The Schizoid Personality Disorder Coming Into Treatment

Few individuals with a Cluster A personality disorder are particularly inclined to seek treatment. Richards (1993, p. 265) notes that individuals with SPD have few complaints and do not seek an interpersonal context for solving their problems. These individuals are society's misfits and can spend a lifetime in single rooms in interpersonal isolation. If they come into treatment, they are often forced to do so by family or the legal system. These individuals are not psychologically resilient and will have severe difficulty in jail. They may not be able to effectively recognize or manage predatory behavior from others; victimization is a serious possibility.

Individuals with SPD who accept treatment voluntarily are those whose need for closeness with others lies closer to the surface and may be more disposed to form a positive therapeutic alliance. Those who are forced into treatment may be less accessible (Gabbard, 1996, p. 953).

In treatment, clients with SPD challenge service providers, not with hostility, distrust, or aggression, but with the absence of response. They do not reciprocate feeling for feeling; they are not responsive to praise, criticism, or other kinds of emotional leverage used between people when one is attempting to influence the other. It is the apparent immunity to influence that can leave service providers feeling frustrated and ineffective. However, the lack of affective bonding or responsiveness does not mean insensitivity or imperviousness. In clinical settings, these individuals, when placed in a social skills group and not pressured to engage at a level they cannot endure or sustain, will become attached in their own way and are inclined to attend regularly. It would appear that they can value contact if the intensity is controlled and safety ensured.

Medication Issues

Kalus, et. al. (Livesley, Editor, 1995, p. 59) suggest that there is a genetic link between schizophrenia and the schizoid personality disorder. The schizoid personality disorder appears to characterize the negative symptoms of schizophrenia, e.g. anhedonia, little affect, low energy. It is the schizotypal personality disorder, also seen as part of the schizophrenia spectrum disorders, that exemplifies the positive symptoms at a non-psychotic level, e.g. non-delusional odd beliefs, eccentric behavior, agitation, and paranoid thinking.

Until the most recent antipsychotic medications, such as risperdal, became available, no psychotropic medication made much of an impact on the negative symptoms of schizophrenia; thus, by implication, no medication appeared to be effective for the symptoms of schizoid personality disorder. Currently, however, Joseph (1997, pp. 46-47) notes that there are several symptoms in SPD that are potentially responsive to medication. These include the symptoms that resemble the negative or deficit symptoms of schizophrenia: emotional apathy, social withdrawal, blunted or constricted affect, anhedonia, dysphoria, poverty of speech and thought, avolition, and slowed thinking. He suggests low doses of risperidone or olanzapine for the social deficits and blunted affect and Wellbutrin (bupropion) for anhedonia. He believes that clozapine is the most effective medication for the negative symptoms found in SPD but notes that the potential for agranulocytosis makes it unwise to use. He states that clozapine does not have FDA approval for treatment of schizoid personality disorder.

There should be some measure of caution exercised in medicating individuals with SPD. They are often comfortable with their own symptoms and do not voluntarily seek treatment. If they report themselves to be fairly comfortable, consideration should be given to using therapy and skills training alone.

continue: Guidelines for Psychotherapy with the Schizoid PD Patient

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Reviewed: 4/2006