Schizoid Personality Disorder, Case vignette (3)

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 Doris

After two weeks of work, Doris’s employer suggested she seek counseling. Her duties include various household chores, such as light cooking and the care of two 3-year-old children. The concern was that she could not identity adequately with the children’s emotional needs, and therefore could not function adequately in the role of caretaker. “My children might feel uncomfortable around her because she’s, well . . . weird, and does not understand them,” her employer asserted.

Although Doris appeared for the appointment neatly dressed, she nevertheless seems shy and withdrawn. Her soft voice is difficult to hear at times. When asked if she understands the reason for the referral, she replies that she does not, for her job responsibilities have been performed flawlessly. She is not indignant, but does state that the food she cooks “tastes good,” that she never leaves the kitchen a mess, and that after her chores are performed, she spends most of her time alone in her room, and never disturbs anyone.(2) When asked if she feels bonded to the family, she answers, “I guess so,” but only after a long, puzzled pause.(1) She becomes more confused when asked which of the children is her favorite and why. Finally, she states, “I love them all equally.” Though her words have a hollow quality, she is not deliberately insincere.(7)  

Other areas of Doris’s life show similar difficulties. At age 17, Doris had her first child, a baby girl, as a result of sexual activities with a teenage male who lived next door. She denies that he was ever her boyfriend, says that that was the first and only time she ever had sex, that she “felt nothing,” and has no interest in such matters.(3) When asked about the experience, she recalls only the facts of her pregnancy and her child’s birthweight.(7) She reports that she did not enjoy nursing the child and felt overstimulated by its constant demands on her time. After two months, she decided to give the child up for adoption.(2)

Doris spends most of her evenings sewing and makes her own clothes. She notes, “I don’t have much use for other people. When I’m working, I got to be with them because it’s my job.”(1) Due to her less than adequate reading skills, a picture vocabulary test is used to assess her intellectual level. She scores within the normal range. Based on both the observations made and the information gathered in the clinical interview, it is recommended that Doris be placed in a position that does not require childcare. Her lack of emotion, preference for solitary activity, and inability to empathize with the emotional states and interpersonal needs of others, prerequisites to nurturance, make her a poor candidate for a caretaking role.

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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