People with the Schizoid personality Disorder Are characterized by a pattern of detachment from social relations and a very limited range of emotions in interpersonal situations.
Others might describe them as"distant,""cold,"and"indifferent"to others. This is because they do not want or enjoy the proximity of others, including sexual or love.
It seems that there are some schizoid people who, if they are sensitive to the opinion of others, although they are not able or are not willing to express them. For this type, social isolation could be painful.
These people are seen as observers instead of participants in the social world, have a empathy Deficient and usually have an inhibited affect (neither positive nor negative emotions).
1- Symptoms
People with schizoid personality are solitary and may have some of these symptoms:
- They prefer solitary activities that accompanied.
- They seek independence and have no close friendships.
- They feel confused about how to respond to social cues and have little to say.
- They feel little need for personal relationships.
- They feel incapable of experiencing pleasure.
- Indifferent and emotionally cold.
- They feel little motivated.
- They may have poor performance at work or school.
2- Causes
More research is needed on the genetic, neurobiological, and psychosocial causes of schizoid personality disorder.
It is interesting to note that social preferences resemble those of the autism .
Autism is characterized by the impediment of social interaction and ignorance of others, or the response to them without emotions.
This indifference is very similar in schizoid people, although these have no problems with language.
As biological causes for autism have been identified, it is possible that this disorder is a combination of biological dysfunction and early problems in interpersonal relationships.
In terms of neurophysiology, research on Dopamine Suggest that those who possess a lower density of receptors obtain a high rating in"detachment". This neurotransmitter may contribute to the social distancing of people with this disorder.
3- Diagnosis
Diagnostic criteria according to DSM IV
A) A general pattern of distancing social relations and restricting emotional expression at the interpersonal level, beginning at the beginning of adulthood and occurring in various contexts, as indicated by four (or more) of the following points :
- Neither wants nor enjoys personal relationships, including being part of a family.
- He almost always chooses solitary activities.
- Has little or no interest in having sexual experiences with another person.
- Enjoy with little or no activity.
- He does not have close friends or trusted people other than first-degree relatives.
- He is indifferent to the praise or criticism of others.
- Shows emotional coldness, estrangement or Flattening of affectivity .
B) These characteristics do not appear exclusively in the course of a schizophrenia, a mood disorder with psychotic symptoms or another psychotic disorder, and are not due to the direct physiological effects of a medical illness.
ICD-10
According to the World Health Organization classifies this characterized by at least four of the following criteria:
- Emotional coldness, detachment or reduced affection.
- Limited ability to express positive or negative emotions to other people.
- Consistent preference for solitary activities.
- Very few, if any, personal relationships, and a lack of desire to have them.
- Indifference to praise or criticism.
- Little interest in having sexual experiences with another person.
- Indifference to social norms or conventions.
- Concern for fantasy and introspection.
Differential diagnosis
The schizoid disorder of the personaliadd shares some conditions with other conditions, although there are characteristics that differentiate them:
- Depression : Unlike people with depression, people with schizoid personality are not considered inferior to others, although they probably recognize that they are different. You do not have to suffer from depression.
- Personality Avoidance Disorder : People with avoidant personality disorder avoid social interactions due to anxiety or feelings of incompetence, people with schizoid personality avoid them because they do not enjoy them. Schizoid individuals may also experience certain levels of anxiety.
- Asperger syndrome : Compared to the schizoid personality, people with asperger syndrome have problems with non-verbal communication, lack of verbal contact, prosody, and repetitive behaviors.
Subtypes
The psychologist Theodore Millon Identified four subtypes of people with schizoid personality:
- Languid schizoid (depressive traits): lethargic, tired, disconcerting, poor level of activation.
- Remote schizoid (with schizoid avoidance features): distant and withdrawn, inaccessible, solitary, disconnected.
- Depersonalized schizoid (with schizotypal features): detachment from others.
- Schizoid without affection (with compulsive features): cold, indifferent, impassive.
4-Treatment
It is rare for patients with TEP to go to therapy on their own initiative, so the treatment would be somewhat complicated, since the patient does not show the motivation or desire for change needed.
At the beginning of the therapy we would mark the main objectives to achieve. These would be based primarily on the patient's shortcomings, which in this case would be the experimentation of feelings such as joy, pain or anger.
Once the first goals have been reached, new sub-targets will be developed along with the patient.
Another objective that we could write down in this case would be, for example, the reduction of social isolation. It would be interesting to do something with a friend or relative
In this way we would be improving the interpersonal relationships of which they lack and at the same time increasing their motivation so important to be able to continue to exceed the proposed objectives.
I will briefly comment on the techniques used to treat patients with PTE.
All these techniques can be used in combination with each other and with a good knowledge of both the evaluation and the limitations of each technique.
Behavior modification techniques
These are used to foster all kinds of social skills and thus teach patients how to establish good interpersonal relationships.
To achieve this, we can use both role playing and in vivo exposure. Video recordings are also very useful for them to realize how they act and can be seen later to correct any difficulties that may arise.
It is necessary to emphasize that before using any technique we must know very well the patient's behavior and carry out an exhaustive review of his medical and personal history.
Interpersonal skills
This type of techniques can even be a problem for everyone with PTSD, since having to establish a relationship with the therapist can be difficult or even worthless.
Otherwise, if the patient showed a positive attitude toward social skills, one might try to Group therapy , So as to motivate and facilitate social attitudes and get them to relate to other people.
It is also used among other therapies, Family therapy Y couple , Especially for relatives to have all the information about the disease, which is its evolution and prognosis, and therefore to be able to offer the patient the appropriate help.
On the other hand, the use of Psychoanalytic strategies , We would also be very useful in this type of patients because they have very complex intrapsychic emotions and defenses that we need to know in depth for a good recovery.
Finally we would talk about treatment with Psychotropic drugs , This would be very useful especially to encourage their initial motivation and their affectivity, through stimulants.
Once the necessary motivation to continue with the treatment was reached, we would reduce the dose to the point of abandoning it completely.
It is necessary to emphasize that during the period of prolonged treatment risks such as abandonment or possible relapses can arise, and for this not to happen the patient must be convinced that the therapy has favored him and has managed to obtain some positive value , It will also be necessary to schedule follow-up sessions to know the evolution of the patient.
To end another of the therapies that are currently in the ascendant and which has achieved successful results in various disorders is the Cognitive behavioral therapy .
Cognitive-behavioral therapy
To begin with, it is desirable for the therapist to point out the importance of social relationships and to teach the emotions that others feel in order to foster empathy.
It is therefore important Social skills training , Acting the therapist as a friend or acquaintance. Role playing allows the patient to practice social skills and maintain them.
Long-term therapy has few outcomes in these patients. Therapy should focus on achieving simple goals such as reshaping irrational thinking patterns that influence asocial behaviors.
Medication
Medication is not usually recommended for this disorder, although it may be used to treat short-term conditions such as anxiety attacks or social phobia .
5-Risk Factors
Among the various factors that can increase the development of TEP we find different types:
Genetic factors
After several scientific studies it is still not possible to verify that PE is genetically inherited, but there are some biological aspects that may have influenced its development.
It is considered that in PTE there is an added risk factor, and this would be the relationship problems and attachment during childhood which will lead to possible social deficits in adulthood.
As for the neurological structures of everyone with a PTE if there could be some differences due to the inability of these patients to demonstrate their feelings or emotions.
One thing to keep in mind is that if during childhood they show a low sensory response, motor passivity and are easy to handle, this could be an indicator of the future inactivity they will have and the lack of emotional tone.
Finally, the deficits of activation and affectivity may also be related to an adrenergic-cholinergic imbalance. Also, problems can arise due to neurohormonal alterations, due to excesses or deficiencies of Acetylcholine Y Noradrenaline , Which could lead to cognitive avoidance or affective deficits.
Environmental factors
1-Stimulation poverty during childhood
Lack of stimulation in care during childhood leads to an absence of emotional learning and maturation, essential for establishing interpersonal relationships and creating secure attachments during development.
2- Passive family environments
Related to the previous point, although it should be added that children learn the pattern of interpersonal relationships to which they have been exposed during their childhood will develop a void and insensitivity both social and emotional. So it will be necessary a family environment where dialogue and communication among its members prevails.
3- Fragmented family communications
Family members, using poor communication and cold communication, cause the necessary interpersonal communication patterns not to develop properly. Thus, this child in adulthood will not create bonds and will be treated in isolation, having an attitude of indifference to others.
6-Complications
Schizoid individuals are at increased risk of:
- Developing other psychotic disorders such as schizotypal personality disorder or schizophrenia.
- Major depression.
- Anxiety disorders .
- Loss of employment.
- Family problems.
7-Epidemiology
Personality disorder is schizoid occurs mostly in men and is rare compared to other personality disorders, with an estimated prevalence of less than 1% in the general population.
If you have this"personality disorder"you may feel identified with Kafka's phrase:
I am a withdrawn person, quiet, unsociable and dissatisfied. From the life I lead at home, at least some conclusions can be drawn. I live in the middle of the family, among the most kind and affectionate people, stranger than a stranger. With my mother I have not spoken in recent years, not even twenty words a day on average; With my father I have almost never exchanged more than good morning. With my married sisters and my brother-in-law I do not cross word and that we are not angry.- Franz Kafka.
References
- Millon, Theodore (2004). Personality Disorders in Modern Life, p. 378. John Wiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471-23734-5.
- American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub., P. 695. Retrieved 2011-02-15.
- American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Pub., P. 695. Retrieved 2011-02-15.
- Weismann, M. M. (1993). "The epidemiology of personality disorders. The 1990 update". Journal of Personality Disorders (Spring issue, Suppl.): 44-62.