schizoid personality disorder

統合失調質人格障害

WordNet

1. bring disorder to (同)disarray
2. a physical condition in which there is a disturbance of normal functioning; "the doctor prescribed some medicine for the disorder"; "everyone gets stomach upsets from time to time" (同)upset
3. a disturbance of the peace or of public order
4. the complex of all the attributes--behavioral, temperamental, emotional and mental--that characterize a unique individual; "their different reactions reflected their very different personalities"; "it is his nature to help others"
5. a person of considerable prominence; "she is a Hollywood personality"
6. marked by withdrawal and inability to form close relationships
7. of or relating to or characteristic of schizophrenia (同)schizophrenic
8. not arranged in order (同)unordered

PrepTutorEJDIC

1. 〈U〉『無秩序』,混乱,乱雑(confusion) / 《しばしば複数形で》(社会的・政治的な)粉争,騒動 / 〈C〉(肉体的・精神的な)不調,異常,障害 / …‘の'秩序を乱す / 〈心身〉‘に'異常を起こさせる
2. 〈C〉〈U〉(他人と区別する)『個性』,性格 / 〈U〉〈C〉『人格』,人柄,風格 / 〈C〉(特にある方面での)著名人,有名人
3. 精神分裂症の(気味の) / 精神分裂症患者

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/06/04 10:57:20」(JST)

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"Schizoid" redirects here. For the game, see Schizoid (video game).

Not to be confused with Schizophrenia, Schizotypal personality disorder, Schizoaffective disorder, or Semantic Pragmatic Disorder.

Schizoid personality disorder
Classification and external resources
ICD-10	F60.1
ICD-9	301.20
MeSH	D012557

Personality disorders
Cluster A (odd)
Paranoid Schizoid Schizotypal
Cluster B (dramatic)
Antisocial Borderline Histrionic Narcissistic
Cluster C (anxious)
Avoidant Dependent Obsessive-compulsive
Not specified
Depressive Passive–aggressive Sadistic Self-defeating

Schizoid personality disorder (SPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy. Affected individuals may also demonstrate a simultaneous rich, elaborate, and exclusively internal fantasy world, although this is often more suggestive of schizotypal personality disorder.

SPD is not the same as schizophrenia, although they share some similar characteristics such as detachment or blunted affect; there is increased prevalence of the disorder in families with schizophrenia.

The psychologist Nancy McWilliams argues that the definition of SPD is flawed due to cultural bias: "One reason schizoid people are pathologized is because they are comparatively rare. People in majorities tend to assume that their own psychology is normative and to equate difference with inferiority".

History

The term schizoid was coined in 1908 by Eugen Bleuler to designate a human tendency to direct attention toward one's inner life and away from the external world, a concept akin to introversion in that it was not viewed in terms of psychopathology. Bleuler also labeled the exaggeration of this tendency the “schizoid personality”.

Studies on the schizoid personality have developed along two distinct paths; (1) the descriptive psychiatry tradition which focuses on overtly observable, behavioral, and describable symptoms (finding its clearest exposition in the DSM-IV revised); and (2) the dynamic psychiatry tradition which includes the exploration of covert or unconscious motivations and character structure as elaborated by classic psychoanalysis and object-relations theory.

The descriptive tradition began in Ernst Kretschmer's (1925) description of observable schizoid behaviors, which he organized into three groups of characteristics:

1. unsociability, quietness, reservedness, seriousness, eccentricity
2. timidity, shyness with feelings, sensitivity, nervousness, excitability
3. pliability, honesty, indifference, silence, cold emotional attitudes.

These characteristics were the precursors of the DSM-IV division of schizoid character into three distinct personality disorders, though Kretschmer himself did not conceive of separating these behaviors to the point of radical isolation; rather, he considered them to be simultaneously present as varying potentials in schizoid individuals. For Kretschmer, the majority of schizoids are not either oversensitive or cold, but they are oversensitive and cold "at the same time" in quite different relative proportions, with a tendency to move along these dimensions from one behavior to the other.

The second path, that of dynamic psychiatry, began with observations by Eugen Bleuler (1924) who observed that the schizoid person and schizoid pathology were not things to be set apart. In 1940, W. R. D. Fairbairn presented his seminal work on the schizoid personality in which most of what is known today about schizoid phenomena is derived. Here Fairbairn delineated four central schizoid themes: (1) the need to regulate interpersonal distance as a central focus of concern; (2) the ability to mobilize self preservative defenses and self-reliance; (3) a pervasive tension between the anxiety laden need for attachment and the defensive need for distance, manifesting in observable behavior as indifference; and (4) an overvaluation of the inner world at the expense of the outer world. Following Fairbairn, the dynamic psychiatry tradition has continued to produce rich explorations on the schizoid character, most notably from writers Nannarello (1953); Laing (1960); Winnicott (1965); Guntrip (1969); Khan (1974); Akhtar (1987); Seinfeld (1991); Manfield (1992); and Klein (1995).

Signs and symptoms

People with SPD are often aloof, cold, and indifferent, which causes interpersonal difficulty. Most individuals diagnosed with SPD have trouble establishing personal relationships or expressing their feelings in a meaningful way, and may remain passive in the face of unfavorable situations. Their communication with other people may be indifferent and concise at times. Because of their lack of meaningful communication with other people, those who are diagnosed with SPD are not able to develop accurate reflections of themselves with respect to how well they are getting along with others.

Supposedly, such reflections are important for a person's self awareness and ability to assess the impact of their own actions in social situations. R.D. Laing suggests that without being enriched by injections of interpersonal reality, there occurs an impoverishment in which one's self image becomes increasingly empty and volatilized, leading the individual himself to feel unreal.

According to Gunderson, people with SPD "feel lost" without the people they are normally around because they require a sense of security and stability. However, when the patient's personal space is violated, they feel suffocated and feel the need to free themselves and be independent. People who have SPD tend to be happiest when they are in a relationship in which the partner places few emotional or intimate demands on them; it is not people as such that they want to avoid, but both negative and positive emotions, emotional intimacy, and self disclosure.

This means that it is possible for schizoid individuals to form relationships with others based on intellectual, physical, familial, occupational, or recreational activities as long as these modes of relating do not require or force the need for emotional intimacy, which the affected individual will reject.

Donald Winnicott summarizes the schizoid need to modulate emotional interaction with others with his comment that schizoid individuals "prefer to make relationships on their own terms and not in terms of the impulses of other people," and failing to attain that, they prefer isolation.

The 'Secret schizoid'

According to Ralph Klein, there are many fundamentally schizoid individuals who present with an engaging, interactive personality style which contradicts the observable characteristic emphasized by the DSM-IV and ICD-10 definitions of the schizoid personality. Klein classifies these individuals as secret schizoids, presenting themselves as socially available, interested, engaged, and involved in interacting in the eyes of the observer, while at the same time remaining emotionally withdrawn and sequestered within the safety of the internal world.

While withdrawal or detachment from the outer world is a characteristic feature of schizoid pathology, it is sometimes overt and sometimes covert. When overt, it matches the typical description of the schizoid personality offered in the DSM-IV. However, according to Klein, it is "just as often" a covert, hidden internal state of the patient in which what meets the objective eye may not be what is present in the subjective, internal world of the patient. Klein therefore cautions that one should not miss identifying the schizoid patient because one cannot see the patient's withdrawal through the patient's defensive, compensatory, engaging interaction with external reality. Klein suggests that one need only ask the patient what his or her subjective experience is in order to detect the presence of the schizoid refusal of emotional intimacy.

Descriptions of the schizoid personality as "hidden" behind an outward appearance of emotional engagement have been recognized as far back as 1940 with Fairbairn's description of 'schizoid exhibitionism,' in which he remarked that the schizoid individual is able to express a great deal of feeling and to make what appear to be impressive social contacts while in reality giving nothing and losing nothing; because he is only "playing a part," his own personality is not involved. According to Fairbairn, "[the person] disowns the part which he is playing and thus the schizoid individual seeks to preserve his own personality intact and immune from compromise."

Further references to the secret schizoid come from Masud Khan, Jeffrey Seinfeld, and Philip Manfield, who gives a palpable description of an SPD individual who actually "enjoys" regular public speaking engagements, but experiences great difficulty in the breaks when audience members would attempt to engage him emotionally. These references expose the problems involved in relying singularly on outer observable behavior for assessing the presence of personality disorders in certain individuals.

Avoidant attachment style

The question of whether SPD qualifies as a full personality disorder or simply as an avoidant attachment style is a contentious one^{[citation needed]}. If what has been known as schizoid personality disorder is no more than an attachment style requiring more distant emotional proximity, then many of the more problematic reactions these individuals show in interpersonal situations may be partly accounted for by the social judgments commonly imposed on those with this style. To date several sources have confirmed the synonymy of SPD and avoidant attachment style which leaves open the question of how researchers might best approach this subject in future diagnostic manuals, and in therapeutic practice. However, characteristically - and depending on the severity of the disorder - individuals do not seek social interactions merely due to lack of interest, as opposed to the avoidant personality type in which there is craving for interactions, but then fear of rejection.

Schizoid sexuality

People with SPD are sometimes sexually apathetic, though they do not typically suffer from anorgasmia. Many schizoids have a healthy sex drive but some prefer to masturbate rather than deal with the social aspects of finding a sexual partner. Therefore, their need for sex may appear to be less than those who do not have SPD, as individuals with SPD prefer to remain alone and detached. When having sex, individuals with SPD often feel that their personal space is being violated, and they commonly feel that masturbation or sexual abstinence is preferable to the emotional closeness they must tolerate when having sex. Significantly broadening this picture are notable exceptions of SPD individuals who engage in occasional or even frequent sexual activities with others.

Harry Guntrip describes the "secret sexual affair" entered into by some married schizoid individuals as an attempt to reduce the quantity of emotional intimacy focused within a single relationship, a sentiment echoed by Karen Horney's resigned personality who may exclude sex as being "too intimate for a permanent relationship, and instead satisfy his sexual needs with a stranger. Conversely he may more or less restrict a relationship to merely sexual contacts and not share other experiences with the partner." More recently, Jeffrey Seinfeld, professor of social work at New York University, has published a volume on SPD in which he details examples of "schizoid hunger" which may manifest as sexual promiscuity. Seinfeld provides an example of a schizoid woman who would covertly attend various bars to meet men for the purposes of gaining impersonal sexual gratification, an act, says Seinfeld, which alleviated her feelings of hunger and emptiness.

Salman Akhtar describes this dynamic interplay of overt versus covert sexuality and motivations of some SPD individuals with greater accuracy. Rather than following the narrow proposition that schizoid individuals are either sexual or asexual, Akhtar suggests that these forces may both be present in an individual despite their rather contradictory aims. For Akhtar, therefore, a clinically accurate picture of schizoid sexuality must include both the overt signs: "asexual, sometimes celibate; free of romantic interests; averse to sexual gossip and innuendo," along with possible covert manifestations of "secret voyeuristic and pornographic interests; vulnerable to erotomania; tendency towards compulsive masturbation and perversions," although none of these necessarily apply to all people with SPD.

Causes

There is some evidence to suggest that there is an increased prevalence of schizoid personality disorder in relatives of people with schizophrenia or schizotypal personality disorder. Unloving, intrusive, or neglectful parenting is hypothesized to play a role. There is a strong correlation between sexual abuse experienced in childhood and the later development of Schizoid Personality Disorder, and most personality disorders in general.

Diagnosis

DSM

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, a widely used manual for diagnosing mental disorders, defines schizoid personality disorder (in Axis II Cluster A) as:

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood (age eighteen or older) and present in a variety of contexts, as indicated by four (or more) of the following:

1. Neither desires nor enjoys relationships or human interaction, 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 with other people
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 affect

B. Does not occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, another psychotic disorder, or a pervasive developmental disorder and is not due to the direct physiological effects of a general medical condition.

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

In the draft of the DSM-V it is proposed that schizoid personality disorder should be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

World Health Organization

The World Health Organization's ICD-10 lists schizoid personality disorder as (F60.1) Schizoid personality disorder.

It is characterized by at least four of the following criteria:

1. Emotional coldness, detachment or reduced affect.
2. Limited capacity to express either positive or negative emotions towards others.
3. Consistent preference for solitary activities.
4. Very few, if any, close friends or relationships, and a lack of desire for such.
5. Indifference to either praise or criticism.
6. Taking pleasure in few, if any, activities.
7. Indifference to social norms and conventions.
8. Preoccupation with fantasy and introspection.
9. Lack of desire for sexual experiences with another person.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Millon's subtypes

Theodore Millon identified four subtypes of schizoid. Any individual schizoid may exhibit none or one of the following:

• Languid schizoid

including depressive features

• Remote schizoid

including avoidant, schizotypal features

• Depersonalized schizoid

including schizotypal features

• Affectless schizoid

including compulsive features

Dynamic diagnostic criteria

Ralph Klein, 1995 brought new light into the commonly held beliefs about the schizoid which focus mainly on the schizoid’s apparent disinterest in relationships. Clarifying the causes and conditions underlying the above characteristics, Klein describes a schism in the object of relations of the schizoid. This split involves: (1) the "slave/master" relationship: characterized by exploitation, appropriation, and dehumanization; and (2) the "self in exile:" the aversive recoiling from the exploitative relationship that the self goes into exile. The distanced or unresponsive self in exile is the more commonly recognized aspect of the schizoid. As Klein states: "[the] seeming detachment from feelings should never be accepted as the real state of affairs."

Of particular significance is the correlation between the narcissistic disorder and the schizoid. For example, the "over entitlement" of the narcissist in a family can result in the "under-entitlement" of the schizoid sibling. It is also the disavowed shame of the narcissist that is often absorbed by, or projected onto the schizoid; thus giving rise to the experience of psychic invasion, and the development of sense of vulnerability to intrusiveness. Paradoxically, a schizoid may also be attracted to exploitative relationships in which they long to experience significance and recognition by serving a need of the other. Yet this same person may be highly aware of any forms of corruption or exploitation outside of this relationship. In this approach diagnosis is based on the dynamic of this split and its consequences, as opposed to diagnosis on the basis of a list of external behaviors.^{[citation needed]}

Guntrip criteria

Ralph Klein, Clinical Director of the Masterson Institute delineates the following nine characteristics of the schizoid personality as described by Harry Guntrip: introversion, withdrawnness, narcissism, self-sufficiency, a sense of superiority, loss of affect, loneliness, depersonalization, and regression.

Introversion

According to Guntrip, "By the very meaning of the term, the schizoid is described as cut off from the world of outer reality in an emotional sense. All this libidinal desire and striving is directed inward toward internal objects and he lives an intense inner life often revealed in an astonishing wealth and richness of fantasy and imaginative life whenever that becomes accessible to observation. Though mostly his varied fantasy life is carried on in secret, hidden away." The schizoid person is cut off from outer reality to such a degree that he or she experiences outer reality as dangerous. It is a natural human response to turn away from sources of danger and toward sources of safety. The schizoid individual, therefore, is primarily concerned with avoiding danger and ensuring safety.

Withdrawnness

According to Guntrip, withdrawnness means detachment from the outer world, the other side of introversion. While there are many schizoid individuals who will present with obvious withdrawnness (a clear and obvious timidity, reluctance, or avoidance of the external world and interpersonal relationships), this defines only a portion of such individuals. Many fundamentally schizoid people present with an engaging, interactive personality style.

Such a person can appear to be available, interested, engaged, and involved in interacting with others; however, in reality, he or she is emotionally withdrawn and sequestered in a safe place in an internal world. While withdrawnness or detachment from the outer world is a characteristic feature of schizoid pathology, it is sometimes overt and sometimes covert. When it is overt it matches the usual description of the schizoid personality. Just as often, it is a covert, hidden internal state of the patient.

In summary, (1) what meets the objective eye may not be what is present in the subjective, internal world of the patient; (2) one should not mistake introversion for indifference; and (3) one should not miss identifying the schizoid patient because one cannot see the forest of the patient's withdrawnness through the trees of the patient's defensive, compensatory, engaging interaction with external reality.

Narcissism

Guntrip: "Narcissism is a characteristic that arises out of the predominately interior life the schizoid lives. His love objects are all inside him and moreover he is greatly identified with them so that his libidinal attachments appear to be in himself. The question, however, is whether the intense inner life of the schizoid is due to a desire for hungry incorporation of external objects or due to withdrawal from the outer to a presumed safer inner world." The need for attachment as a primary motivational force is as strong in the schizoid person as in any other human being. However, because the schizoid's love objects are internal, he or she finds safety without connecting and attaching to objects in the real world.

Self-sufficiency

Guntrip writes, "This introverted narcissistic self-sufficiency, which does without real external relationships while all emotional relations are carried on in the internal world, is a safeguard against anxiety breaking out in dealing with actual people." The more that schizoids can rely on themselves, the less they have to rely on other people and expose themselves to the potential dangers and anxieties associated with that reliance or, even worse, dependence. The vast majority of schizoid individuals show an enormous capacity for self-sufficiency, for the ability to operate alone, independently and autonomously, in managing their worlds.

Sense of superiority

Guntrip states, "a sense of superiority naturally goes with self-sufficiency. One has no need of other people, they can be dispensed with... There often goes with it a feeling of being different from other people." The sense of superiority of the schizoid has nothing to do with the grandiose self of the narcissistic disorder. It does not find expression in the schizoid through the need to devalue or annihilate others who are perceived as offending, criticizing, shaming, or humiliating. This type of superiority was described by a young schizoid man:

"If I am superior to others, if I am above others, then I do not need others. When I say that I am above others, it does not mean that I feel better than them, it means that I am at a distance from them, a safe distance."

It is a feeling of being horizontally, rather than vertically distant.

Loss of affect

Further information: Affect (psychology)

According to Guntrip, "Loss of affect in external situations is an inevitable part of the total picture." Because of the tremendous investment made in the self—the need to be self-contained, self-sufficient, and self-reliant—there is inevitable interference in the desire and ability to feel another person’s experience, to be empathic and sensitive. Often these things seem secondary, a luxury that has to await securing one's own defensive, safe position. The subjective experience is one of loss of affect.

For some patients, the loss of affect is present to such a degree that the insensitivity becomes manifest in the extreme as cynicism, callousness, or even cruelty. The patient appears to have no awareness of how his or her comments or actions affect and hurt other people. More frequently, the loss of affect is manifest within the patient as genuine confusion, a sense of something missing in his or her emotional life.

Loneliness

According to Guntrip, "Loneliness is an inescapable result of schizoid introversion and abolition of external relationships. It reveals itself in the intense longing for friendship and love which repeatedly break through. Loneliness in the midst of a crowd is the experience of the schizoid cut off from affective rapport." This is a central experience of the schizoid that is often lost to the observer. Contrary to the familiar caricature of the schizoid as uncaring and cold, the vast majority of schizoid persons who become patients express at some point in their treatment their longing for friendship and love. This is not the schizoid patient as described in the DSMs. Such longing, however, may not break through except in the schizoid’s fantasy life, to which the therapist may not be allowed access for quite a long period in treatment. If longing is immediately present, however, it is more likely avoidant personality disorder.^{[citation needed]}

There is a very narrow range of schizoid individuals, the classic DSM-defined schizoids, for whom the hope of establishing relationships is so minimal as to be almost extinct. The longing for closeness and attachment is almost unidentifiable to this type of schizoid. These individuals will not voluntarily become patients; the schizoid individual who becomes a patient does so often because of the twin motivations of loneliness and longing. This type of schizoid patient still believes that some kind of connection and attachment is possible, and is well suited to psychotherapy. Yet the irony of the DSMs is that they may lead the psychotherapist to approach the schizoid patient with a sense of therapeutic pessimism, if not nihilism, misreading the patient by believing that the patient’s wariness is indifference and that caution is coldness.

Depersonalization

Guntrip describes depersonalization as a loss of a sense of identity and individuality. Depersonalization is a dissociative defense, often described by the schizoid patient as "tuning out," "turning off", or as the experience of a separation between the observing and the participating ego. It is experienced most profoundly by those with schizoid personality disorder when anxieties seem overwhelming. It is a more extreme form of loss of affect: whereas the loss of affect is a more chronic state in schizoid personality disorder, depersonalization is an acute defense against more immediate experiences of overwhelming anxiety or danger.

Regression

Further information: Regression (psychology)

Guntrip defined regression as "Representing the fact that the schizoid person at bottom feels overwhelmed by their external world and is in flight from it both inwards and as it were backwards to the safety of the metaphorical womb." Such a process of regression encompasses two different mechanisms: inward and backwards. Regression inward speaks to the magnitude of the reliance on primitive forms of fantasy and self-containment, often of an autoerotic or even objectless nature. Regression backwards to the safety of the womb is a unique schizoid phenomenon and represents the most intense form of schizoid defensive withdrawal in an effort to find safety and to avoid destruction by external reality. The fantasy of regression to the womb is the fantasy of regression to a place of ultimate safety.

The description of the nine characteristics first articulated by Guntrip should bring more clearly into focus some of the major differences that exist between the traditional descriptive (track 1, DSM) portrait of the schizoid disorder and the traditional psychoanalytically informed (track 2, object relations) view. All nine characteristics are internally consistent. Most, if not all, should be present in order to diagnose a schizoid disorder.

Akhtar's phenomenological profile

In an article in the American Journal of Psychotherapy, Salman Akhtar, M.D., provides a comprehensive phenomenological profile of Schizoid Personality Disorder in which classic and contemporary descriptive views are synthesized with psychoanalytic observations. This profile is summarized in a table (reproduced below) listing clinical features, involving six areas of psychosocial functioning and designated by "overt" and "covert" manifestations. Dr. Akhtar states that "these designations do not imply conscious or unconscious but denote seemingly contradictory aspects that are phenomenologically more or less easily discernible," and that "this manner of organizing symptomology emphasizes the centrality of splitting and identity confusion in schizoid personality."

Clinical Features of Schizoid Personality Disorder

Area	Features
	Overt	Covert
Self-Concept	compliant stoic noncompetitive self-sufficient lacking assertiveness feeling inferior and an outsider in life	cynical inauthentic depersonalized alternately feeling empty, robot-like, and full of omnipotent, vengeful fantasies hidden grandiosity
Interpersonal Relations	withdrawn aloof have few close friends impervious to others' emotions afraid of intimacy	exquisitely sensitive deeply curious about others hungry for love envious of others' spontaneity intensely needy of involvement with others capable of excitement with carefully selected intimates
Social Adaptation	prefer solitary occupational and recreational activities marginal or eclectically sociable in groups vulnerable to esoteric movements owing to a strong need to belong tend to be lazy and indolent	lack clarity of goals weak ethnic affiliation usually capable of steady work quite creative and may make unique and original contributions capable of passionate endurance in certain spheres of interest
Love and Sexuality	asexual, sometimes celibate free of romantic interests averse to sexual gossip and innuendo	secret voyeuristic interests vulnerable to erotomania tendency towards compulsive perversions
Ethics, Standards, and Ideals	idiosyncratic moral and political beliefs tendency towards spiritual, mystical and para-psychological interests	moral unevenness occasionally strikingly amoral and vulnerable to odd crimes, at other times altruistically self sacrificing
Cognitive Style	absent-minded engrossed in fantasy vague and stilted speech alternations between eloquence and inarticulateness	autistic thinking fluctuations between sharp contact with external reality and hyperreflectiveness about the self autocentric use of language

One patient with SPD commented that he could not fully enjoy the life he has because he feels that he is living in a shell. Furthermore, he noted that his inability distressed his wife. According to Beck and Freeman, "Patients with schizoid personality disorders consider themselves to be observers, rather than participants, in the world around them."

Differential diagnosis

Although SPD shares several aspects with other psychological conditions, there are some important differentiating features:

psychological condition	Features
Depression	While people who have SPD may also suffer from clinical depression, this is certainly not always the case. Unlike depressed people, persons with SPD generally do not consider themselves inferior to others, although they will probably recognize that they are different.
Avoidant personality disorder	Unlike avoidant personality disorder, those affected with SPD do not avoid social interactions due to anxiety or feelings of incompetence, but because they are genuinely indifferent to social relationships; however, in a 1989 study, "schizoid and avoidant personalities were found to display equivalent levels of anxiety, depression, and psychotic tendencies as compared to psychiatric control patients." One SPD patient remarked that previous knowledge, expectations, or assumptions may result in such elevated levels. Patients can mentally simulate damaging scenarios in order to flatten negative effects, should one occur.
Asperger syndrome	Asperger syndrome (AS) is an autism-spectrum disorder. Unlike AS, SPD does not involve an impairment in Nonverbal communication (i.e., a lack of eye contact), unusual prosody or a pattern of restricted interests or repetitive behaviors (e.g., a strict adherence to routines or rituals, or an unusually intense interest in a single topic). Compared to AS, SPD is characterized by prominent conduct disorder, better adult adjustment, and a slightly increased risk of schizophrenia.

Under stress, some people with schizoid personality features may occasionally experience instances of brief reactive psychosis.^{[citation needed]} Schizoid individuals are also prone to developing pathological reliance on fantasizing activity as concomitant with their withdrawal from the world. Viewed in this fashion, fantasy constitutes a core component of the self in exile, though on closer examination fantasizing in schizoid individuals reveals as far more complicated than a means of facilitating withdrawal.

Fantasy is also relationship with the world and with others by proxy. It is a substitute relationship, but a relationship nonetheless, characterized by idealized, defensive, and compensatory mechanisms. It is an expression of the self in exile because it is self-contained and free from the dangers and anxieties associated with emotional connection to real persons and situations.

According to Klein it is "an expression of the self struggling to connect to objects, albeit internal objects. Fantasy permits schizoid patients to feel connected, and yet still free from the imprisonment in relationships. In short, in fantasy one can be attached (to internal objects) and still be free." This aspect of schizoid pathology has been generously elaborated in works by Laing (1960); Winnicott; (1971); and Klein (1995).

According to Seinfeld, schizoid individuals frequently act out with substance and alcohol abuse and other addictions which serve as substitutes for human relationships. The substitute of a nonhuman for a human object serves as a schizoid defense. Providing examples of how the schizoid individual creates a personal relation with the drug, Seinfeld tells how "one addict called heroin his 'soothing white pet.' Another referred to crack as his 'bad mama.' I knew a female addict who termed crack her 'boyfriend.' Not all addicts name their drug, but there often is the trace of a personal feeling about the relationship." The object relations view emphasizes that the drug use and alcoholism reinforce the fantasy of union with an internal object, while enabling the addict to be indifferent to the external object world. Addiction is therefore viewed as a schizoid and symbiotic defense.

S. C. Ekleberry suggests that marijuana "may be the single most egosyntonic drug for individuals with SPD because it allows a detached state of fantasy and distance from others, provides a richer internal experience than these individuals can normally create, and reduces an internal sense of emptiness and failure to participate in life. Also, alcohol, readily available and safe to obtain, is another obvious drug of choice for these individuals. Some will use both marijuana and alcohol and see little point in giving up either. They are likely to use in isolation for the effect on internal processes."

According to Ralph Klein, suicide may also be a running theme for schizoid individuals, though they are not likely to actually attempt one. They might be down and depressed when all possible connections have been cut off, but as long as there is some relationship or even hope for one the risk will be low. The idea of suicide is a driving force against the person's schizoid defenses. As Klein says: "For some schizoid patients, its presence is like a faint, barely discernible background noise, and rarely reaches a level that breaks into consciousness. For others, it is an ominous presence, an emotional sword of Damocles. In any case, it is an underlying dread that they all experience."

Treatment

Since schizoid traits are very similar to negative schizophrenic symptoms, atypical antipsychotics may have efficacy in alleviating them. Those who do seek treatment have the option of medication or therapy. For medication, the schizoid personality disorder seems to have similar negative symptoms of schizophrenia such as anhedonia, blunted affect, and low energy. The medication that is most recently used to treat the negative symptoms is risperidone. Before this, there was no psychotropic medication that made an impact on the negative symptoms.

According to Joseph, low doses of risperidone or olanzapine also work for the social deficits and blunted affect; Wellbutrin (bupropion) for anhedonia. Furthermore, the use of SSRIs, TCAs, MAOIs, low dose benzodiazepines, and beta-blockers may help social anxiety in the SPD. However, social anxiety may not be a main concern for the people who have SPD. Supportive psychotherapy is also used in an inpatient or outpatient setting by a trained personnel that focuses on areas such as: coping skills, improving social skills and social interactions, communication, and self esteem issues. Mark Zimmerman suggested the following questions for evaluation of patients with SPD:

• Do you have close relationships with friends or family? If yes, with whom? If no, does this bother you?
• Do you wish you had close relationships with others?
• Some people prefer to spend time alone, others prefer to be with people. How would you describe yourself?
• Do you frequently choose to do things by yourself?
• Would it bother you to go a long time without a sexual relationship? Does your sex life seem important or could you get along as well without it?
• What kind of activities do you enjoy?
• Do you confide in anyone who is not in your immediate family?
• How do you react when someone criticizes you?
• How do you react when someone compliments you?

In the assessment process, note if these individuals make eye contact, smile or express affect nonverbally.

According to Beck and Freeman, people with SPD have "defective perceptual scanning which results in missing environmental cues. The defective perceptual scanning is characterized by a tendency to miss differences and to diffuse the varied elements of experience." The perception of varied events only increases their fear for intimacy and limits them in their interpersonal relationships. Also because of their aloofness, this barrier does not allow them to use their social skills and behavior to help them pursue relationships.

Therefore, socialization groups may help these people with SPD. As said by Will, educational strategies also work with people who have SPD by having them identify their positive and negative emotions. They use the identification to learn about their own emotions; the emotions they draw out from others; and feeling the common emotions with other people whom they relate with. This can help people with SPD create empathy with the outside world.

Shorter-term treatment

According to Ralph Klein, Clinical Director of the Masterson Institute, the concept of closer compromise means that the schizoid patient may be encouraged to experience intermediate positions between the extremes of emotional closeness, and permanent exile.

As mentioned by Laing without being enriched by injections of interpersonal reality there occurs an impoverishment in which the schizoid individual's self-image becomes more and more empty and volatilized, leading the individual himself to feel unreal. Therefore, to create a more adaptive and self-enriching interaction with others in which one "feels real," the patient is encouraged to take risks by creating less interpersonal distance through greater connection, communication, and the sharing of ideas, feelings, and actions. Closer compromise means that while the schizoid patient's vulnerability to the anxieties is not overcome, it is modified and managed more adaptively. Here the therapist repeatedly conveys to the patient that anxiety is inevitable, yet manageable, without any illusion that the schizoid vulnerability to such anxiety can be permanently dispensed with. The limiting factor is the point at which the dangers of intimacy become overwhelming and the patient must again retreat.

Klein suggests that closer compromise must be directly stated as the patient's responsibility; "It seems to me that in order to accomplish your goals, it is necessary to put yourself at risk," or "It seems to me that your willingness to come here (to treatment) and struggle with your anxieties must be mirrored by your willingness to challenge yourself outside of here," or "It seems to me that your efforts to connect with me are only half the battle; the other half must take place in the more dangerous arena of your life outside this office," i.e. therapist is always conveying that these are the therapists impressions.

He or she is not reading the patient's mind or imposing an agenda, but is simply stating a position. Also, the therapist's position is an extension of the patient's therapeutic wish ("your goals," "your willingness," and "your efforts"). Finally, the therapist specifically directs attention to the need for employing these actions outside the therapeutic setting.

Longer-term therapy

Klein suggests that working through is the second longer-term tier of psychotherapeutic work with schizoid patients. Its goals are to change fundamentally the old ways of feeling and thinking, and to rid oneself of the vulnerability to experiencing those emotions associated with old feelings and thoughts. A new therapeutic operation of 'remembering with feeling' is called for.

One must remember with feeling the coming into being of one's false self through childhood. (The concept of false self and true self comes from D. W. Winnicott, and is viewed as representative of schizoid phenomenology.) This means that one must remember the conditions and proscriptions that were imposed on the individual’s freedom to experience the self in company with others. Ultimately, remembering with feeling leads the patient to the understanding that he or she had no choice in the process of developing a schizoid stance toward others. The patient did not have the opportunity to choose from a selection of possible ways of experiencing the self and of relating with others, rather, the patient had few if any options. The false self was simply the best way in which the patient could experience repetitive predictable acknowledgment, affirmation, and approval (the emotional supplies necessary for emotional survival), while warding off the effects associated with the abandonment depression.

If the goal of shorter-term therapy is for patients to understand that they are not the way they appear to be and can act differently, then the longer-term goal of working through is for patients to understand who and what they are as human beings, what they truly are like and what they truly contain. The goal of working through is not achieved by the patient’s sudden discovering of a hidden, fully formed talented and creative self living inside but is a process of slowly freeing oneself from the confinement of abandonment depression in order to have the opportunity to uncover a potential. It is a process of experimentation with the spontaneous, nonreactive elements that can be experienced in relationship with others.

Working through abandonment depression is a complicated, lengthy, and conflicted process which can be an enormously painful experience in terms of what is remembered and what must be felt. It involves a mourning, a grieving, for the loss of the illusion that the patient had adequate support for the emergence of the real self. Also, it is a mourning for the loss of an identity, the false self, which the person constructed and with which he or she has negotiated much of his or her life. The dismantling of the false self requires a relinquishing the only way of being that the patient has ever known of his interactions with others, an interaction which was better than no stable, organized experience of the self, no matter how false, defensive, or destructive that identity may be.

According to Klein the dismantling of the false self "leaves the impaired real self with the opportunity to convert its potential and its possibilities into actualities." The process of working through brings with it its own unique rewards, of which the most important element in new self-awareness is the growing realization by the individual that they have a fundamental, internal need for relatedness, which they may express in a variety of ways. "Only schizoid patients", suggests Klein, "who have worked through the abandonment depression ... ultimately will believe that the capacity for relatedness and the wish for relatedness are woven into the structure of their beings, that they are truly part of who the patients are and what they contain as human beings. It is this sense that finally allows the schizoid patient to feel the most intimate sense of being connected with humanity more generally, and with another person more personally. For the schizoid patient, this degree of certainty is the most gratifying revelation, and a profound new organizer of the self experience."

Epidemiology

SPD is uncommon in clinical settings. It occurs slightly more commonly in males.

SPD is rare compared with other personality disorders. Its prevalence is estimated at less than 1% of the general population.

As an interesting comment on the usual low-prevalence figures for this disorder, Philip Manfield in Split Self, Split Object, Arenson (1992) states that "I believe that the schizoid condition is far more common... comprising perhaps as many as 40 percent of all personality disorders. This huge discrepancy is probably largely because someone with a schizoid disorder is less likely to seek treatment than someone with other axis-II disorders." Manfield backs this claim with a study by Valliant & Drake (1985) who found that over 40% of a particular sample group of inner city males were schizoid.

See also

• Counterphobic attitude
• Narcissistic defences
• Schizoid withdrawal
• Schizophrenia spectrum
• Schizotypy

References

External links

• Schizoid: Self in Exile
• NY Times article "Like a Fish Needs a Bicycle: For Some People, Intimacy Is Toxic"
• A Comprehensive Profile of Schizoid Personality Disorder
• Schizoid forums: A forum for people with schizoid personality dedicated to research and understanding of this disorder.
• Psychology & mental health: Schizoid Personality Disorder message board, with open discussions, and online support group.
• Psychology Tools: Schizoid Personality Disorder discussion and information

UpToDate Contents

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• 1. 人格障害 personality disorders
• 2. 境界性人格障害：疫学、臨床的特徴、診断、および鑑別診断 borderline personality disorder epidemiology clinical features diagnosis and differential diagnosis
• 3. 成人における間欠性爆発性障害：疫学、臨床的特徴、評価、および診断 intermittent explosive disorder in adults epidemiology clinical features assessment and diagnosis
• 4. 心因性不随意運動 psychogenic movement disorders
• 5. 困難な患者との遭遇 the difficult patient encounter

English Journal

• Personality pathology and increased use of medical resources in later adulthood.

• Powers A1, Strube MJ2, Oltmanns TF2.
• The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.Am J Geriatr Psychiatry.2014 Dec;22(12):1478-86. doi: 10.1016/j.jagp.2013.10.009. Epub 2013 Oct 27.
• OBJECTIVES: Personality pathology is associated with many negative health outcomes in young adulthood, including overutilization of healthcare resources. It is unclear, however, what the relation between personality pathology and medical resource utilization is as individuals age and develop new phy
• PMID 24315559

• Personality disorders and physical comorbidities in adults from the United States: data from the National Epidemiologic Survey on Alcohol and Related Conditions.

• Quirk SE1, El-Gabalawy R, Brennan SL, Bolton JM, Sareen J, Berk M, Chanen AM, Pasco JA, Williams LJ.
• Social psychiatry and psychiatric epidemiology.Soc Psychiatry Psychiatr Epidemiol.2014 Oct 15. [Epub ahead of print]
• PURPOSE: There is a paucity of research examining the relationship between personality disorders (PDs) and chronic physical comorbidities. Consequently, we investigated associations between individual PDs and PD Clusters, and various common disease groups [cardiovascular disease (CVD), diabetes, art
• PMID 25314916

• Cluster A personality pathology in social anxiety disorder: a comparison with panic disorder.

• O'Toole MS1, Arendt M, Fentz HN, Hougaard E, Rosenberg NK.
• Nordic journal of psychiatry.Nord J Psychiatry.2014 Oct;68(7):460-3. doi: 10.3109/08039488.2013.858770. Epub 2013 Dec 9.
• BACKGROUND: Social anxiety disorder (SAD) has been associated with cluster A personality disorder (PD) traits, mainly paranoid and schizoid traits.AIM: The aim of the study was to further investigate cluster A personality pathology in patients with SAD.METHODS: Self-reported PD traits were investiga
• PMID 24320019

Japanese Journal

• 成人期のアスペルガー症候群(障害)とシゾイドパーソナリティ障害,および統合失調病質(Kretschmer) (特集 成人期のアスペルガー症候群(1))

• 加藤 敏
• 精神医学 50(7), 669-679, 2008-07
• NAID 40016128457

• パーソナリティ障害と広汎性発達障害の関連性と鑑別診断 (特集 パーソナリティ障害の現在)

• 岡田 俊
• 精神科 12(2), 102-106, 2008-02
• NAID 40015907049

Related Links

• Schizoid personality disorder - Wikipedia, the free encyclopedia

Schizoid personality disorder (SPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy. Affected individuals may also ...

• 分裂病質人格障害(Schizoid Personality Disorder)

分裂病質人格障害(Schizoid Personality Disorder)は、統合失調症の病理研究や 臨床活動の中から発見された性格上の問題で、対人関係や社会活動を拒絶する『非 社会的問題行動』との関連が深い人格構造の偏りです。『非社会的な分裂病質』の問題 を ...

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★リンクテーブル★

リンク元	「人格障害」「統合失調質人格障害」「schizoid personality」
関連記事	「disorder」「schizoid personality」「personality」

「人格障害」

　　[★]

英

personality disorder

関

性格障害

• 精神系 090515 I

DSM-IV

A群人格障害

他人から見て奇異、風変わりな印象を与え、内向的で社会から孤立し、引きこもる傾向があり、社会の辺縁に身を置く。

• 妄想性人格障害 paranoid personality disorder 301.0

• 他者への根強い不信の念があり、しかるべき根拠がないのに、自分に対する敵意を感じたり、馬鹿にする、他人が利用する、危害を加えるなどという疑念を抱く。

• 統合失調質人格障害 schizoid personality disorder 301.20

• きわめて内向的で、人との接触に乏しく、自分の中に引きこもり、周囲から変わり者と見なされていることも少なくない。親しい友人や信頼できる友人がなく、他人との親密な関係に欠ける。他人との感情の分かち合い、優しさ、温かさがない。

• 統合失調型人格障害 schizotypal personality disorder 301.22

• 統合失調質人格障害の諸特徴にくわえて、他人に対する被害的内容を中心とした関係念慮、テレパシーや超能力への関心、また話が要領を得ず論理的なまとまりを欠く、不適切な思考が出没するといった明らかな病的障害が認められるもの。

B群人格障害

情動面の激しさと不安定さがあり、外向的だが、時に他者に対する関係は嵐が来たように激しく攻撃的となる。

• 反社会性人格障害 antisocial personality disorder 301.7

• 行動：他者に対する攻撃性が目立ち、喧嘩、他者への暴力、器物破損などが繰り返される。社会規範が守れず、盗みや暴力、あるいは薬物乱用のため警察に逮捕されることが少なくない。職を転々と変えたりして、持続的な就労がなされない。社会的な責任感を欠き、無責任な行動だらしなさが目立つ。
• 感情・情動：不安定かつ荒々しい気象で、些細なことを我慢できず易怒的となる。罪悪感、後悔の念、優しさに欠け、他者に対する憎しみ、冷酷な感情を抱く。また不安感は乏しい。
• 対人関係：自己中心的で共感性を欠き、しばしば誇大的で、他者に対し、支配的あるいは操作的な態度が目立ち、長期的な人間関係を維持できない。

• 境界性人格障害 borderline personality disorder 301.83

• 人格の様々な領域における不安定性と自己の空虚感が目立つ
• 感情・情動：挿間的に出現する強い不快感、いらいら、不安の出現
• 行動：こうした空虚感や抑うつを伴う感情・情動不安定の中で、突然、手首切傷や薬を大量に服用した自殺企図、あるいは性的逸脱、薬物乱用、浪費、過食などが衝動的な行為の形で出現する。
• 対人関係：友人や初対面の人を前にして限られた時間なら表面的には如才ない。身近な他者に対し、しがみつくような形の依存的態度が目立ち、他者との適切な距離がとれない。

• 演技性人格障害 histrionic personality disorder 301.50

• 対人関係にもっとも大きな特徴がある。劇場の演技に比較される、他人の注意を引こうとする度を過ぎた自己顕示的行動が多い。

• 自己愛性人格障害 narcissistic personality disorder 301.81

• 自分には実際以上に優れた才能、力があるという度を超した自負心を持つ
• 他人の注意を自分にずっと引きつけ、賞賛されたいという自己顕示的欲求を持つ
• 他者の自己評価には過敏で、些細な批判的な言葉や態度で容易に傷つき、手ひどい羞恥心や屈辱感を味わう。

C群人格障害

不安げで、臆病で内向的

• 回避性人格障害 avoidant personality disorder 301.82

• 他人と親しく交わりたい、他人に自分を受け入れてもらいたいという願望を強く持っている者の、自信がなく、劣等感があり、低い自己評価のため他者の批判や拒絶を気にし、恥をかくことや非難されることをおそれて、対人関係は浅くなる。

• 依存性人格障害 dependent personality disorder 301.6

• 自分の信頼できる人に著しい依存を見せ、面倒を見てもらいたいという強い願望を持ち、その人へ自分をゆだね、没主体的な従属的な振る舞いをする。

• 強迫性人格障害 obsessive-compulsive personality disorder 301.4

• 過度の秩序意識や、几帳面さと完全主義が認められ、そのため、日常生活や仕事の場面で柔軟性を欠き、かたくなな態度が目立つ。

USMLE

• Q book p.405 12

「統合失調質人格障害」

　　[★]

英

schizoid personality disorder

同

シゾイド人格障害

関

統合失調質人格、F6

ICD-10

F60.1

「schizoid personality」

　　[★]

• 統合失調質人格

関

schizoid personality disorder

「disorder」

　　[★]

• 障害：個人的苦痛や機能の障害があるので「疾病」とは言えるものの、その背景にある臓器障害がもう一つはっきりしない場合に用いられる。(PSY.9)

• n.

• an untidy state; a lack of order or organization (⇔order)
• violent behaviour of large groups of people
• an illness that cause a part of the body to stop functioning correctly

• 注意

disease <> illness <> disorder

• vt.

• 乱す、乱雑にする。(人)の(心身の)調子を狂わせる。

• vi.

　 　 　 　

「schizoid personality」

　　[★]

• 統合失調質人格

関

schizoid personality disorder

「personality」

　　[★]

• n.

• 性格、人格

関

character