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 Hillary
Hillary, a 22-year-old junior in college, sought counseling
at the urging of
her dormitory roommate, who felt she might have latent homosexual tendencies. Although this
concern proved unjustified, other pathological characteristics were clearly evident.
When asked about her dating experiences, Hillary replied that
she never enjoyed
herself on dates.(1) Not that she found herself disgusted or repelled by the
inevitable sexual overtones of dating, but that “those kinds of things simply
aren’t fun for me.”(3) Relationships with same-sex peers were almost nonexistent. When asked if she would miss her roommate after the
semester was over, Hillary seemed confused, as if she could not understand what it would
be like to miss
someone. She avoids invitations to parties, preferring to stay in her room reading or
working at her studies.(5) She is an excellent
student, majoring in geology. On several occasions, she had been chosen to assist her professors
in fieldwork, but could appreciate only the intellectual aspects of the work,
not the joy of a mentoring relationship.(2)
Classmates viewed Hillary as distant and aloof. She turned
down an opportunity
to join a sorority and could name no close friends, with the exception of one cousin back
home.(5) Though she was asked out frequently, she had never had more
than two dates with a single boy, with one exception. “I think they find me confusing,”
she said. “They seem
interested in me, but I don’t understand why, and I’m not really interested in them.”(1) In the dormitory, the other girls
sometimes referred to her as “Strange
Brain,” but Hillary did not seem to care. “At least with that reputation they don’t try
to involve me in
things,” she said.(6)
Her one significant relationship, with a quiet young man who shared her interest in rocks, lasted
only a couple of months. Together, they took nature hikes and commented on the
“childish” behavior of
their classmates. After a while, however, she found they had nothing to say to each other.
Hillary “believes” she would have liked to continue this friendship,
but she experienced no dismay over its termination. Indeed, Hillary seems content to sit on
the sidelines, while
others become perturbed, ecstatic, or hostile about “silly little things.” In describing
her few relationships, past and present, she seems to be vague, superficial, and naïve, and
unable to organize
her thoughts. Sometimes, she wanders into irrelevancies, such as what shoes
certain people preferred, or the physical characteristics of their parents.(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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