A CASE OF Schizoid Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the case
“meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Leonard
Leonard
is a tall, slender man referred to the Employee Assistance Program at the
university by his supervisor. When asked why he was being seen, Leonard
replied, “Maybe he thought I’d do better by now.” He offers no other
explanation, cannot explain why his supervisor might be dissatisfied, and does
not seem especially concerned. (6) He
has worked at the library for not quite a year. At first, he was assigned to
book checkout, but was unable to engage the patrons inter-personally and was
eventually reassigned to work alone in the stacks, a position he prefers. (2)
The
most notable aspect of his presentation is an absence of emotion. There is no
restrained anger, nor even any sign of fear or annoyance. Nor is there any
anxiety or curiosity about what he might experience. In fact, Leonard seems
quite detached from the surrounding world, responding slowly but automatically,
as if he were just going through the motions. Eye contact is minimal. (7)
Gathering
information from Leonard takes time. Sometimes, he seems to misunderstand the questions. Sentences loaded with emotional nuance take a long time for him to process. Even when he does
understand, his responses are brief and nearly devoid of emotional content. The
few facial expressions he uses seem inappropriate to the content of his words.
And
yet, Leonard is not malicious. Rather, he is simply not connected to the
interviewer, nor to the world. No mention is made of friends, coworkers, or any significant relationships, either past or present. (5)
Instead, he prefers to spend his free time alone, watching television or
working on model airplanes, which are “all I need.” (2) Nevertheless, he
cannot name a show or series he likes. He does not understand the idea of a
“favorite.” When asked if he is close to anyone in his family, he is confused by
the idea of “closeness,” but does mention that his older sister had suggested
that work at the university would give him health insurance coverage. (4)
Further inquiry reveals that although his family lives in the area, it is they who
stay in touch with him, while Leonard has been known to move without notifying
anyone for months. (1)
Leonard’s
conduct cannot be seen as insubordinate, because he has no understanding of
what “insubordinate” might mean. When it is explained to him that if job
improvements were not seen, termination might result, he seems to understand
but is not perturbed by the possibility. (7)
DSM-IV Criteria
A. 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 four (or more) of the following:(1) neither desires nor enjoys close relationships, including being part of a family
(2) almost always chooses solitary activities
(3) has little, if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others
(7) shows emotional coldness, detachment, or flattened affectivity
B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder with Psychotic Features, or another Psychotic Disorder, and is not due to the direct physiological effects of a general medical condition.
Note: If criteria are met prior to the onset of Schizophrenia, add “Premorbid,” e.g. “Schizoid Personality Disorder (Premorbid).”
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
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