Schizoid personality disorder: Overview, symptoms, and treatment

Schizoid personality disorder is a complex mental health condition that’s typically characterized by blunted emotions and difficulty engaging with others.

Despite its low prevalence, it can have a serious impact on an individual’s life, potentially leading to isolation, depression, anxiety, or other mental health conditions. Treatment is available for the disorder, and those who experience it can live full, healthy lives. Below, we’re going to discuss schizoid personality disorder, its symptoms, and how it can be managed.

What is schizoid personality disorder?

There are ten different personality disorders outlined in the DSM-V, and they are separated into three categories—clusters A, B, and C. Schizoid personality disorder is one of three personality disorders in cluster A, a group of conditions marked by behaviors, thoughts, and interactions that may be considered unconventional or unusual by others. Thought to be the least common cluster A disorder, schizoid personality disorder is a rare condition, but one that can have a serious impact on those who experience it.

While its name sounds like schizophrenia—and it can, in fact, lead to that mental illness—schizoid personality disorder is a distinct condition, with its own symptoms and effects.  

Those with schizoid personality disorder often prefer to be alone and have trouble developing relationships. They may not experience or express emotions in an observable way and often have trouble feeling pleasure. Many people with the condition fail to realize that their behaviors or thoughts are different than those around them. 

The lack of social interaction and difficulty reacting to emotional situations that are often present in schizoid personality disorder can potentially have negative effects on many facets of life. Schizoid personality disorder can impact an individual’s ability to nurture fulfilling relationships, express their emotions in healthy ways, and maintain a career. 

Signs and symptoms of schizoid personality disorder

While the symptoms of schizoid personality disorder can vary widely based on the individual, there are several common signs to look out for. 

The diagnostic criteria for schizoid personality disorder, as laid out by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), are as follows:

A lack of social interaction and a limited ability to experience or show emotion in social situations, as evidenced by at least four symptoms from the below list.

• Dislike and avoidance of close relationships
• Desire to spend time alone
• Reduced or absent desire for sexual activity
• Difficulty enjoying activities
• Trouble developing close friendships
• Little to no reaction to criticism or admiration
• Aloofness, indifference, and detachment from surroundings and emotions 

The above symptoms also must not arise out of a separate medical condition or be caused by autism spectrum disorder, schizophrenia, bipolar disorder, or a mood disorder that has psychotic symptoms.  

Relationship between schizoid personality disorder and schizophrenia

It can be easy to confuse schizoid personality disorder and schizophrenia due to the similarity of their names; and, in fact, the two conditions are closely related. People who live with eccentric personality disorders—as cluster A disorders are often called—share some genetic markers with those who experience schizophrenia. For this reason, individuals who have a relative living with schizophrenia may have a higher chance of experiencing a cluster A disorder like schizoid personality disorder. 

Many symptoms of schizoid personality disorder and schizophrenia—including lack of emotional expression, enjoyment, and social interaction—are similar. People with both conditions may also have beliefs that are considered outside of the norm.   

Despite their similarities, though, there are several important differences between the two disorders. One of the biggest differences is that schizoid personality disorder does not typically involve breaks with reality. While people with schizophrenia will often experience hallucinations and disordered thoughts that can cause paranoia, those with schizoid personality disorder generally will not—and if they do, their breaks with reality are normally short term. 

Additionally, people who live with schizoid personality disorder usually do not exhibit the disordered speech patterns that people with schizophrenia often display, though they may still speak with a distinctive inflection or tone.  

Causes of schizoid personality disorder

While the precise cause of schizoid personality disorder is unknown, like many mental health conditions, it is thought to develop due to a combination of genetics and external factors. Studies show that the disorder’s heritability could be anywhere from 28% to 59%, which proves that there is a substantial genetic component. Common environmental factors are thought to include a household in which emotions were not readily expressed, brain injury, and low birth weight. 

How do symptoms of schizoid personality disorder manifest?

Unlike schizotypal personality disorder (a different cluster A personality disorder) or schizophrenia, those who have schizoid personality disorder typically understand the world that they live in and their place in it. As with schizophrenia and other eccentric personality disorders, though, people with schizoid personality disorder often have a lack of interest in doing things that would help them develop strong social relationships. 

Where many people reach out to others to form relationships and enjoy their company, those with schizoid personality disorder may be more likely to relish time spent by themselves. In fact, they may go to great lengths to find solitude, potentially seeking out a job that doesn’t require a collaborative environment, a solo living situation, and hobbies that they can participate in alone.  

People who live with schizoid personality disorder rarely experience the loneliness or desire to belong that others may feel when socially isolated. This can make it hard for them to acknowledge the presence of a mental health concern. When individuals seek treatment, it is often at the urging of other people in their lives. 

Treatment for schizoid personality disorder

Schizoid personality disorder can produce complex symptoms and potentially have a serious impact on an individual’s life, so management can be vital to an individual’s mental and emotional well-being. However, because the disorder is rare—and people with it are often hesitant to seek care—there is limited research into the most effective methods of treatment. 

Evidence for efficacious treatment often comes from studies on other personality disorders. So, symptoms of the disorder are thought to be best treated through a combination of medication and therapy. 

Medication may be used to treat symptoms of depression, anxiety, or other conditions that may appear concurrently with schizoid personality disorder. The specific medication will often depend on the individual and their symptoms. 

Psychotherapy is a common form of treatment for personality disorders and, as such, may be an effective method of managing schizoid personality disorder. Family therapy is thought to be a particularly useful modality. Often, being with family members can help the individual open up more than they might with only a mental health professional. Family members may also be able to help identify areas of concern that need to be addressed. 

Individual therapy sessions can also help decrease symptoms. One of the most widely used modalities for personality disorders is cognitive behavioral therapy (CBT). CBT helps people reframe intrusive thoughts that may lead to unwanted behaviors. A therapist can help the individual see the connection between negative thoughts about social interaction or vulnerability with others and the desire to self-isolate. One way to help people with schizoid personality disorder approach treatment like CBT in a more comfortable way is online therapy, which eliminates the need to meet with a therapist in a more formal setting. 

Support groups and group therapy can also help an individual with schizoid personality disorder because these settings can include conversation and other forms of social interaction. It may be necessary to introduce these social environments slowly, as these can be overwhelming to someone who is not comfortable in these situations.

Managing personality disorders with online therapy

Studies show that online therapy can help individuals with conditions like schizoid personality disorder address their symptoms. A review of 11 studies on the efficacy of online therapy found that app-enabled treatment can be as effective as in-person therapy when it comes to treating personality disorders. Researchers found that treatment could significantly reduce symptoms of personality disorders and that participant satisfaction was high in many of the studies.

If you're living with schizoid personality disorder or similar mental health-related concerns, consider taking advantage of online therapy through BetterHelp. If you aren’t yet comfortable conversing face to face with someone, you can participate in therapy remotely, through video call, voice call, or in-app messaging. You’ll also be able to utilize helpful resources, like at-home exercises that may assist in reinforcing certain concepts or help you learn how to express your emotions in healthy ways.