Psychopatholog

y of schizoid
personality
disorder

Dr. Ayatulla Elsayed

• Themain feature seen in individuals with schizoid personality
disorder is a lack of, and indifference to, interpersonal
relationships. There is a pervasive pattern of detachment
from social relationships across all contexts.
• Such individuals often present as withdrawn and solitary,
seeking little contact with others and gaining little or no
satisfaction from any contact they do have, irrespective of
its focus. They spend the majority of time alone and choose
to opt out of any activities involving contact with others.
• Individuals
with schizoid personality disorder also present
with marked restriction in their displayed affect. They
may appear slow and lethargic Speech, when present, is
frequently slow and monotonic, with little expression.
They rarely show changes in their mood, despite
external events.
• Themood is generally moderately negative, with neither
marked positive nor negative shifts. On questioning,
these individuals rarely report strong emotions such as anger
and joy. Such individuals, if functioning well, are likely to
choose occupations with limited contact with the public
or colleagues
• Because of the schizoid person’s slow and disengaging style
of interaction, others tend to withdraw or ignore him or
her. Over time, this leads to degeneration of the
individual’s already minimal social skills due to a lack
of practice.
Differential Diagnosis
• Schizoid
Personality Disorder and Delusional Disorder,
Schizophrenia and Mood Disorders with Psychotic Features
• Schizoid Personality Disorder and Avoidant Personality
Disorder
• Schizoid Personality Disorder and Those with Milder Forms of
Autistic Disorder and Asperger’s Disorder
Historic background
• It
is composed of the prefix “schizo” meaning “splitting” and
“oid” meaning “representing or like.”
• Traditionally,
Kraeplin (1913) viewed individuals with schizoid
personality disorder as quiet, shy and reserved and
“schizophrenic-like.” = latent schizophrenia.
• This
pattern of behavior was seen by many authors of this
period as part of the schizophrenic process and indeed
as a precursor to schizophrenia.
• Otherssuch as Campbell (1981) argue that schizoid behavior
can represent either a genetically determined chronic
vulnerability to schizophrenia or present in those who are in
partial recovery from schizophrenia.
Etiology
•Biological

Molecular Genetic Studies

•Some very exciting molecular genetic work has begun to appear and provides
tangible links between schizotypic psychopathology and schizophrenia.
•Avramopoulos et al. (2002) found that individuals who carried the high-activity
catechol-Omethyltransferase (COMT) gene showed elevations on the PAS
•Lin et al. (2005) found that elevations in PAS scores were associated with a variant
of the neuregulin- 1 gene that is thought to be a susceptibility locus for
schizophrenia.
•Family History of Schizophrenia

Overall, it is now generally established that schizotypic psychopathology does indeed

occur in
the biological first-degree relatives of persons with schizophrenia at rates much
higher than the population rate

Studies have found elevated rates of schizophrenia among the first-degree

biological relatives of schizotypic patients.
•Neuroimaging and Neurobiology of Schizotypic Psychopathology

Limited number of studies revealed many areas of abnormality in SPD and they note many
areas of similarity between the SPD brain abnormalities and structural abnormalities
found in patients with first-episode schizophrenia: it appears that individuals with SPD may
have reduced gray matter of the superior temporal gyrus, asymmetry of the
parahippocampus, abnormalities in thalamic shape and pulvinar volume, larger sulci,
abnormalities in the shape of the corpus callosum

Dickey et al. noted the relative absence of medial temporal lobe abnormalities in SPD (vs.
their presence in clinical schizophrenia), and they speculate, with caution, that the absence of
such abnormalities in SPD might help to suppress psychosis in those with SPD. A particularly
exciting new finding concerns reduction in gray matter volumes in SPD patients who have
never been exposed to neuroleptics.
• Neurotransmitters

• Evidence from pharmacological studies indicates that dopamine (DA) is involved in

the etiology of schizophrenia. Based on the assumption of a continuum between
schizophrenia and schizotypy, researchers have begun investigating the association
between DA and schizotypy.
Psychoanalytic theory
Object relation theory

• The way individuals perceive and relate to others people during their early
development especially significant others like parents or care givers, will frame
future relationships and attachment styles
• Negative relationships at a young age would deeply impact their future lives.

Concept of motivation
object relations theory is clearly indicated that object seeking (rather than instinctual
drives) is the primary or central human motivation. other drives and needs including
higher needs such as safety, esteem, achievements emerge in the context of a
relations and cannot be divorced from it.
Personality structure:
 In development (self-object affect units) compromise the building block of the
personality.

 This view can be explained as follows : unconscious object relations originate from the
transformation of external interpersonal relationships into internalized structures i.e.,
internalized representations of the relationships.

 what is internalized is not simply an object or a person but rather an entire relationship
experience a whole set consisting of
a. one self representation
b. object representation
c. associated affect or mood and fantasies linking the two
 These representations to not literally reflect the actual reality of the object self or
situation but are largely coloured by the child subjective experience or fantasy life.
 During early development, opposing sides of object relations are Internalized :
positive loving experience and negative rejecting experience

a. positive loving experience example in attentive caring mother nursing care child in
response to his needs this leads to positive experience of the self positive
experience of the object and positive affects of experience

b. negative rejecting experience in which the mother absent or in attentive to the

needs of the hanging child this leads to negative experience of the self negative
experience of the object, negative affective experience
• Paranoid Schizoid Position
• During the first six months
• when faced with experiences in which his mother is
perceived as hostile and unavailable or in attentive to his
needs and the infant develops sever anxiety.
• In
the face of such anxiety and in order to preserve the good
object relation experience that with the mother the
beginning of splitting operate.
• From this early traumatic object relational situation stem
from different dynamic features of the schizoid state
including :
The basic schizoid conflict of whether to love or not to love
To love produces the same
results since he regards his
love as bad and destructive
Not to love the loss of the ( as it was not accepted by
love object the mother)
He avoids offering his love
to others because his love
of others is not to be
trusted
• Defense mechanism
A. Introjection
 External object is internalized but is experienced and continues to exist is an object relation
rather than self representation (adoption of the thoughts). It occurs as a normal part of
development, such as a child taking on parental values and attitudes)
B. Identification
 Significant external figure who is used as a model is internalized and a assimilated as part of
self representation (rather than object representation)
 Example: assimilated of (parental qualities, personality traits and behaviour) which becomes
experienced as part of the self.
c. Splitting
• unconscious process which separate contradictory self representation, object
representation and associated feeding from one another (good- bad , love-
hate..).
• Example: images of good and bad mother in a child, so that his feeding
experience would not be contaminated by the terrifying anxieties about the bad
mother.
 Early experience
Cognitive theory
Symptoms of Formation of
depression, cognitive
affective distortion and
somatic dysfunctional
behavioral assumptions

Assumption
activated
leading to
Critical
automatic incident
thoughts
In individuals with schizoid personality disorder, a set of early
experiences in which the themes of rejection and bullying are
major factors is often present.
Alongside this, the individual has often experienced being seen as
different from the closer family unit or in some way
diminished in comparison with others, and thus has come to
view him- or herself as different in a negative sense, others as
unkind and unhelpful, and social interaction as difficult
and damaging.
As a result, a set of rules or assumptions may develop to
provide “safety” for such individuals, leading them into a
lifestyle of solitude and lack of engagement.
Case
Derek (36) has been unemployed and survived on income
support for the last 11 years. He spends much of his time alone
in his flat (apartment), listening to the radio or reading books. He
goes to church daily, slipping in just after the morning service has
started and leaving just before it ends.
Derek presented to therapy with increasing anxiety and low
mood. On initial presentation, Derek avoided eye contact and
spoke only minimally to answer questions posed to him by his
therapist. He requested that the therapist “get his family to leave
him alone and let him be” and reported that their attempts to
get him to attend family functions were causing him extreme
anxiety.
In addition, Derek spoke about an increased sense of the
futility of life and his concerns that his oddness meant
that nothing could change. It appeared that such beliefs were
leading to his increased feelings of low mood.
Derek was one of three brothers born to Jack, a plumber. The
family was outgoing and physical, and Derek’s two brothers had
followed in their father’s footsteps, one working directly for him
and the other dealing in hardware for the plumbing trade. Since
childhood he had been a solitary person and had been more
interested in study than playing football with his father and
brothers.
When Derek was young he was called “a square peg in a round
hole” and was often told by his father that “he must have been
switched in the hospital.” Throughout his life, Derek had tried to
become involved in sports or the family business, but his efforts
were often met with comments as to his ineptitude, and he
eventually he gave up.
: Psychotherapy
1. Cognitive behavioral therapy
2. Family therapy
3. Group therapy
Treatment Approach

Axis I Comorbidity
Although Derek clearly presented with low mood and anxiety
• Anxietyseems to be related to social situations; however, there
appears to be a marked lack of fear of negative evaluation, which
would be expected in either social phobia or in avoidant personality
disorder. Rather, he exhibited a feeling of being overwhelmed by
social contact that he considered excessive.
• With respect to depression, although this diagnostic group is not
particularly prone to strong affective responses, such
individuals’ moods can be driven down due to their beliefs
regarding the futility of life and their existence.
:Challenges
• Collaboration Strategy
As therapy is by its very nature an interpersonal event, it is
likely that the individual with schizoid personality disorder will
have some difficulties in engaging in a collaborative
therapeutic relationship.
Therefore, therapist and client needed to discuss the
advantages and disadvantages of attending therapy
alongside the advantages and disadvantages of not attending
therapy. Only when possible advantages appeared to
outweigh possible disadvantages, the patient will be able to
engage in the therapeutic process.
Therapist Reactions to Client:
• Workingwith clients whose sets of beliefs contrast sharply
with those of the therapist may raise difficult issues.
• The expression of the beliefs held by an individual who meets
criteria for schizoid personality disorder may elicit strong
affective responses in the therapist that may need to be
understood and worked with in order for therapy to proceed in
a collaborative manner.
• Theseincluded “People are cruel,” “People are
unwelcoming,” and “People should only talk if there is
something to say (directionless communication).
• Negotiating a Collaborative Problem List and Goal List:
it is important that the therapist be able to listen to what
clients are saying and ask them to specify what element of
their experience is problematic to them, as it may differ
markedly from what the therapist expects the problematic
area to be.
Derek outlined his problem list as follows:
(1) not working, (2) not busy enough, (3) no friends, (4) anxiety, (5)
not accomplishing anything, and (6) feeling too low to talk.
With respect to the problem list identified in therapy, Derek
came up
with the following goals for therapy:
1. To help his father out in the business if he was needed
2. To be able to fill his time more
3. For his brothers to respect his lack of friends and to have one
person with whom he can discuss difficulties (this did not have
to be in person)
4. To be less worried
5. To be able to accomplish tasks which need to be done
6. Feeling better in himself
• Reframing Core Beliefs:
Earlier in therapy, some patients may refuse to look at his beliefs about
oddness, but later on this may change and the patients feel that this
is central to his distress and may need to be addressed.
it is proposed that collect data (as homework) which fitted with “I am
normal” using a positive data log, as recommended by Padesky (1994).
Questions used to help him elicit such information were: Is there
anything that you have done today that seems to suggest that
you are normal or that someone else would view as a sign that
you are normal? Is there anything that you have done today that,
if someone else did it, you would view as a sign that they are
normal?