Mark Dombeck, Ph.D. Updated: Oct 25th 2005
Symptoms 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:
* neither desires nor enjoys close relationships, including being part of a family
* almost always chooses solitary activities
* has little, if any, interest in having sexual experiences with another person
* takes pleasure in few, if any, activities
* lacks close friends or confidants other than first-degree relatives
* appears indifferent to the praise or criticism of others
* shows emotional coldness, detachment, or flattened affectivity
Cynthia Levin, Psy.D. Updated: Oct 25th 2005
Personality disorders are typically some of the most challenging mental disorders to treat, since they are, by definition, an integral part of what defines an individual and their self-perceptions. Treatment most often focuses on increasing coping skills and interpersonal relationship skills through psychotherapy.
While there are many suggested treatment approaches one could make for this disorder, none of them are likely to be easily effective. As with all personality disorders, the treatment of choice is individual psychotherapy. However, people with this disorder are unlikely to seek treatment unless they are under increased stress or pressure in their life. Treatment will usually be short-term in nature to help the individual solve the immediate crisis or problem. The patient will then likely terminate therapy. Goals of treatment most often are solution-focused using brief therapy approaches.
The development of rapport and a trusting therapeutic relationship will likely be a slow, gradual process that may not ever fully develop as in seeing people with other disorders. Because people who suffer from this disorder often maintain a social distance with people in their lives, even those close to them, the clinician should work to help ensure the client's security in the therapeutic relationship. Acknowledging the client's boundaries are important and the therapist should not look to confront the client on these types of issues.
Long-term psychotherapy should be avoided because of its poor treatment outcomes and the financial hardships inherent in lengthy therapy. Instead, psychotherapy should focus on simple treatment goals to alleviate current pressing concerns or stressors within the individual's life. Cognitive-restructuring exercises may be appropriate for certain types of clear, irrational thoughts that are negatively influencing the patient's behaviors. The therapeutic framework should be clearly defined at the onset. Stability and support are the keys to good treatment with someone who suffers from schizoid personality disorder. The therapist must be careful not to "smother" the client and be able to tolerate some possible "acting-out" behaviors.
Group therapy may be an alternative treatment modality to examine, although it is usually not a good initial treatment choice. A person who suffers from this disorder who is assigned to group therapy at the onset of therapy will likely terminate treatment prematurely because he or she will be unable to tolerate the effects of being in a social group. If, however, the person is graduating from individual to group therapy, they may have enough minimal social skills and abilities to tolerate group therapy much better.
People who suffer from this disorder see little to no reason for social interactions and often will be quite quiet in group therapy, contributing little to others and offering little of themselves. This is to be expected and the individual who has schizoid personality disorder should not be pushed into participating more fully in the group until he or she is ready and on their own terms. Group leaders must be careful to help protect the individual from criticism from other group members for their lack of participation. Eventually, if the group can tolerate the initially silent member with this disorder, the individual may gradually participate more and more, although this process will be very slow and drawn out over months. Clinicians should be wary of too much isolation and introspection on the part of the patient. The goal is not to keep the individual in therapy as long as possible (although they may appreciate, if not fully utilize, therapy). As in group therapy, the individual who suffers from this disorder may engage in long periods of not talking and silence in session. These may be difficult to bear for the clinician. Phillip W. Long, M.D., also notes that the patient may eventually, "reveal a plethora of fantasies, imaginary friends, and fears of unbearable dependency - even of merging with the therapist. Oscillation between fear of clinging to the therapist may be followed by fleeing through fantasy and withdrawal." These types of feelings must be normalized by the clinician and brought into proper focus in the therapeutic relationship.
Medication is usually not an issue for someone who suffers from this disorder, unless they also have an associated psychological disorder, such as major depression. Most patients show no additional improvement with the addition of an antidepressant medication, though, unless they are also suffering from suicidal ideation or a major depressive episode. Long-term treatment of this disorder with medication should be avoided; medication should be prescribed only for acute symptom relief. Additionally, prescription of medication may interfere with the effectiveness of certain psychotherapeutic approaches. Consideration of this effect should be taken into account when arriving at a treatment recommendation.
The medical profession often overlooks self-help methods for the treatment of this disorder because very few professionals are involved in them. The social network provided within a self-help support group can be a very important component of increased, higher life functioning and a decrease in an inability to function in the face of unexpected stressors. A supportive and non-invasive group can help a person who suffers from schizoid personality disorder overcome fears of closeness and feelings of isolation. Many support groups exist within communities throughout the world that are devoted to helping individuals with this disorder share their commons experiences and feelings.
Patients can be encouraged to try out new coping skills and learn that social attachments to others don't have to be fraught with fear or rejection. They can be an important part of expanding the individual's skill set to develop new, healthier social relationships
Portions are from Internet Mental Health, by Phillip W. Long, M.D.