DSM-II

In DSM-II, this disorder is called Schizoid personality

This behavior pattern manifests shyness, over-sensitivity, seclusiveness, avoidance of close or competitive relationships, and often eccentricity. Autistic thinking without loss of capacity to recognize reality is common, as is daydreaming and the inability to express hostility and ordinary aggressive feelings. These patients react to disturbing experiences and conflicts with apparent detachment.

DSM-III

Diagnostic Criteria

The following are characteristic of the individual's current and long-term functioning, are not limited to episodes of illness, and cause either significant impairment in social or occupational functioning or subjective distress.

A. Emotional coldness and aloofness, and absence of warm, tender feelings for others.

B. Indifference to praise or criticism or to the feelings of others.

C. Close friendships with no more than one or two persons, including family members.

D. No eccentricities of speech, behavior, or thought characteristic of Schizotypal Personality Disorder.

E. Not due to a psychotic disorder such as Schizophrenia or Paranoid Disorder.

F. If under 18, does not meet the criteria for Schizoid Disorder of Childhood or Adolescence.

Differential Diagnosis

Schizotypal Personality Disorder

In Schizotypal Personality Disorder there are eccentricities of communication or behavior, and these preclude a diagnosis of Schizoid Personality Disorder.

Avoidant Personality Disorder

In Avoidant Personality Disorder, social isolation is due to hypersensitivity to rejection, but a desire to enter social relationships is present if there are strong guarantees of uncritical acceptance. In contrast, individuals with Schizoid Personality Disorder have no desire for social relations.

Schizoid Disorder of Childhood or Adolescence

In Schizoid Disorder of Childhood or Adolescence there is a similar clinical picture and this diagnosis preempts the diagnosis of Schizoid Personality Disorder if the individual is under 18.

DSM-IV

Diagnostic Criteria

A. 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:

  1. neither desires nor enjoys close relationships, including being part of a family
  2. almost always chooses solitary activities
  3. has little, if any, interest in having sexual experiences with another person
  4. takes pleasure in few, if any, activities
  5. lacks close friends or confidants other than first-degree relatives
  6. appears indifferent to the praise or criticism of others
  7. shows emotional coldness, detachment, or flattened affectivity

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition.

Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizoid Personality Disorder (Premorbid)."

Differential Diagnosis

Psychotic Disorders

Schizoid Personality Disorder can be distinguished from Delusional Disorder, Schizophrenia, and Mood Disorder With Psychotic Features because these disorders are all characterized by a period of persistent psychotic symptoms (e.g., delusions and hallucinations). To give an additional diagnosis of Schizoid Personality Disorder, the Personality Disorder must have been present before the onset of psychotic symptoms and must persist when the psychotic symptoms are in remission. When an individual has a chronic Psychotic Disorder (e.g., Schizophrenia) that was preceded by Schizoid Personality Disorder, Schizoid Personality Disorder should be recorded followed by "Premorbid" in parentheses.

Autistic Disorder and Asperger's Disorder

There may be great difficulty differentiating individuals with Schizoid Personality Disorder from those with milder forms of Autistic Disorder and from those with Asperger's Disorder. Milder forms of Autistic Disorder and Asperger's Disorder are differentiated by more severely impaired social interaction and stereotyped behaviors and interests.

Personality Change Due to a General Medical Condition and symptoms related to substance use

Schizoid Personality Disorder must be distinguished from Personality Change Due to a General Medical Condition, in which the traits emerge due to the direct effects of a general medical condition on the central nervous system. It must also be distinguished from symptoms that may develop in association with chronic substance use (e.g., Cocaine-Related Disorder Not Otherwise Specified).

Other Personality Disorders

Other Personality Disorders may be confused with Schizoid Personality Disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more Personality Disorders in addition to Schizoid Personality Disorder, all can be diagnosed.

Schizotypal and Paranoid Personality Disorders

Although characteristics of social isolation and restricted affectivity are common to Schizoid, Schizotypal, and Paranoid Personality Disorders, Schizoid Personality Disorder can be distinguished from Schizotypal Personality Disorder by the lack of cognitive and perceptual distortions and from Paranoid Personality Disorder by the lack of suspiciousness and paranoid ideation.

Avoidant Personality Disorder

The social isolation of Schizoid Personality Disorder can be distinguished from that of Avoidant Personality Disorder, which is due to fear of being embarrassed or found inadequate and excessive anticipation of rejection. In contrast, people with Schizoid Personality Disorder have a more pervasive detachment and limited desire for social intimacy.

Obsessive-Compulsive Personality Disorder

Individuals with Obsessive-Compulsive Personality Disorder may also show an apparent social detachment stemming from devotion to work and discomfort with emotions, but they do have an underlying capacity for intimacy.

Normal personality traits

Individuals who are "loners" may display personality traits that might be considered schizoid. Only when these traits are inflexible and maladaptive and cause significant functional impairment or subjective distress do they constitute Schizoid Personality Disorder.

 DSM-5

Diagnostic Criteria

A. 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:

  1. Neither desires nor enjoys close relationships, including being part of a family.
  2. Almost always chooses solitary activities.
  3. Has little, if any, interest in having sexual experiences with another person.
  4. Takes pleasure in few, if any, activities.
  5. Lacks close friends or confidants other than first-degree relatives.
  6. Appears indifferent to the praise or criticism of others.
  7. Shows emotional coldness, detachment, or flattened affectivity.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add "premorbid," e.g., "schizoid personality disorder (premorbid)."

Differential Diagnosis

Other mental disorders with psychotic symptoms

Schizoid personality disorder can be distinguished from delusional disorder, schizophrenia, and a bipolar or depressive disorder with psychotic features because these disorders are all characterized by a period of persistent psychotic symptoms (e.g., delusions and hallucinations). To give an additional diagnosis of schizoid personality disorder, the personality disorder must have been present before the onset of psychotic symptoms and must persist when the psychotic symptoms are in remission. When an individual has a persistent psychotic disorder (e.g., schizophrenia) that was preceded by schizoid personality disorder, schizoid personality disorder should also be recorded, followed by "premorbid" in parentheses.

Autism spectrum disorder

There may be great difficulty differentiating individuals with schizoid personality disorder from those with milder forms of autism spectrum disorder, which may be differentiated by more severely impaired social interaction and stereotyped behaviors and interests.

Personality change due to another medical condition

Schizoid personality disorder must be distinguished from personal change due to another medical condition, in which the traits that emerge are attributable to the effects of another medical condition on the central nervous system.

Substance use disorders

Schizoid personality disorder must also be distinguished from symptoms that may develop in association with persistent substance use.

Other personality disorders

Other personality disorders may be confused with schizoid personality disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more personality disorders in addition to schizoid personality disorder, all can be diagnosed.

Schizotypal and paranoid personality disorders

Although characteristics of social isolation and restricted affectivity are common to schizoid, schizotypal, and paranoid personality disorders, schizoid personality disorder can be distinguished from schizotypal personality disorder by the lack of cognitive and perceptual distortions and from paranoid personality disorder by the lack of suspiciousness and paranoid ideation.

Avoidant personality disorder

The social isolation of schizoid personality disorder can be distinguished from that of avoidant personality disorder, which is attributable to fear of being embarrassed or found inadequate and excessive anticipation of rejection. In contrast, people with schizoid personality disorder have a more pervasive detachment and limited desire for social intimacy.

Obsessive-compulsive personality disorder

Individuals with obsessive-compulsive personality disorder may also show an apparent social detachment stemming from devotion to work and discomfort with emotions, but they do have an underlying capacity for intimacy.

Other personality traits

Individuals who are "loners" may display personality traits that might be considered schizoid. Only when these traits are inflexible and maladaptive and cause significant functional impairment or subjective distress do they constitute schizoid personality disorder.

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