reasons for the development of the disease. A number of researchers believe that SPD is stimulated by gene mutations (mutation theory). Environmental pollution leads to “breakdowns” of the DNA code. Gene disorders are transmitted to descendants. Other scientists see the reasons in the low self-esteem of the individual himself. Still others are the lack of attention to the child from adults and his subsequent isolation. Fourth - in increased mental activity, expressed in control over every action and the simultaneous inability to express one’s own thoughts and come to conclusions.

At Dr. Isaev’s psychiatric center, research into the causes of SPD is given special importance. Treatment directly depends on what exactly contributed to the development of the pathology: inability to respect oneself, cerebral/endocrine insufficiency, abuse in childhood by parents, lack of skill in establishing emotional contact with others, the desire for self-isolation, or something else.

Pathogenesis

A schizoid personality, when communicating with others like themselves, feels discomfort and begins to move away from society, withdrawing within themselves and within their fantasies. Connections with others are becoming increasingly rare and not emotionally charged. At first, it may seem that a person has autism , since this term was originally introduced to describe a condition called “schizoid psychopathy.” But in this case there is no “affective resonance ” and worries about other people, while the internal paradox and inconsistency of the state does not make it possible to correctly express and convey internal sensations. People do not become too vulnerable, they are simply unable to adequately show emotions and find ways to communicate.

Manifestations in children

In a child prone to this mental illness, the disorder manifests itself already in the early stages of development. At 3-4 years old, parents may notice traits that are uncharacteristic of natural behavior. The child retires, sits very quietly, playing with his cars or dolls. When communicating directly with peers the same age, the child is inadequate; he displays the worst personality traits.

Children who early show an interest in the other world, in death, while they are completely fenced off from the outside world and do not want to come into social contact with their peers, arouse doctors’ suspicions.

As soon as such a child enters school, teachers will immediately notice his penchant for logic and mathematical thinking. At the same time, everyday situations are beyond the control of such a person. He isolates himself from his peers, showing passivity in sports and social games.

Children with schizoid psychopathy love to stick to adult society, not paying attention to their peers. A schizoid child “gives” all his experiences to his parents. This is especially true for adolescence. Parents cannot cope with such an offspring, talking about his uncontrollability. These children do not feel respect from their parents.

Some experts say that children with schizoid psychopathy exhibit abnormalities in thinking. The reasons lie in genetics. Only specialists diagnose this disease. The doctor gives his conclusion after a long observation. But it has been found that such patients cannot empathize with their peers or older people in any situation.

Classification

Theodore Millon and other scientists have identified several subtypes of schizoid disorder:

• the phenomenon of a “secret” schizoid , different from the classic one , by the ability to play active social roles, demonstrates great feelings and excellent relationships, while not involving his real personality and this process does not experience real experiences;
• the addition of characteristics of a depressive personality disorder to a “ flaccid schizoid ” - has pronounced inertia, an extremely low level of activity, is phlegmatic, apathetic, slow, exhausted, weakened, suffers from chronic fatigue;
• the features of a “distant schizoid” are similar to anxious and schizotypal types of personality disorder, they are distinguished by the desire to isolate themselves from society, withdraw and live in reclusion, with an obsessive feeling of loneliness, disunity and isolation;
• “depersonalized schizoids” are at the same time disunited in relation to themselves, considering themselves as something disembodied and distant from society, their body and consciousness are separated, split and one might even say dissociated;
• “unemotional schizoid” has features of obsessive-compulsive disorder and manifests itself in the form of emotional coldness, dryness, unresponsiveness, excessive restraint, indifference, equanimity, lack of excitability, lifelessness, gloominess, all emotional manifestations are reduced to zero.

In general, the schizoid “temperament” may differ depending on the state of psychaesthetic proportion - the ratio of anesthetic to hyperaesthetic elements, or more precisely - the prevalence of lack of emotional interest in the surrounding world and indifference over increased sensitivity and withdrawal into the world of dreams.

Indifference and mild timidity, as well as coldness and hostility, a violent desire to be left alone are characteristics that can be combined in different ways and in different combinations. This can manifest itself either in the form of shyness and gentle anxiety, or turn into gloominess, bizarre stupidity, irony and misanthropy.

Causes

The formation of an abnormal schizoid personality type is caused by its borderline level of organizational development with neurotic and psychotic traits. Defensive total fantasy becomes a characteristic support as a way to escape reality. Intellectualization, sublimation and projection also become a psychological method of protection.

psychopathy based on interpersonal conflicts, problems getting closer to people, as well as other biological and genetic factors. It is believed that the development of schizoid disorder in a child is also influenced by:

• the effect of contradictory “double signals” and cruel methods of education, psychotrauma and schizophrenic psychopathic reactions;
• irritation and disgust from life, subjective intolerance of reality and increased sensitivity to the surrounding world;
• inability to accept or show love, attitude of others;
• disharmony of one’s own “I”, uncertainty, lack of self-esteem and the inability to create a favorable comfortable space around oneself;
• genetic affinity with schizophrenia , the diagnosis of schizoid psychopathy is often given to individuals who have schizophrenics in their families.

Symptoms of schizoid personality disorder

The first to describe schizoid personality disorder were psychiatrists E. Beiler and E. Kretschmer at the beginning of the last century. They noted in such individuals the predominance of life within the individual, detachment from the outside world and maladaptive symptoms. P.B. Gannushkin called them “dreamers,” because the patients were prone to constant fantasizing. The main signs of schizoid personality disorder are:

• antisocial behavior - avoidance of communication with other people due to a lack of internal motivation and desire to interact with them, as well as committing actions that do not correspond to the norms of a healthy society, incl. preference for strange clothes, untidiness, talking to oneself, reluctance to go on dates and start a family, lack of reactions to praise or criticism;
• anhedonia - a reduced or lost ability to enjoy life, which is usually caused by a decline in activity and determination to achieve pleasure, the subject does not experience pleasure from any social actions and activities;
• lack of emotional coloring can manifest itself in the form of coldness towards loved ones (flattened affectivity), monotonous unemotional speech, unchanging facial expression, inability to make eye contact, cause a smile, laughter , anger or sadness;
• the predominance of “life” in dreams, the person is carried away by fantasy and introspection;
• the presence of an original, sometimes even strange hobby, which the schizoid treats with special trepidation; there is a certain emotional disharmony when sensitivity and vulnerability regarding one’s own interests prevails over indifference to the problems of others.

In addition, patients may exhibit signs of narcissism, introversion, regression, and depersonalization. A person loses affect (the ability to show emotions and feelings), he considers himself self-sufficient and has a certain sense of superiority.

The essence of the disorder

A schizoid lives in a fantasy world and avoids emotional attachments; he is cold and even callous towards other people. Due to frequent being alone with oneself and excessive preoccupation with one’s own inner world, a schizoid has specific, non-standard, creative thinking. He perceives the world adequately, but behaves strangely and incomprehensibly to those around him.

The schizoid seems to build a wall between himself and the world that he never crosses. However, in rare cases, complete social isolation is observed. More often, a schizoid chooses one or two close people. Schizoids are very selective when it comes to social contacts. But in essence, as such, they have no need for communication and intimacy. The best leisure time for a schizoid is fishing, reading a book, drawing and other solitary activities.

The peculiarity of schizoids is a lack of empathy, poorly developed intuition and an inability to empathize. They do not know how to feel, understand hints and non-verbal speech. Therefore, most of the relations are rational and formal in nature.

What’s interesting is that the general psychological portrait of a schizoid can be completely different: from a timid and vulnerable person to an absolutely cruel and indifferent person. A schizoid may look like a funny eccentric, or he may look like a gloomy petty villain or a dreamer, a sarcastic pedant. But they are all united by perseverance, stubbornness, perseverance, business acumen and willfulness.

It is customary to distinguish two types of schizoids: sensitive and expansive.

Sensitive schizoids

Very sensitive people with a subtle mental organization, vulnerable. Such schizoids react painfully to criticism and rudeness, and experience and remember insults for a long time. They feel subtly and deeply, are wary of the outside world, and have one or two attachments. These are modest dreamers with asthenic traits. However, self-examination in their inner world closely borders on pride.

Traumatic situations for them are conflicts and reproaches of immorality and immorality. Accusation of something unworthy quickly throws you out of balance, drives you into lethargy and depression, and makes you withdraw even more from the world. At the same time, sleep deteriorates, appetite decreases, and mistrust increases.

Expansive schizoids

These are cold, decisive and strong-willed people who do not take into account the opinions of other people. If sensitive schizoids are easily hurt, then expansive schizoids themselves will hurt anyone. They are principled in business, but are indifferent to the fate of people. While appearing arrogant and cruel, they are actually insecure, vulnerable, and dissatisfied.

They react to life's difficulties with irritation, aggression and anger, fussiness, and impulsiveness. Sometimes mistrust develops into paranoid disorder.

Tests and diagnostics

In addition to the tendency to loneliness, to make a diagnosis, a psychiatrist needs to study and identify other behavioral aspects, for example, psychological inflexibility and social maladaptation, deterioration in psychophysiological functions. There are a number of criteria that help identify a personality disorder:

• the patient has a disturbed harmonious state of personal attitudes and behavior, involving several areas of activity;
• affectivity, excitability of thinking, control of impulses and perception processes, compliance with social norms, taking into account the characteristics of different cultures;
• an abnormal lifestyle arises in childhood or adolescence, covers all adaptive, personal and social phenomena, persists into adulthood and is stable with increasing manifestations of personal distress without episodicity as in other mental illnesses;
• social and productive productivity is impaired in most cases;
• there are no close friends or trusted connections, as well as the desire to create them.

The cause of hospitalization can be a hypochondriacal, depressive and panic state, anxieties, neurosis and the presence of persistent paranoid ideas. In addition to examining the history and symptoms, differential diagnoses are made for schizophrenia, bipolar, paranoid and depressive disorders, and tests for schizoid personality disorder are performed.

Test for schizoid personality disorder

The test usually consists of 74 questions and tries to identify:

• the influence of the media, crowded places, other persons, emergency forces on the internal state and behavior of a person;
• the ability to express true feelings, create various intimate and other social contacts;
• how a person reacts to the supernatural, clairvoyance, telepathy, thoughts in the head, the desire to be alone;
• how others, in his opinion, subjectively evaluate his eccentricity, personal life, secrecy, unemotionality, distrust, discuss behavior;
• tendency to exaggerate interest in his personality, secrecy, fantasies;
• a person’s desires and aspirations when interacting with others, often expressed in coldness and detachment.

Diagnosis of the disease

Diagnosis of SPD is made only by a psychiatrist. At the diagnosis stage, it is important to distinguish psychopathology from other mental disorders. Schizoid personality disorder is accompanied by neuroses, depression, phobias, and anxiety. A schizoid should not be confused with a narcissist. A schizoid, like a narcissist, is enough of himself, but he will never declare his merits as superiority over others. Carriers of pathology take care of their own uniqueness in a completely different way. They do not show it off, but seem to hide it, worrying that multiple contacts can destroy it.

People with SPD seem to be unable to feel. They have a very subtle mental organization. However, showing emotions is not for schizoids. Having once decided that emotions are an art of which they understand nothing, schizoids refuse to be outwardly emotional and choose coldness. Sexuality is alien to them. Rare memories of sex are confined to the need to satisfy sexual needs, nothing more.

Schizoids should not be confused with schizophrenics. The vivid fantasies of schizoids always have boundaries with the real world. This is also the cause of unbearable pain for schizoids. These people understand that their fantasies will not come true. Therefore, the inner world is closed, frankness is excluded. Why share the pain? The lack of desire for contact with the outside world leads to the fact that schizoids stop taking care of their appearance. Untidyness and sloppiness are a common manifestation of the disorder.

Unfortunately, there is no detailed classification of schizoids that can help doctors accurately diagnose the disease and choose methods for its correction. American psychologist Theodore Millon identifies the following types of schizoid personality disorder:

• sluggish: slow, phlegmatic, apathetic;
• distanced: tending to self-isolate;
• depersonalized: transferring one's own states onto someone else;
• unemotional: cold, unresponsive.

The psychiatric department of Dr. Isaev’s clinic is always a qualified diagnosis of the disease. Doctors at the center will not confuse pathology with other diseases. The diagnosis will be preceded by observation of the patient, long-term communication with him and with relatives. This is the only way to prescribe competent treatment that can return the patient to normal life.

Consequences and complications

• This borderline schizoid state can develop into other disorders of the schizophrenia spectrum, the apogee of which is considered to be nuclear schizophrenia . Thus, in 44% of those suffering from schizophrenia, the schizoid type was identified before the manifestations of the disease.
• As a result of schizoidity, patients experienced the development of schizophrenic dementia, delusional disorder and psychosis.
• Schizoids have an increased risk of suicide. Moreover, suicide has true motives; they carefully plan it, hiding their intentions and thoughts, unlike hysterical people. Their true desire to die is usually rationally justified and reasoned; the construction of a “suicidal construct” is a stable position in the mind.