Psychiatry and Behavioral Health Rotation

Psychiatry EOR: Schizoid personality disorder

Patient will present as → a 50-year-old male who lives alone in a cabin on several acres of land. He rarely interacts with his family or community other than when he comes to town once a month to pick up supplies.

Key Points:

Patients tend to have emotional aloofness, indifferent to praise or criticism, without bizarre or idiosyncratic thinking

  • Exhibit voluntary social withdrawal 
  • Content with social isolation (vs avoidant)
  • Limited emotional expression
  • No association with schizophrenia

DSM-5 Diagnostic Criteria

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:

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

Is not attributable to another medical condition; does not occur in the setting of schizophrenia, manic depression, autism spectrum disorder, or another affective disorder with psychotic features.

Psychotherapy

  • cognitive, behavioral, psychoanalysis

Pharmacologic

  •  only if patient suffers from concomitant depression or transient psychosis
IM_NUR_Schizoid-Personality-Disorder_V1.3_ Schizoid personality disorder is characterized by an inability to form and maintain meaningful personal relationships. They lack close relationships with others and enjoy solitary activities. They find little interest in having sex. Individuals with schizoid personality disorder present with a flat affect and are indifferent to praise.

Schizoid Personality Disorder Picmonic

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Question 1
A 46-year-old-man presents to a primary care physician with a chronic cough. He reports that he has not seen a physician in 25 years, but he has not been sick during this time. He lives in a cabin in the woods, and although he does not have any friends, he reports that he does not feel lonely. He is well-groomed, dressed normally, and does not have any bizarre beliefs. He describes his mood as "fine", and his speech is fluid, albeit limited in amount. His thought process is linear, and his thought content is appropriate. He denies any visual or auditory hallucinations. Which of the following is true about this patient's psychiatric condition?
A
It has a high correlation with schizophrenia
Hint:
Schizotypal, not schizoid, personality disorder is related to schizophrenia.
B
The patient should be treated with an antidepressant
Hint:
Since this patient does not present with symptoms of co-morbid depression, he does need to be treated with antidepressants.
C
No specific treatment is needed at this time
D
The patient is likely very responsive to criticism and praise
Hint:
Patients with SPD are often indifferent to praise or criticism, and likewise do not offer praise or criticism as readily as non-affected patients.
E
The patient likely suffers from a co-morbid substance use disorder
Hint:
Patients with antisocial, borderline, or schizotypal personality disorders are likely to have substance use disorders, but not patients with schizoid personality disorder.
Question 1 Explanation: 
This patient's clinical presentation is consistent with schizoid personality disorder (SPD), which does not require treatment, unless the patient presents with a co-morbid Axis I disorder, such as depression, psychosis, or anxiety.
Question 2
What behavior would be most typical for a patient diagnosed with schizoid personality disorder?
A
Chooses solitary activities
B
Odd thinking and speech
Hint:
Schizotypal personalities have this along with magical thinking and ideas of reference. They may become withdrawn due to the lack of acceptance.
C
Reckless disregard for safety of others
Hint:
Reckless disregard for safety of others is typical of antisocial personality disorders.
D
Uses physical appearance to draw attention
Hint:
Using physical appearance to draw attention is more typical of histrionic disorder.
Question 2 Explanation: 
Persons with schizoid personalities are very withdrawn and do not seek or enjoy relationships and are indifferent to praise or criticism. They generally appear cold and unfeeling to others.
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