By: THEODORE MILLON
et al.
The schizoid is
the personality disorder that lacks a personality. Schizoids prefer isolation because relationships seem to hold no
rewards for them. They are often described as detached and emotionally flat,
but in general, they are rarely noticed by anyone because they are so
quiet and unobtrusive.
The DSM-IV criteria for the schizoid focuses solely on what schizoids are lacking:
any sense of being emotional, sexual, or interpersonal. Put on a continuum, the more
normal variant of the schizoid is seen as an introvert who may have more developed
emotional capacities and, though still preferring a solitary life, has a richly
developed fantasy life. In the realm of normal personality, Oldham and Morris
describe the solitary style: one who feels the most free when alone in a
calm, self-contained, and self-sufficient lifestyle. Millon describes the retiring style
as one who is capable of relating to others when necessary but truly prefers to be alone.
On the opposite end, the most severe schizoids may seem to develop a kind of
schizophrenic syndrome.
Several
variations of the schizoid personality have been proposed. The languid schizoid blends schizoid tendencies with depressive
characteristics. Remote schizoids have withdrawn so completely that they lost their
innate capacity to feel and relate to others. The depersonalized schizoid is viewed as
dreamy, distant, and cognitively absent. The affectless schizoid shares with
the compulsive the desire for structured settings but not the compulsive’s
conflict of autonomy versus obedience.
Biological
explanations of the schizoid remain speculative, but the arguments become more
compelling as the schizoid moves into the realm of the more severely
disordered. Schizoids are seen as chronically underactive or underaroused,
which could be explained by a biological
deficit in normal functioning. There is some preliminary genetic evidence for schizoid
personality that is linked with schizophrenia, but other possibilities exist, such as
focal brain abnormalities in the limbic system or in the reticular activating
system.
Classical
psychoanalysis has limited power to describe the schizoid personality primarily
because psychodynamics are based on the premise that the person presents one view of self to the outside world but has deep inner
struggles and conflicts that are hidden on the inside. The schizoid seems to be
void on the inside. One exception to this thinking is Fairbairn, who
traced the schizoid’s lack of affection to the child who, at an early age, learns that love
(represented by the breast) implies death and thus withdraws to protect the self. The
object relationists, who focus on early interpersonal attachments, have more to
offer, defining schizoids by their lack of early attachments.
It may seem
counterintuitive to have an interpersonal perspective on a disorder that appears to have no interpersonal relationships, but
living in a social world forces schizoids to have a pattern for interacting with
others and it is their intrinsic lack of desire to do so that warrants interpersonal analysis.
Kiesler describes this pattern as escapist-unresponsive because they ignore others and
become hermetic. Although they
are detached and not
socially sensitive, schizoids are not callous or harsh toward other
people. Their
communication style tends to be dry and impersonal, and because they
fail to attach to
others, they never experience the pleasure of being part of a family or
being loved by a friend
or mate.
Cognitively, more
normal schizoids may give free reign to their intellectual endeavors, becoming mathematicians or philosophers, but more
severe schizoids appear to develop some cognitive eccentricities akin to the schizotypal.
The more isolated the schizoid becomes, the more unlikely he or she is to have
a coherent and rich sense of self. Schizoids are often unaware of any goals
or drives that motivate them and, in the most severe cases, are incapable of
introspection. Beck and Freeman describe schizoids as observers of life,
not participants.
The evolutionary
neurodevelopmental perspective describes the schizoid as one of the pleasure-deficient personalities, insensitive to both
pleasure and pain. They passively accommodate to life’s circumstances and
rarely take the initiative to change things. This perspective also
espouses multiple pathways to development of the schizoid personality,
as all domains
(biological, interpersonal, dynamic) interact to form the whole person.
Although the
schizoid may appear to share some surface qualities with other disorders, such
as avoidant, depressive, and compulsive, schizoids are identifiable by their lack of emotion or desire for human interaction.
Schizoids appear relatively immune to anxiety and mood disorders but may be vulnerable to
developing dissociative disorders, schizophrenic symptoms, and psychotic disorders.
The therapeutic
outlook for the schizoid is fairly bleak. It is important to not expect too much change and to not get frustrated and give up
too early on the schizoid. Some change can be effected by finding something the
schizoid enjoys or derives pleasure from, increasing interpersonal contact, and engaging
in a vocation or education. These goals can be achieved through interpersonal means as
well as cognitive modalities focusing on a hierarchy of social interaction goals.
Group therapy can be instrumental in affecting a substantiated differential diagnosis,
thereby determining a more realistic prognosis. Role playing and in vivo exposure can help
ensure that the changes extend beyond the walls of the clinic or hospital and help
schizoids learn to broaden their interpersonal experiences.
References
Personality Disorders in Modern Life, second edition, 2000,
2004 by John Wiley & Sons, Inc.
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