Schizoid personality disorder - how to recognize danger

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Reason and emotions... They write a lot about them and often talk about them. Mismatch between the intellectual and emotional spheres at the personal level, the destruction of their delicate balance is a real threat to health. Psychiatrists and psychologists call inconsistency (disconnection) of a person’s inner “I” schizoid personality disorder (SPD). The schizoid organization of the psyche is full of contrasts: a person’s external emotionlessness turns into internal creativity, the desire to protect personal boundaries correlates with the desire to violate the boundaries of another person. How does the disease manifest? Is it a death sentence or treatable?

Specialists at Dr. Isaev’s psychiatric clinic provide treatment for schizoid personality disorder in Moscow, invariably achieving stable results in remission. If you suspect that your subtle psycho-emotional world is disturbed and are trying to understand the causes of this condition, call us at the phone number listed on the website. The psychologist on duty will advise you free of charge and invite you to attend an appointment with a specialized doctor. Don’t refuse to get help, because correction in the early stages gives lasting results in a short time.

What is schizoid personality disorder?

Violations of this profile are disorders of an eccentric nature. The complexity of the dysfunction lies in the negative impact of SPD on all areas of life. Uncommunicative people, immersed in their own inner world, cannot create full-fledged families, and have a poor attitude towards fulfilling their own responsibilities. Conversation with themselves is more important to them than dialogue with others. They rarely smile and are prone to constant fantasizing.

Psychiatrists do not distinguish the concept of “schizoid” syndrome. It is often understood as Asperger's syndrome (a type of autism). While outwardly similar in the desire for isolation and avoidance of contact with the external environment, schizoid personality disorder and Asperger's disease have significant differences in symptoms and manifest themselves in different ways. While Asperger's syndrome is clearly evident in early childhood, SPD only becomes clear in adolescence.

Accentuation has nothing to do with impaired socialization. Persons with schizoid accentuation easily adapt to the situation. They interact well with society, are successful in their careers and are quite capable of building harmonious relationships with other people. The only thing that can “bring them closer” to schizoids is stress. Under conditions of strong psychological stress, the boundaries between accentuation and disorder are blurred. Being in conditions of constant stress threatens people with accentuation of the schizoid type with the development of schizoid personality disorder.

The psychiatric department of Dr. Isaev’s clinic specializes, among other things, in the treatment of patients with SPD. Patients with a complex illness bordering on schizophrenia require special attention from doctors. It should be noted that the disease often manifests itself in people who have relatives with schizophrenia. Only experienced doctors are able to conduct a competent diagnosis, distinguish between a disorder, syndrome, accentuation and prescribe competent treatment.

In 2008, in the Journal of Neurology and Psychiatry. S.S. Korsakov, ours was published, together with M.E. Burno, article “Psychotherapy of patients with personality disorders characterized by a predominance of hypochondria” [6], which reviewed the state of the problem according to the literature and general diagnostic, clinical and psychotherapeutic issues. The materials presented in it gave reason to believe that it is advisable for patients with specific personality disorders with a predominance of hypochondria to use the version of the creative self-expression therapy method developed by us according to M.E. Stormy (TTSB). It was emphasized that in this case, it is important for patients to make sure that creative passion for life with the awareness of oneself surrounded by people, an inspired understanding of one’s feasible social usefulness (in accordance with the nature of one’s character) softens and relieves painful mental characterological tension, and with it a predisposition to manifestations of hypochondria.

We attempted an additional study of this group of patients using a special version of the TTSB method [1, 2, 8]. The features of this option are: 1) an adapted (somewhat simplified) approach, designed for the method to be used by both a psychotherapist and a general practitioner; 2) “splitting” the method into short, emotionally vivid techniques (for example, a 20-minute attempt by a patient to communicate with nature for therapeutic purposes, etc.); 3) strengthening the meaningful sound when teaching patients on general medical (somatic) topics.

This article provides an observation reflecting the experience of successful application of the described method of psychotherapy.

Patient A.

, 44 years old, is an art teacher at school by profession.

Anamnesis of life.

There is no hereditary history of mental illness. She was born from her first labor without any pathology. In preschool and primary school age, she developed a closed-in-depth character, “on her own mind,” was not sociable enough, “uncompromising” in relation to others, and “too serious.” She played with pencils, imagining them as people. At school - from the age of 7, I studied with excellent marks. After graduating from school, she received a specialty as an art teacher at a pedagogical school. From the age of 20 she taught in primary school. Then she married “a man of the opposite character - a cheerful, sincere and warm optimist.” I didn’t feel in love, I remained cold internally. She always had persistent idealized ideas about family relationships. She couldn’t get pregnant until she was 30, and she was worried because it didn’t fit into her “life plan.” By mutual agreement, my husband and I adopted an infant girl from an orphanage. At the age of 31, she entered the Pedagogical Institute, where she received the profession of educational psychologist, assuming that this education would help her raise her daughter. In 2000, she underwent surgery—layer-by-layer marginal corneal keratoplasty for complicated viral keratitis of the right eye. In 2005, she left her job, and at the time she contacted us for help (2007), she was not working anywhere. She lives with her husband and 15-year-old daughter in a communal apartment, where she has a conflictual relationship with a neighbor.

History of the disease.

The patient attributes the first signs of unusual mental experiences to the age of 3: she clearly remembers that she could not stay in kindergarten, being frightened by loud music in class. At the age of 5, I experienced an unusual feeling, as if “I had already lived before,” “I came from somewhere.” At the onset of menarche (age 13), she developed a “ridiculous fear” of becoming pregnant (despite the fact that she was a virgin at the time). I realized the absurdity of this fear and considered it an obsession. This kind of obsessive fear “dissipated on its own” after a few months. At the age of 14-16, she was susceptible to asthenic conditions - attacks of weakness, sweating, palpitations, and decreased blood pressure. At the same time, for no reason, suspiciousness intensified (“I was looking for illnesses in myself”) and a tendency to anxious and moral and ethical doubts appeared: I doubted whether I was doing the right thing, could not make a decision for a long time, worried whether I had done something “inappropriate.” In these cases, she closed herself off, carefully thinking about real and imaginary problems. At the same time, a feeling of purposelessness in life and one’s own insecurity began to periodically arise. At the age of 31, she began to realize her lack of emotionality, manifested by her coldness and formal attitude towards her daughter, and felt a painful inferiority about this, but could not help herself. At the same time, fear of traveling in public transport first appeared due to large crowds of people. In this regard, she began to find it difficult to endure trips to Ukraine, where her close relatives live. She understood the stupidity of her “state, reaching the point of horror.” In addition, a feeling of “full intestines” began to appear at the moment the toilet was closed, when the train stopped in the border zone, and I also feared the rudeness and rudeness of customs officers (although rudeness had always been difficult to bear in the past).

The experiences described inevitably led to obsessive thoughts about a serious illness, but she did not share them with anyone. At the age of 37, after undergoing keratoplasty, an unreasonable fear of losing vision appeared. For a long time she did not believe in the successful outcome of the operation, despite the good results of the examination and the assurances of the doctors that “she was fine.” She was referred by an ophthalmologist for a consultation with a neurologist with complaints of alarming fears of “losing her vision.”

On the referral of a neurologist, she was hospitalized in the neurosis clinic, where she stayed for 20 days with a diagnosis of “vegetative-vascular dystonia, asthenodepressive syndrome.” She received therapy with antidepressants and benzodiazepines (Zoloft 0.05 g once daily; phenazepam 0.0005 g twice daily), as well as psychotherapy. According to the patient, the treatment was ineffective, and after discharge from the hospital she continued to periodically experience hypochondriacal fears. At the age of 40, she returned to the clinic at City Clinical Hospital No. 71 with complaints of dizziness, aching pain in the left side of the chest, and anxiety. After a thorough somatoneurological examination, the polyclinic neurologist sent her back to the neurosis clinic, where she received treatment in a day hospital for 15 days. She received drug therapy (cipramil, mezapam), as well as vitamin therapy and a course of autogenic training. During this period, all results of ECG, EEG and laboratory hematological and biochemical tests were normal. After discharge, she continued taking the prescribed medications for about 1.5 months, noting a slight improvement in her condition. Due to ongoing health concerns and constant “mental stress,” she quit her job at the age of 42.

After 2 years, she again went to the above-mentioned clinic to see a psychotherapist and came under our supervision. The patient complained of headaches arising against the background of anxiety, a painful feeling of inferiority, a painful tendency to loneliness, various painful sensations in the body (for example, during palpitations, with a feeling of “full bladder”), anxiety arising outside the home due to for fears of “not finding a toilet.” I constantly experienced an obsessive feeling that I was suffering from a serious illness, while admitting the presence of both somatic and mental illness.

Mental condition.

Looks younger than his age. Dressed neatly and tastefully. In conversation he is somewhat aloof. Painfully shy, does not look the interlocutor in the eye, speaks in a melodic, slightly muffled voice. Delicately, rather coldly, she reports that she is “an unpretentious person,” admits that she often experiences a painful feeling of inferiority and helplessness “in front of life,” although everyone around her considers her a “strong” woman. She notes a difficult relationship with her daughter, whose behavior causes her painful anxiety. Schematically, “with his own logic,” he sets out his problems and painful sensations. Thus, I am convinced that even short communication with a roommate who abuses alcohol has a negative impact on her mental state; can’t stand “his rudeness”; when he’s at home, she gets tremors all over her body, which “gives” migraines and other unpleasant sensations and pains. He treats his condition as painful, suspecting the presence of a serious neurological disease (even a brain tumor is possible). From time to time he feels internal tension, similar to a “stretched string”. I always considered myself “internally contradictory.” She is burdened by her painful shyness in relationships with strangers - she is concerned about what people “from the outside” will think about her, since she “doesn’t know how to communicate with people in a group” (“I can’t be completely frank even with my loved ones”). It seems that the patient is “confused in herself” and is angry with people for this, trying to understand her “difficult” character. Seeks reassurance and reassurance that her mental health is “okay.” He reports that he paints portraits and landscapes “for himself and his relatives,” thus softening “mental tension.” She says that among the artists the patient is in tune with painters depicting nature, for example Levitan, Kuindzhi. He believes that he “will not be able to paint nature like them, because it is “different.” Among her literary preferences, she notes Sholom Aleichem’s novel “Wandering Stars” and says that “she never loved A.P. Chekhov is boring." With great pleasure, without stopping, I read George Sand’s novel “Consuelo”. Among the works of Agatha Christie I like is the work “Portrait in the Interior”. In the conversation, it turns out that from her youth the patient “vaguely” felt the independence of her spirit in relation to her body, believing that this was a feeling of immortality of the soul. Being cold towards people, she notes her heightened sensitivity to dogs, especially toy poodles, which she often draws. She says that they are dearest to her (“the poodle is a symbol of a warm, comfortable, harmonious life.” In married life, she values an abstract family scheme and emphatically respectful relationships more than warm feelings. In conversation she repeatedly repeats that in recent years she has become especially clearly aware that “harmony is eternal.”

During the observation period, the patient was consulted by a number of specialists. Psychologist's conclusion:

in the personality structure, the leading ones are schizoid and psychasthenic traits, expressed at the psychopathic level;
social adaptation is reduced. Neurologist's conclusion
: no signs of organic damage to the central nervous system were identified.
Therapist's conclusion
: no signs of organic pathology from the internal organs were identified.

The patient was also examined using a number of scales and questionnaires. So, in accordance with the short characterological questionnaire of M.E. Burno [4] found that the patient’s character structure was dominated by the schizoid (autistic) radical and psychasthenic-like experiences. According to the clinical and psychological protective stress test, Vl. Ivanova (Bulgaria) did not identify identification disorders, ambivalence, ambitendence, paranoid symptoms, reasoning, etc., characteristic of the endogenous process (schizotypal disorder), but noted the presence of increased emotional reactivity characteristic of the neurotic (psychopathic) register of disorders, as well as exhaustion, decreased performance and instability of the autonomic nervous system.

When using the MMPI test (modified by L.N. Sobchik [9]), the dominance of the psychopathy scale was determined, the second most pronounced was the hypochondria scale, which indicates the uniqueness of the personality and the combination of hypochondriacal symptoms with social maladjustment and internal disharmony (in a broad sense).

A diagnosis was made: “schizoid personality disorder” (category F 60.1 according to ICD-10); hypochondriacal disorder (section F 45.2). Decompensation with a predominance of hypochondriacal manifestations in the clinical picture.

As can be seen from the anamnesis and the results of a personality study of the patient, she suffers from schizoid personality disorder with a predominance of hypochondria. This is evidenced by the autistic features of her thinking, features of emotional manifestations and behavior. This is a tendency from childhood to live with introverted spiritual experiences, schemes, a clear psycho-aesthetic proportion, revealed in heightened sensitivity to animals and coldness towards people; autopsychic resonance to the detriment of allopsychic resonance; schizoid reactions typical in their structure. The characterological conflict is imbued with defensive autism, the desire to achieve autistic harmony in life, and a sense of the secondary nature of material reality. Reality for the patient in this case is spiritual reality, beauty, harmony. The basis for decompensation in this case was a difficult domestic situation (living in a communal apartment with a neighbor addicted to alcohol) coupled with a difficult relationship with his daughter. Decompensation resulted in a significant worsening of schizoid personality disorder and hypochondriacal experiences. It is represented by the following phenomena: fear of contracting a serious somatic or mental illness; obsessive thoughts of a hypochondriacal nature; anxiety disorder with symptoms of agoraphobia, anxious painful doubts, mental inertia; somatoform autonomic dysfunction of the genitourinary system. But let us emphasize that there are no endogenous-processual manifestations in the patient’s personality.

Considering the known similarity of the clinical manifestations of schizoid psychopathy in the stage of decompensation with the manifestations of endogenous schizotypal disorder, it was necessary to differentiate them diagnostically. The differential criterion confirming the presence of schizoid personality disorder, and not schizophrenia, is the Gannushkin tetrad [7]: 1) the presence of pathological personality traits that maladapt a person in society, drawing attention to their morbidity (in this case, this is autistic thinking, feeling, autistic behavior characteristics in relation to people, etc.); 2) persistence of pathological personality traits with the possibility of compensation and decompensation (these characterological properties occurred throughout the entire life course; depending on how much the patient was able to find an environment favorable to her autism and express herself, she was more or less compensated); 3) the totality of pathological personality traits that permeate the personality as a whole; 4) the innateness of these pathological properties, total personality traits (from early childhood and throughout her life, the patient was psychologically complex, had a limited number of contacts, and preferred individual activities to work in a team).

It is characteristic that the first decompensation occurred during puberty. Subsequently, psychopathic properties worsened to the level of subcompensation during changes in living conditions, against the background of psychotraumatic situations. Periods of subcompensation were followed by periods of compensation, when the patient adapted to the microenvironment or initially found herself in favorable conditions. In this case, the following signs testify against a schizotypal disorder: the dynamics of the state indicated above, typical for psychopathy; absence in the anamnesis of indications of endogenous-processual episodes; the absence of qualitative endogenous-processual shifts in the personality structure, the absence of manifestations of schism; no signs of decreased mental activity; absence of psychotic level disorders; the close connection in this case between experiences and behavioral reactions with the structure of a given schizoid personality and their certain psychological adequacy. Thus, the psychaesthetic proportion is also psychologically understandable: it is sensitive to what expresses its original spiritual reality (beauty, symbols, harmony in nature, painting, family life, etc.) and coldness, formality towards people - colleagues, relatives. Integrity and safety of the personality, its interests and guiding tendencies, which is especially well observed in the compensation stage; with age, the corresponding autistic individuality increasingly reveals itself: the personality becomes internally richer, subtler, more perfect (with schizophrenia, stereotyping of the personality occurs, loss of originality); MMPI test, as well as stress test Vl. Ivanov did not reveal manifestations characteristic of schizophrenia; painful hypochondriacal sensations in schizophrenia are often pretentious, bizarre, and unusual in nature.

A differential diagnosis with psychasthenic psychopathy was also carried out. The following speaks in favor of schizoid psychopathy: 1) autistic thinking (a sense of independence of one’s Spirit in relation to the body, a sense of the eternity of Truth and Harmony, immersion in one’s inner world, complex internal processing of one’s experiences, the search for the Meaning of life, a penchant for dream painting, a conceptual approach to one’s own creative activity, etc.); 2) early development of schizoid traits (from early childhood she was formally uncompromising with pronounced difficulties in adapting to a new environment and little contact with peers (with a conscious desire for varied formal communication, she was always somewhat burdened internally by this, getting real pleasure in drawing, reading, thinking alone with oneself; relationships in the family, despite the “trustful atmosphere,” always remained formal); 3) persistent idealized ideas about relationships in the family, with friends and in the team (work, school, etc.) that do not correspond to reality.

Thus, there is enough reason to believe that we are not talking about character accentuation, but about psychopathy. With accentuations, there is fragmentation and isolation of overly expressed character traits; in this case, we are dealing with pathological personality traits that permeate the personality as a whole.

Treatment

The patient was treated on an outpatient basis in the psychotherapeutic office of the clinic at City Clinical Hospital No. 71, where she received both individual psychotherapy and group psychotherapy using a specially developed version of the TTSB method for patients with specific personality disorders with a predominance of hypochondria.

Previously, we pointed out that in psychotherapeutic assistance to patients with a schizoid character, it is important to take into account the autonomy of their personality and rely on it. It was necessary to help the patient non-directively free herself from the “labels” of a critical attitude towards herself, understand herself through positive self-perception and, thus, move closer to self-support and self-acceptance. Thanks to her fairly high desire to understand herself and the people around her, trusting relationships quickly developed.

Individual conversations were aimed at correcting painful reactions associated with the awareness of her “foreignness,” since the patient believed, for example, that from the point of view of others she was “an unnecessary, cold, narcissistic egoist.” The following statement made by the psychotherapist helped: “focus on oneself is not destructiveness or selfishness, but is the tendency of a creative person to use his personality as the main instrument of cognition.” It was also important for the patient in individual conversations to discuss the issue that her “feeling that she is alone” is apparent, since there are many people like her - lonely and withdrawn. In order to free themselves from hypochondria, symptomatic psychotherapy was used in individual conversations. For example, the technique of Frankl’s paradoxical intention, conceptual-inspiring psychotherapy (elements of influence, symbolism, corresponding to the patient’s craving for harmony and beauty).

At first, the patient treated therapy with creative self-expression with distrust; at each session she kindly and coldly expressed her opinion in this regard, emphasizing that a person’s character is multifaceted and complex and “it is not so easy to put it into several types.” During classes she kept herself somewhat aloof, “to herself,” and did not immediately attract the attention of the group. I became interested in the book “On the Characters of People” [5] - at first I found there “my” case of a patient with an obsessive fear of becoming pregnant, and asked about the diagnosis in the described clinical case with anxious fears. But then she gradually began to get involved in group classes. At one of them I made a report about the artist A. Ivanov. She spoke quite clearly and to the point about him, outlining some of the painful manifestations he had. At the same time, she understood for herself the essence of its polyphonic character and became convinced that she did not have “this mosaic,” and therefore there was no “painful process.” She even drew a table where she indicated each characterological radical and its features. This table was subsequently used by the entire group when discussing a person’s character. Then she said that she “felt”, “lived” the group classes, the group creativity classes according to our version of TTSB, which dealt with the topics “Love and Creativity”, “Cat and Dog”, “About one “psychotherapeutic consolation”, were especially adequate for her. “To collect your “I”,” “Towards the peculiarities of the experience of nature by an autistic person” [3]. Over time, she became close to the group members, unobtrusively communicated smoothly with everyone, but did not actively disclose her experiences. During a lesson on character, M. Lermontova actively spoke out and noted that in “A Hero of Our Time,” some characters, despite their ugly appearance (“as if the author had specially endowed them with such an appearance”), have a “strong” inner core. Lermontov’s character was briefly described as a “single character,” i.e. the closed-in-depth character of an autistic person is close to her. Having information about different characters, she tried to understand herself and at first said that she “looked like an anancast, but I’m not sure,” but later came to the conclusion that she had a “closed-in-depth” character.

After several sessions, the patient’s anxiety and vegetosomatic disorders significantly decreased, she “began to pay less attention to unpleasant sensations in the body,” and “learned to relax.” I realized that the warmer she treats people, the more they will understand her. I found my own way to communicate with group members by inviting them to “drawing lessons” at my home. By the end of the course of treatment using our method, she came to her own conceptual autistic creativity, which helped her become inspired: she began to make dolls, creating from them entire compositions from famous fairy tales (“The Snow Queen”, “Puss in Boots”, etc.). Thanks to this rather individual creativity, I found a way to improve my financial condition by selling these compositions for a lot of money. She was grateful for the classes, the opportunity to communicate in the group (which she “always really missed”), and studied with interest the characters of the other participants. Classes in the group helped her improve her relationship with her daughter. Moreover, she began to study the nuances of the formation of her personality.

After the end of treatment, I corresponded by e-mail with the doctor. These letters were rich in content, reflecting on character, group activities, and creativity. Having finally realized what was autistic in herself, she noted that from then on it became easier for her to understand many things about herself, to create in her own way, “with healing inspiration in her soul,” and the feeling of hostility from the world receded. She wrote that “discovering myself in big things and in everyday small things was exciting.”

The patient remained anxious about her health for a long time, but the high motivation to “understand herself” smoothed out the psychopathic traits and the patient adapted socially; over time, her manifestations of hypochondria weakened.

In this case, a clear improvement in the patient’s condition began to be noted during individual sessions after the 1st month, and during short-term group therapy according to our version of the TTSB method - from the 9th session. We can talk about complete stabilization (compensation) of the patient’s condition after the end of group therapy (12 sessions). If during individual sessions the stabilization of the condition continued for 1-3 months, then after completing the course of short-term therapy it lasted for about 2 years.

Catamnesis.

Observation of the patient for 2 years showed that her mental state remains stable at the level of improvement achieved. She writes a diary, draws, creates dolls and doll compositions. She created her own website on the Internet, where she happily publishes her own poems and short stories; collects her “close to soul” artistic works, with the help of which she was able to “look into herself”, accept herself as she is. She believes that thanks to self-knowledge, she manages not to be afraid of her disorders, not to get lost in front of them, as before. She notes that she has become calmer about life’s difficulties, has learned to experience pleasure in communication, and to perceive her surroundings creatively.

Thus, as a result of the psychotherapeutic influence of creative self-expression, a significant improvement in the patient’s mental state was noted.

With the help of creative self-expression therapy, it was possible to achieve stable compensation for schizoid personality disorder and hypochondriacal manifestations.

The effectiveness of therapy in this case can be assessed as quite high, since the patient currently does not need the help of a psychotherapist. Although the presented case does not allow us to draw general conclusions, given the patient’s creative profession (artist), it nevertheless illustrates the ability of the version of the TTSB method we developed to positively influence personality disorders in patients whose clinical picture is dominated by hypochondria.

Causes of the disease

According to statistics, 5% of the planet's population suffers from pathology. The tendency to develop the disease manifests itself in childhood. Hyperactive children are usually hypersensitive. While studying psychopathology, scientists noticed that already in infancy such children clearly define their personal boundaries, reacting rather strangely to the touch of adults. They instinctively deviate when their parents approach.

Schizoid personality organization does not mean that it is the beginning of the schizophrenic process and will contribute to the development of schizophrenia. Moreover, a large percentage of schizophrenics are people who previously had pronounced signs of SPD syndrome. A person with schizoid personality disorder is capable of self-identification: he experiences shame, guilt and perceives the world in its real manifestation. Concern for safety is the main manifestation of the disease.

There are several theories explaining the reasons for the development of the disease. A number of researchers believe that SPD is stimulated by gene mutations (mutation theory). Environmental pollution leads to “breakdowns” of the DNA code. Gene disorders are transmitted to descendants. Other scientists see the reasons in the low self-esteem of the individual himself. Still others are the lack of attention to the child from adults and his subsequent isolation. Fourth - in increased mental activity, expressed in control over every action and the simultaneous inability to express one’s own thoughts and come to conclusions.

At Dr. Isaev’s psychiatric center, research into the causes of SPD is given special importance. Treatment directly depends on what exactly contributed to the development of the pathology: inability to respect oneself, cerebral/endocrine insufficiency, abuse in childhood by parents, lack of skill in establishing emotional contact with others, the desire for self-isolation, or something else.

Causes

The exact causes of schizoid disorder are difficult to identify. Doctors usually talk about factors predisposing to it. Among them:

congenital, genetically determined characteristics;
environmental factors - upbringing, social status, etc.;
the attitude of parents towards each other, towards the child;
psychological trauma, violence, loneliness, stress.

This disorder is little studied when it comes to its etiology. During diagnosis, doctors try to identify the trigger that provoked the first symptoms. This often helps stop the progression of the disease.

Symptoms of schizoid personality disorder

The disease is difficult to diagnose. In order not to make a mistake in prescribing treatment, the doctor must be convinced that the patient has at least four of the following symptoms:

inability to enjoy close relationships (relatives, family);
persistent desire for solitude;
loss of interest in sex;
satisfaction from a limited number of activities;
small social circle (preference for relatives over friends);
indifference to blame or praise;
emotional coldness.

A large number of contacts and social roles are clearly not for them. The most attractive thing is to perform responsibilities alone. However, this rule does not apply to everyone. Schizoids cannot be accused of primitivism. Many of them achieve heights in their careers and create surprisingly close and harmonious relationships.

Schizoids can be expansive or sensitive. Strong-willed people (expansivists) usually act under the influence of their own judgments. They are easily vulnerable and are responsible for violating their own boundaries with negativity and short, sharp phrases. The lack of a social environment and friends does not bother them much. Sensitive schizoids withdraw into themselves. Vulnerable people who do not strive for aggression constantly experience dissatisfaction with themselves. They are prone to various types of addictions: emotional, alcohol, drugs.

Conflict traits of the schizoid personality type

To understand the problematic side of Schizoids, it is useful to understand their fears. Schizoid people are in a state of defense almost all the time, because their biggest fear is that everything does not make sense, and first of all, their own life. “There is no meaning or value in my life” is one of the biggest fears, and in order to protect yourself from it, you begin to devalue everything else around you. Thus, the Schizoid also devalues himself. They are prone to sarcasm and devaluation of the interlocutor. These are the types who can express doubts about the intelligence of their interlocutor with one facial expression

They fence themselves off from society, oppose themselves to it: “I really don’t need anyone.” Schizoid people actively defend their own territory, even when this is not necessary at all, when no one is encroaching on the territory. A typical schizoid song: “Everything will be my way.” The problem is that while they crave personal freedom, they deny it to their loved ones.

And like people who are afraid of desires, they over-idealize their ideas. This is a defensive reaction, because the more complex the desire, the more difficult it is to realize it: “Only mega-wishes are fulfilled, the most important ones!” In personal life it results in the phrase:

“This is not my prince, but some chubby fool”

The same Doctor House does not go to treat any case, he only takes on the most incredible cases. And that’s why they don’t like to help people just like that, from the heart. Only from the idea.

They defend their own territory and borders even when it is not required (“don’t put pressure on me - I myself know what to do and how”, “this is my home - free the territory”).

Manifestation of SPD in men

Men with schizoid personality disorder do not seek pleasure. They are not happy about holidays, art and meeting with friends. They do not go to the top of their careers. Such people show equal indifference to grief and joy. Emotionally cold natures are rarely capable of sympathy and empathy. Men tend to suffer from decreased libido. Interest in the opposite sex decreases, the need for intimate relationships is practically absent. Maintaining one's own status in society is a real problem for schizoid men. The opinions of others are of little interest to them. Indifference to praise and criticism does not at all contribute to the harmonization of relationships.

Men with SPD are not interested in politics. The lack of curiosity and sustained interest in something can be compensated for in schizoids by the emergence of a hobby. A very “childish” hobby traditionally shocks others. A grown man suddenly starts collecting butterflies, matchboxes, postcards and chocolate candy wrappers.

Appearance and behavior

People with schizoid disorder have a characteristic appearance. They are thin, asthenic in build, with long legs and a high waist. They are characterized by angularity, lack of coherent transitions, clumsiness and clumsiness. Movements lack smoothness and harmony. For some they are pretentious and original, for others they are stingy and stereotypical. Although there are also those who amaze with their ideal posture. At the same time, they are so collected and fit that they create the effect of a wooden man - they walk as if on hinges.

The gait of autistic people is different: some walk with a hop, some walk robotically, others have difficulty moving their legs. They move along a strange trajectory, stumble or stumble. Sitting, they take pretentious poses.

In a crowd of people, schizoautistic people hurt or unintentionally push those around them, experiencing difficulty in instantly assessing space. They are not at all concerned about what they wear. They can wear an old shabby jacket for decades, they wear whatever they have to. In appearance one can see sloppiness, uncleanliness, greasy, unkempt hair, unshaven or beard, dirty clothes. This is not a challenge or laziness, but simply indifference to formalities and requirements.

Of course, not all schizoids are so sloppy. But they all give preference to clothing items that isolate them from people: hoods, raincoats, voluminous sweaters. They love backpacks, bags, bags. They wear clothes in black or gray colors.

Patients are able to surprise others with an elaborate outfit. Bright elements of clothing, oddly fitting and not matching in style, create the image of such a person. In a crowd of people it contrasts noticeably, attracting the eye.

The speech of patients is distinguished by strangeness of logical content, intonation, and grammatical structure. They place accents incorrectly in certain words. Some speak pretentiously, complexly, ornately, others speak monotonously and laconicly. Sometimes there is a discrepancy between the meaning of what was said, its intonation and gestures.

The expressive appearance and eccentric behavior of schizoid people is not at all a reason to attract attention to themselves. They simply ignore him. Rather, it is a result of their peculiar nature and interaction with the world.

Schizoid personality disorder in women

Women's natural sociability and emotionality seem to protect the fair half of humanity from illness. Women suffer from SPD much less often than men. Motherhood also becomes a natural protection for a woman. Nature forces the mother to be emotionally contact. Otherwise, she will not be able to teach the child tender feelings, and he will grow up to be a copy of his mother.

The laws of procreation naturally eliminate all threats. If a woman still has schizoid personality disorder, it manifests itself in a less acute form. In particular, female asexuality, which is traditionally perceived by women as natural, is not so noticeable. SRD brings significantly less discomfort to women than to men.

Diagnosis of the disease

Diagnosis of SPD is made only by a psychiatrist. At the diagnosis stage, it is important to distinguish psychopathology from other mental disorders. Schizoid personality disorder is accompanied by neuroses, depression, phobias, and anxiety. A schizoid should not be confused with a narcissist. A schizoid, like a narcissist, is enough of himself, but he will never declare his merits as superiority over others. Carriers of pathology take care of their own uniqueness in a completely different way. They do not show it off, but seem to hide it, worrying that multiple contacts can destroy it.

People with SPD seem to be unable to feel. They have a very subtle mental organization. However, showing emotions is not for schizoids. Having once decided that emotions are an art of which they understand nothing, schizoids refuse to be outwardly emotional and choose coldness. Sexuality is alien to them. Rare memories of sex are confined to the need to satisfy sexual needs, nothing more.

Schizoids should not be confused with schizophrenics. The vivid fantasies of schizoids always have boundaries with the real world. This is also the cause of unbearable pain for schizoids. These people understand that their fantasies will not come true. Therefore, the inner world is closed, frankness is excluded. Why share the pain? The lack of desire for contact with the outside world leads to the fact that schizoids stop taking care of their appearance. Untidyness and sloppiness are a common manifestation of the disorder.

Unfortunately, there is no detailed classification of schizoids that can help doctors accurately diagnose the disease and choose methods for its correction. American psychologist Theodore Millon identifies the following types of schizoid personality disorder:

sluggish: slow, phlegmatic, apathetic;
distanced: tending to self-isolate;
depersonalized: transferring one's own states onto someone else;
unemotional: cold, unresponsive.

The psychiatric department of Dr. Isaev’s clinic is always a qualified diagnosis of the disease. Doctors at the center will not confuse pathology with other diseases. The diagnosis will be preceded by observation of the patient, long-term communication with him and with relatives. This is the only way to prescribe competent treatment that can return the patient to normal life.

Diagnostics

When diagnosing, it is important to differentiate the disorders due to the similarity of many of their symptoms. To achieve this, many tests are carried out using various clinical scales. In this case, it is necessary to obtain information not only from the patient himself, whose feelings are too subjective, but also from his environment. In some cases, it is necessary to collect anamnesis from the patient’s relatives.

Standard laboratory and instrumental methods are also prescribed, including CT, MRI, EEG, etc. Tests for thyroid hormones are collected. This allows us to exclude pathologies of the endocrine system, organic brain damage, depression, etc.

Treatment of schizoid personality disorder in Moscow

Therapy for schizoid disorder is based on a comprehensive treatment methodology. An experienced doctor competently combines neuroleptics, antipsychotics, cognitive and group therapy, a biobehaviouristic approach and psychoanalysis:

The acute course of the disorder is treated with haloperidol. Due to the influence of the drug on the mediators of nerve fibers, the behavior of the individual is regulated. All the doctor’s efforts are directed towards correcting thinking.
Antipsychotics risperidone, sulpiride, amisulpride, aripiprazole, etc. eliminate depression and apathy. The younger generation of drugs are very effective and have a mechanics of action similar to the antipsychotic Haloperidol.
The task of a cognitive therapist is to teach a person to recognize and manage their emotions. Together with the patient, the doctor identifies certain feelings for observation, and analysis is started. Positive emotions play a very important role in cognitive therapy.
Biobehavioral techniques are aimed at creating situations in which a person would experience discomfort. In the format of a role-playing game, relationships that are difficult for a person are worked out. The patient is required to show genuine feelings.
Psychoanalysis is based on a frank conversation with the patient. The dialogue builds the existing destructive model of behavior. Corrections are made to it, errors are sorted out. The doctor gives advice to prevent the repetition of difficult situations and the emergence of new ones.
Working in a group (collective/group therapy) aims to create a model of a healthy society. Group members are in search of the merits of those with whom they interact. Through self-acceptance comes acceptance of another. A person begins to understand how significant he is for society. Fears, complexes, unnecessary defensive reactions go away.

Of unconditional importance in the treatment of schizoid personality disorder in Moscow is the desire of the patient himself to be healed.

“The therapist’s task is to be a stable mirror image (double) who provides a fairly free, friendly space for “escaping” and does not get too close,” says Professor Gerhard Dammann, psychiatrist, psychologist, psychoanalyst, head of the psychiatric clinic Thurgau, Switzerland.

In addition to inpatient treatment, the psychiatric center of Dr. Isaev’s clinic offers . Treatment for schizoid personality disorder requires hospitalization in extremely rare cases. Not everyone wants to advertise a health problem. A doctor's home visit is the best solution. Qualified assistance can be obtained in a calm, familiar environment. If necessary, relatives can always be involved in the conversation.

Refusal of treatment for SPD is guaranteed to lead to its transition to schizophrenia or schizotypal disorder. Schizophrenia debuts with delusions, speech and thinking disorders, and hallucinations. A complication may be another psychopathological disorder: obsessive-compulsive, affective or addiction disease.

Timely consultation with a doctor will eliminate the risk of suicide. The problem of suicidality in patients with SPD, unfortunately, does exist. Suicides by schizoids are carefully planned and hidden. A self-absorbed person, unlike a hysterical person, is constantly looking for compelling reasons to justify his death. Stopping him in time is a great success.

Prevention

Families who have previously had cases of schizophrenia in their family should especially think about preventive activities in matters of schizoid personality disorder. The main condition is to reduce the number of stress factors that have a negative impact on the developing psyche of the child. It is important to teach a teenager the correct emotional response to the reactions and influences of the social environment.

The difficult but necessary task of parents is to accustom their child to the correct work and rest schedule and explain the value of a healthy diet. A culture of relaxation is important. Ideally, during adolescence, a child develops the habit of reading before bed. It will be great if he learns to prioritize listening to relaxing music over playing computer games and watching blockbusters. Preventing the recurrence of the disease is an equally important task in the compensation phase of the disease. It is important to prevent personal disharmony and a decrease in the degree of social adaptation.

“If you find out that your loved one or relative is schizoid, try to translate all your arguments into terms of reason, do not overload with emotional manifestations. Remember that there is always an internal logic in the decisions of such a person, even if his action seems strange. It is not so easy to understand, but if you figure it out, the person will become quite predictable for you. It’s not necessary to guess; you can simply ask why your friend acted this way and not otherwise,” Pavel Beschastnov, psychiatrist and psychotherapist.

If a person, regardless of the treatment and rehabilitation therapy completed, still resumes the usual reactions: increased anxiety, deception of perception reappear, thinking is disorganized, it is necessary to consult a doctor. A psychiatrist will prescribe antipsychotic drugs and thereby prevent the disorder from transforming into a deeper mental disorder. Severe forms of psychosis will be excluded. The person will become normal again and will not interfere with the lives of others.

What does a schizoid personality type look like externally?

Schizoid personalities are very mobile, like a ball of energy. Motor activity is confident, indifferent to outside views, sweeping, like a sea wave. At the same time, especially looking at men, there is a feeling of looseness, articulation, as if the joints are not secured. But women are characterized by increased mobility and grace.

Schizoid people like to dress in rich colors, noticeably, exclusively. At the same time, it is often without taking into account external opinion whether it suits or does not suit, fashionable or not fashionable. The main thing for them is that they like it themselves. These are introverts, self-confident, and even indifferent to social views.

Madonna and Benedict Cumberbatch

A common phenomenon in schizoid women, less often in men, is an elongated tailbone. Introverts have a more curved spine, and X-rays can easily determine whether a person is an introvert or an extrovert.