Schizoid personality disorder is a psychiatric disorder distinguished by detachment from social relationships and a restricted range of emotional expression in interpersonal settings. People with schizoid personality disorder are described as aloof, blunted, isolated, disengaged, and distant. The origins of schizoid personality disorder are complex and involve genetic, environmental, and psychological factors.
The following should be carefully considered in the psychiatric evaluation, including the mental status examination, of someone suspected of having schizoid personality disorder:
- Appearance: The patient may be disheveled.
- Behavior: The patient may be uncomfortable and have difficulty making eye contact. The patient may be reluctant to cooperate, aloof, and difficult to engage.
- Speech: Decreased amount of speech with short answers. No difficulties with speech initiation, volume, or vocabulary.
- Affect: Affective flattening (blunting) is a common feature of schizoid personality disorder
- Thought content: No hallucinations or delusions should be present. If magical content is present, the differential diagnosis should include schizotypal personality disorder.
- Thought process: The thought process in schizoid personality disorder is usually linear, albeit limited in range and logic. Some disorganization may be present (such as looseness of associations); however, if this is a prominent feature, the differential diagnosis should be broadened to include schizotypal personality disorder and other schizophrenia spectrum illnesses.
- Cognition: General cognition and orientation are not impaired in schizoid personality disorder but should be evaluated to rule out other psychiatric conditions where this is common, including schizophrenia.
DSM 5 Criteria for Schizoid Personality Disorder:
In interpersonal settings, there is a pervasive isolation pattern, limited social relationships, and restricted emotional expression. This pattern of behaviors starts in early adulthood and persists through a variety of contexts, including at least 4 of the following:
- No or limited enjoyment of close relationships, including with family.
- Nearly always chooses solitary activities.
- Little interest in sexual experiences with others.
- Takes pleasure in few activities.
- Limited close friendships/relationships other than first-degree relatives.
- Indifference to praise and criticism.
- Displays emotional coldness, detachment, and affective flattening.
These symptoms do not occur during a course of schizophrenia, bipolar, or a depressive episode with psychotic features. Symptoms are not better explained by autism spectrum disorder or another medical condition.
Notably, if schizophrenia develops after a diagnosis of schizoid personality is made, schizophrenia is added as a diagnosis, and schizoid personality disorder is then specified as: “schizoid personality disorder (premorbid).”
Many behaviors observed in schizoid personality disorder may overlap with symptoms of other psychiatric illnesses, so it is crucial to assess if schizoid personality disorder is occurring in isolation or conjunction with another psychiatric condition.
Fariba KA, Madhanagopal N, Torrico TJ, et al. Schizoid Personality Disorder. [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559234/