In this series, I dig a little deeper into the meaning of psychology-related terms. This week we’re doing a 2-for-1 looking at schizoid and schizotypal personality disorder.
Both schizoid and schizotypal personality disorders fall within the DSM-5‘s cluster A, which is the odd/eccentric cluster. Despite the similarities in names (it took me a long time to get straight in my head which was which), there are considerable differences.
Schizoid personality disorder
While the name sounds like schizophrenia, schizoid PD is more along the lines of an asocial personality disorder (not that such a thing exists), with asociality taken to extremes. Still, a family history of schizophrenia is a risk factor for schizoid PD, so there is some link there, although no clear genetic links have been identified. Emotionally cold, neglectful, or detached parents can also increase the risk.
Symptoms
Schizoid personality disorder symptoms can include:
- feeling detached from and completely disinterested in social relationships, including sexual relationships
- lack of emotional expression during interpersonal interactions
- no interest in or pleasure from social relationships, including family or romantic relationships
- strong preference for solitary activities
- lack of enjoyment in activities
- lack of close social relationships
- appear indifferent to what others think of them (not in the sense of feeling confident without others’ validation; rather, it’s a matter of total disinterest in other people)
- emotional coldness or detachment, lack of strong emotions
Like any personality disorder, symptoms begin early and are well established by adulthood, and cause significant functional impairment and/or distress. The disorder is consistent over time, even more so than other personality disorders. It occurs in less than 5% of the population, with no difference in prevalence between males and females.
About half of people with schizoid PD also experience major depressive disorder. It’s common to have other co-occurring personality disorders, such as schizotypal, paranoid, borderline, or avoidant.
Differentiating between schizoid PD and the autism spectrum
There is some overlap between traits observed in schizoid personality disorder and autism spectrum disorder. While autism is most often diagnosed in childhood, schizoid PD is rarely diagnosed in childhood. A key difference when it comes to social difficulties appears to be that people on the autism spectrum have difficulties with skills needed to form social relationships, while people with schizoid PD lack the desire or motivation to form such relationships.
Treatment
Lack of interest in having anything to do with other people means that people with this disorder lack motivation to participate in treatment. Little research has been done on treating schizoid PD, but cognitive behavioural therapy (CBT) focused on social skills training may be helpful. Even with therapy, people are unlikely to find social engagement pleasurable.
Schizotypal personality disorder
Schizotypal PD is sort of like schizophrenia lite. It’s thought to be quite biologically based, and it’s more common when there is a family history of some form of psychotic disorder. Trauma may contribute to the development of the disorder in people who have a genetic vulnerability. A number of genes have been identified that may play a role, including the COMT Val158Met polymorphism, which encodes for an enzyme involved in the metabolism of neurotransmitters like dopamine.
Schizoid PD has been associated with reduced volume in the brain’s temporal lobes. These changes are more localized and stable over time compared to differences that are observed in people with schizophrenia.
Symptoms
Schizotypal personality disorder symptoms can include:
- decreased ability to function in social relationships, with intense discomfort and lack of understanding of social cues
- distorted thoughts /perceptions and behavioural eccentricities
- belief that things in the environment around them are specifically directed at them, known as ideas of reference, but not to the intensity level of delusions
- odd beliefs (e.g. in the paranormal) or magical thinking (the belief that thinking something can make it happen)
- odd perceptual experiences, such as hearing whispering
- suspicious/paranoid (but not to the intensity of delusions)
- odd/eccentric behaviours or appearance
- don’t have close social relationships
- social anxiety (related to paranoia)
Some of the symptom criteria (like suspiciousness and lack of close relationships) overlap with other personality disorders, but the ideas of reference, odd beliefs, and odd perceptions are more specific to schizotypal PD.
As a personality disorder, this begins when younger and is well established by adulthood. It occurs in about 4% of the population, and it’s slightly more common in males. Over half of people with this disorder have co-occurring major depressive disorder, and a co-occurring substance use disorder is also common.
Treatment
Limited research has been done investigating treatment options. Antipsychotics and antidepressants are sometimes used, and there’s some research to support the use of the antipsychotic risperidone. Cognitive behavioural therapy (CBT) is another treatment option that may be used, but as with medications, limited research has been done on psychotherapeutic interventions.
Thoughts
In my mental health nursing career, I didn’t tend to come across either of these disorders, which probably has a lot to do with the types of settings I worked in. I’m pretty darn asocial, but schizoid PD is an entirely different thing from my strong introvert leanings. Schizotypal sounds like a very difficult disorder to live with. The symptoms might not be as severe as schizophrenia, but they’re very persistent, and I would imagine that quality of life is probably rather low.
Were you familiar with either of these disorders, or do you know people that experience them?
References
- Cook, M. L., Zhang, Y., & Constantino, J. N. (2020). On the continuity between autistic and schizoid personality disorder trait burden: A prospective study in adolescence. The Journal of Nervous and Mental Disease, 208(2), 94.
- Fariba, K.A., & Gupta, V. (2022). Schizoid personality disorder. StatPearls.
- Kirchner, S. K., Roeh, A., Nolden, J., & Hasan, A. (2018). Diagnosis and treatment of schizotypal personality disorder: Evidence from a systematic review. NPJ Schizophrenia, 4(1), 1-18.
- Rosell, D. R., Futterman, S. E., McMaster, A., & Siever, L. J. (2014). Schizotypal personality disorder: a current review. Current Psychiatry Reports, 16(7), 1-12.
- Zimmerman, M. (2021). Schizoid personality disorder. Merck Manual Professional Version.
- Zimmerman, M. (2021). Schizotypal personality disorder. Merck Manual Professional Version.
Other personality disorders in the What Is… series
- Cluster A:
- Cluster B:
- Cluster C:
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
I was not very familiar with these, other than as names, so thanks for explaining.
I seem to recall that schizoid personality disorder can be difficult to distinguish from autism in some people.
I can see how that could be an issue.
This is a really good distinction to cover. I don’t think these two get enough clarity as to the overlap and differences between schizoid and schizotypal PD, and I’ve never seen them be compared like this before I don’t think. I would have struggled to adequately describe them both. Being schizotypal PD as ‘schizophrenia lite’ version is a good way of putting it, I like that. x
Thanks!
I too read through the description of schizoid PD and thought ‘autism’, even extreme introversion. I didn’t know these conditions existed so I found this very interesting. I think this is one of the topics that would be covered in Abnormal Psychology and all the students started self-diagnosing.
Remember back in the old days when schizophrenia was commonly described as ‘split personality’? “Roses are red, violets are blue, I’m schizophrenic and so am I” I think schizophrenia and bipolar disorder must be so very very difficult, not just for the person suffering from them but for the people who live with and care for them. (Been watching a tv series where a continuing story arc deals with bi-polar disorder in a family and how it impacts the unaffected family member.)
Yeah, it can be really hard for families.
I was literally just reading about these topics last night in my textbook and couldn’t decipher the difference between them, and avoidant personality disorder. This blog post was perfect timing!
Oh good!
It’s good to have someone clarify these terms for the lay person. I wondered, as I began to read about schizoid PD, and the list of terms, how therapists and mental health doctors discerned between that and chronic depression or dysthemia. Or avoidant personality disorder. All the symptoms match up well, save one or two of the more extreme ones (in my opinion). Is there an element of ‘nurture’ to schizoid PD? As in having cold or emotionless parents raise a person might lead to the disorder? Do children of narcissists ever exhibit SPD? The other one, schizotypal, I’m more familiar with. My mother, who probably had borderline personality disorder was misdiagnosed as ‘schizophrenic” early in her dealings with mental health care workers (of the time, the 1960s). She was given Thorazine as a medication. It’s fascinating to learn more about these terms. Thank you for providing an opportunity!
I haven’t come across anything about parents with certain personality disorders being more likely to have kids with a particular personality disorder. Granted, I haven’t deliberately gone looking, but it’s certainly interesting to consider.
I have never heard of any of those terms. I am familiar with schizophrenia because my aunt was diagnosed as a schizophrenic back in the mid eighties.
I believe I have a great aunt who was also schizophrenic. I never knew her because she lived in some type of sanitarium in St. Thomas, Ontario.
When I first started having issues I remember telling this to my psychiatrist and she told me not to worry. Yet, I have read other’s opinions who think it is hereditary. Any information that you could shed on this.
A family history definitely increases the risk. It’s not like some genetic disorders where you either inherit the gene for it or not, but it can make you vulnerable. There’s no depression in my own family history, but there is schizophrenia.
Thank you Ashley!
I’ve heard a little bit about both these disorders, but didn’t really know how they differ from each other, I think your post clarifies it very well. 🙂
When I think of schizoid PD, what comes to mind is my last therapist – she was psychodynamic – whom I stopped seeing for several reasons, but I guess the very first time when an alarm went on in my head was when she said something like that people are divided into “communicative” people (who are generally just like her, or that was the impression I got, that is, outgoing, warm, extroverted, cheerful, seeking connection with others and sociable) and “schizoid” people (who are not communicative, very materialistic and don’t express their emotions clearly) and the worst tragedy for a “communicative” person is when they end up in a relationship with a “schizoid”. I don’t even know what got her started on that, but she did like to go off topic. Apparently this was something she was taught at uni, so I was quite horrified about where they teach such crazy things. And how does she know, after a few sessions, that I am not a “schizoid”? 😀 I hope it’s not a common stereotype/misconception or whatever it is and that actual schizoid people aren’t exposed to something like this frequently, or at least aren’t treated by people with such weird thinking.
Oh my, that is weird.
While working in acute setting in a large city (London) I had lots of opportunities to meet patients with these disorders. Unfortunately, like any other personality disorders, they can be difficult to live with, and frustrating to work with and/or treat.
It can take years working out the right combination of medication and talking therapies only for the patient to withdraw, disengage and/or refuse treatment. Who can blame them sometimes, what with all the medication and side-effects!
Very true.