Schizoid personality disorder is characterized by a pervasive pattern of detachment from and general disinterest in social relationships and a limited range of emotions in interpersonal relationships. Diagnosis is by clinical criteria. Treatment is with cognitive-behavioral therapy.
(See also Overview of Personality Disorders.)
In schizoid personality disorder, the ability to relate to others meaningfully is limited.
The estimated median prevalence is 0.9% but may be as high as 3.1% (1, 2). Some studies suggest it is slightly more common among men, whereas other studies find no gender difference. Schizoid personality disorder may be more common among people with a family history of schizophrenia or schizotypal personality disorder.
Comorbidities are common. Up to half of patients have had at least one episode of major depressive disorder. They often also have other personality disorders, most commonly schizotypal, paranoid, borderline, or avoidant.
General references
1. Grant BF, Hasin DS, Stinson FS, et al: Prevalence, correlates, and disability of personality disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 65(7):948-958, 2004. doi: 10.4088/jcp.v65n0711
2. Morgan TA, Zimmerman M: Epidemiology of personality disorders. In Handbook of Personality Disorders: Theory, Research, and Treatment. 2nd ed, edited by WJ Livesley, R Larstone, New York, NY: The Guilford Press, 2018, pp. 173-196.
Etiology of Schizoid Personality Disorder
Having caregivers who were emotionally cold, neglectful, and detached during childhood may contribute to the development of schizoid personality disorder by fueling the child's feeling that interpersonal relationships are not satisfying.
Symptoms and Signs of Schizoid Personality Disorder
Patients with schizoid personality disorder seem to have no desire for close relationships with other people, including relatives. They have no close friends or confidants, except sometimes a 1st-degree relative. They rarely date and often do not marry. They prefer being by themselves, choosing activities and hobbies that do not require interaction with others (eg, computer games). Sexual activity with others is of little, if any, interest to them. They also seem to experience less enjoyment from sensory and bodily experiences (eg, walking on the beach).
These patients do not seem bothered by what others think of them—whether good or bad. Because they do not notice normal clues of social interaction, they may seem socially inept, aloof, or self-absorbed. They rarely react (eg, by smiling or nodding) or show emotion in social situations. They have difficulty expressing anger, even when they are provoked. They do not react appropriately to important life events and may seem passive in response to changes in circumstances. As a result, they may seem to have no direction to their life.
Rarely, when these patients feel comfortable revealing themselves, they admit that they feel pain, especially in social interactions.
Symptoms of schizoid personality disorder tend to remain stable over time, more so than those of other personality disorders.
Diagnosis of Schizoid Personality Disorder
Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR) criteria
For a diagnosis of schizoid personality disorder (1), patients must have a persistent pattern of
Detachment from and general disinterest in social relationships
Limited expression of emotions in interpersonal interactions
This pattern is shown by the presence of ≥ 4 of the following:
No desire for or enjoyment of close relationships, including those with family members
Strong preference for solitary activities
Little, if any, interest in sexual activity with another person
Enjoyment of few, if any, activities
Lack of close friends or confidants, except possibly 1st-degree relatives
Apparent indifference to the praise or criticism of others
Emotional coldness, detachment, or flattened affect
Also, symptoms must have begun by early adulthood.
Differential diagnosis
Clinicians should distinguish schizoid personality disorder from the following:
Schizophrenia and related disorders: Patients with schizoid personality disorder, unlike those with schizophrenia, do not have cognitive or perceptual disturbances (eg, paranoia, hallucinations).
Autism spectrum disorders: Social impairment and stereotyped behaviors or interests are less prominent in patients with schizoid personality disorder.
Schizotypal personality disorder: This disorder is characterized by distorted perceptions and thinking; these features are absent in schizoid personality disorder.
Avoidant personality disorder: Social isolation in schizoid personality disorder is due to pervasive detachment from and general disinterest in social relationships, whereas in avoidant personality disorder, it is due to fear of being embarrassed or rejected.
Diagnosis reference
1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed Text Revision (DSM-5-TR). Washington, DC, American Psychiatric Association, 2022, pp 741-744.
Treatment of Schizoid Personality Disorder
Social skills training
The general principles for treatment of schizoid personality disorder are the same as those for all personality disorders.
No controlled studies have been published about psychotherapies or pharmacotherapy for schizoid personality disorder.
Generally, efforts to share interest in impersonal topics (eg, possessions, collections, hobbies) that appeal to people who prefer solitary pursuits can help establish a relationship with a patient and perhaps facilitate a therapeutic interaction.
Cognitive-behavioral approaches that focus on acquiring social skills may also help patients change. Because patients with schizoid personality disorder lack interest in other people, they may not be motivated to change.
