5 Common Misconceptions About Schizoid Personality Disorder

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Most people that I meet have never heard of schizoid personality disorder (SPD). And if they have heard the word “schizoid,” they do not have an accurate understanding of what the term means.

Schizoid personality disorder (SPD) is a fairly common disorder that is characterized by a severe lack of trust in others and the use of emotional and physical distancing to create a sense of safety. SPD gets underdiagnosed because most people with it go out of their way to look normal and blend in. This is in marked contrast to people with more dramatic and obvious types of personality disorders, such as borderline or narcissistic personality disorders, who often create problems for those around them.

Note: I am using the terms schizoid and SPD as shorthand for someone who qualifies for a full diagnosis of schizoid personality disorder.

People with SPD are very private and do their best to handle their problems on their own. They do not usually draw attention to themselves. They are much more likely to hide their problems from others than to ask anyone for help. They are likely to appear somewhat introverted.

Some of the ways my schizoid clients cope with their need for safety include:

• Substituting a rich fantasy life for actual relationships.
• Living alone.
• Keeping an emotional and physical distance from others.
• Dissociating from their body or their emotions when stressed.
• Building a life in which they are as self-sufficient as possible.

Schizoid personality disorder is believed to start before age four, when a child's personality is still forming. While certain people may have genetic traits that make it easier for them to develop schizoid issues, my schizoid clients have had difficult childhoods that included some combination of abuse, neglect, indifference, lack of attunement, or extreme intrusiveness.

As a result of these experiences, people with SPD grow up to believe that everyone is like their parents and that no one can be trusted. Many of my clients report that at around age seven they concluded that they could only depend on themselves.

Common Misconceptions About Schizoid Personality Disorder

1. Schizoid is the same thing as schizophrenia. I find that many people mistakenly assume that the word schizoid refers to schizophrenia. This is probably due to schizophrenia often being part of the plot in movies and television shows, while schizoid personality disorder is not mentioned. They may also have heard the word “schizo” thrown around as synonymous with a "crazy" person (“He’s a real schizo.”).

It is unfortunate that so many different mental health diagnoses start with the prefix “schizo”—schizoid, schizotypal, schizophrenia, and schizoaffective. “Schizo” is actually a Latinized version of a Greek word meaning “split.”

Schizophrenia is not a personality disorder. It is a serious psychotic disorder that has a strong genetic component. In studies of identical (monozygotic) twins, if one develops schizophrenia, the other has about a 48% chance of developing it as well—even if the twins are not raised together (Gottesman, 1991). This contrasts with the 1% chance of developing schizophrenia that most people have. And, unlike SPD, which starts in early childhood, schizophrenia usually shows up in the late teens in males and a few years later in females. Schizophrenia is not driven by inadequate parenting and can be treated with medications.

2. People with SPD do not feel emotions. People with SPD do feel emotions. They actually feel more emotions than they can handle. As a result, at some point in their childhood, perhaps while they were being abused and could not physically leave, they learned to dissociate from their body and their feelings and go away to a safe place in their head. In that dissociated state, they cannot feel their emotions, although normally they can.

Another thing that contributes to the mistaken belief that people with SPD do not feel emotions is that schizoid individuals are very private and do not want other people to know what they are feeling. Most are quite good at masking their emotions. They hide their real feelings deep inside while showing the world a normal-seeming false self. Unless someone with SPD confides in you, you are highly unlikely to recognize that they are schizoid.

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3. People with SPD do not want an intimate relationship. Everyone I know with SPD has yearned for a close, safe, intimate, and loving relationship. The problem is that they do not feel safe around other people. They have no basic trust. They are afraid that if they lower their defenses and get close to someone, they will become trapped, abused, and taken advantage of in some way, the way they may have been as a child.

As a result, people with SPD may be afraid of being drawn into a serious romantic relationship that otherwise has no impediment to going forward. Many become so frightened that they either stay and dissociate from their emotions or physically distance themselves in order to feel safer—even when they are in a great relationship with a compatible partner.

I have had schizoid clients whose yearning for intimacy and a family was stronger than their fear. One is now married with a child and is an excellent father. His wife has no idea that he struggled for years with SPD due to childhood abuse. When I first met him, he spent most of his time in a dissociated state fantasizing about unavailable women. He worked very hard in therapy and had good results.

4. People with Schizoid PD are dangerous. I have been treating people with SPD for over 40 years; none of them were dangerous. Most of my schizoid clients are hardworking, sensitive people who try to avoid any form of angry interchange. They generally want to be let alone and are unlikely to pick fights.

The reality is that my most dangerous clients were malignant narcissists, and my schizoid clients were the least dangerous.

So why do they get stigmatized as dangerous? Partly it's because some serial killers have been described as possessing schizoid traits because they were loners—but that is different than qualifying for a diagnosis of SPD.

5. There is no psychotherapy treatment for Schizoid PD. There are a number of useful approaches to the therapy of people with schizoid personality disorder. The ones I believe are most effective are based on the work of British Object Relations theorists such as Harry Guntrip (1901-1975).

I have found Ralph Klein’s approach to SPD the most generally useful. He was the Director of Training of The Masterson Institute when personality theorist James F. Masterson was still alive. Klein incorporated and expanded on Guntrip’s insights and developed a highly effective approach to treating SPD in line with Masterson’s developmental, self, and object relations approach to personality disorders. I still use and teach Klein’s methods today (Klein, 1995, Guntrip, 1969).

Klein also explained that it is fairly common for people with SPD to never come for psychotherapy because they manage to find an adaptation to their disorder that gives them enough human contact without triggering their need to isolate themselves. If they marry, they may use their work as a way to avoid feeling trapped in the relationship. Many take jobs that require them to be away for weeks at a time. Others may take a lover on the side to dilute marital intimacy.

The psychotherapy of people with SPD tends to be slow because of their lack of basic trust, but motivated clients with schizoid personality disorder can benefit from appropriate psychotherapy. No single treatment that works for every person with SPD; all treatments need to be adapted to the specific needs of the client.

Why do people think SPD is less common than it is?

Highly functional people with SPD who are doing well in life rarely come for psychotherapy. And the DSM-5, the diagnostic manual used for insurance coding in the U.S., contributes to the confusion around SPD because its method of diagnosis relies on descriptions of visible symptoms. Therefore, its example of SPD fits only the lowest functioning individuals, those who cannot muster a convincing “false self.”

Summary

Schizoid personality disorder is one of the less well-known personality disorders because people with it rarely create problems for those around them. Most people with SPD never come for psychotherapy because they manage to find a compromise between their need for interpersonal safety and having a reasonably satisfying life. Unfortunately, the usual descriptions of people with SPD are based on the lowest-functioning group, whose problems are more obvious. Most people with SPD walk among us and work alongside us without ever being recognized as having a personality disorder.

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