People with personality disorders often feel and behave in socially deplorable ways but are perceived as normative by them. People with cluster A personality disorders perceive the world as abnormal instead of perceiving their behaviors as out of line with their external world. Schizoid personality disorder (ScPD) is an unconventional disorder characterized by social detachment and a restricted range of expression of emotions in social interactions. ScPD is among the rarest and most perplexing personality disorders and occurs in about 1% of the U.S. population. People with ScPD lack interest in social interactions and activities and prefer little social connectedness and a lonely lifestyle. ScPD is among the three nonpsychotic schizophrenia-spectrum personalities because its symptoms overlap with negative symptoms of schizophrenia. People with ScPD are motivated by fear to seclude themselves as sources of validation and enhancement in social relationships. Developments in medical science and technology constantly update the etiology, causes, and treatments of ScPD. This paper explores ScPD using a biopsychosocial model to explain the biological, psychological, and social causes of ScPD and available treatments. ScPD results from an interplay between biological, psychological, and social factors, which affect the development of socioemotional abilities needed to maintain social attachments and interactions.
Biopsychosocial Perspective of Schizoid Personality Disorder
Biological causes of ScPD include genetic influence and brain damage. Research indicates that ScPD can be inherited from relatives with the disorder. A family history of ScPD increases the likelihood of developing the disorder. Genetic studies by Reichborn-Kjennerud (2022) show that the heritability of ScPD is about 29%. Low serum levels of low-density lipoprotein cholesterol (LDL-c) are associated with ScPD symptoms such as loneliness, isolation, and low trust in others. Hayakawa et al. (2022) analyzed the relationship between blood biomarkers such as LDL-C and ScPD and found that LDL-C influences ScPD.
Anatomical abnormalities and related biochemical diseases lead to the development of ScPD. The research investigated the occurrence of psychiatric disorders in patients with traumatic brain injury and found that 6.7% developed ScPD (Masi et al., 2021). The parts of the brain that control social abilities and social withdrawal are the orbitofrontal cortex and temporal cortex. They are involved in processing social stimuli such as opioid, serotonin and dopamine. Social withdrawal associated with ScPD results from dopamine neurons’ hyperactivity in the ventral tegmental area. Alterations in the frontal lobe, parietal lobes, and limbic system lesions lead to social-emotional inadequacies, loneliness, and social interaction problems associated with schizoid personality disorder (Masi et al., 2021). Neuropeptides such as oxytocin and vasopressin control social behaviour based on gender. Candidate genes for genetic inheritance of ScPD include hormones that regulate neurotransmitters such as dopamine.
Psychological factors of ScPD include loneliness, negative childhood experiences, maladaptive thought patterns, and lack of social skills. Research indicates that social emotion and personality development are often influenced by social psychology and cultural factors, impairing people’s social abilities and increasing societal misunderstandings (Cui et al., 2020). As a result, people thrive in isolation and become accustomed to reduce or no social-emotional interaction. Further, social-psychological factors hinder people from practicing core social communication skills, leading to difficulties in responding to social-emotional cues. People with ScPD cannot accurately interpret and respond to social stimulations and tend to avoid social interactions for fear of rejection. ScPD also develops a false belief that their safety is found in secluded places and develops social indifference. Research also shows that people with ScPD are insensitive to criticism from others and do not value social validation (Velikonja et al., 2019). ScPD individuals face internal personality conflicts and possess shameful and exalted self-images projected onto the external environment in fear, social withdrawal, paranoid attitudes, and loneliness.
Negative childhood experiences can lead to social withdrawal and isolation. Negative experiences elevate existing behavioural patterns, creating amplified personalities, especially in the face of chronic and long-lasting stressors. Family dysfunctions and poor parenting are major psychological risk factors for ScPD. Effective parenting styles such as authoritative parenting accommodate children’s temperaments and are flexible to adapt their styles to children’s needs. Inflexible parenting strategies focus on parents’ rules, and expectations become exaggerated, leading to abnormal personalities. Family dysfunction such as lack of family norms, broken extended family ties, and loss of consensual values create negative experiences. Negative interactions with family members and other social institutions can lead to ScPD.
Poor parenting during childhood increases the risk of ScPD. Velikonja et al. (2019) found that adolescents exposed to verbal abuse in childhood portray ScPD symptoms during early adulthood. Neglective parenting styles negative affect a child’s social-emotional, moral, and cognitive development. Parenting behaviours such as harsh punishment during childhood increase the risk of ScPD. A study by Reising et el. (2019) studied the impact of childhood violence on ScPD and found a positive correlation between negative childhood experiences and ScPD. Violence acts in childhood increased the symptoms of ScPD. Physical, verbal, and social abuse during childhood evokes in ScPD individuals negative feelings of self-hate, inferiority, frustration, and embarrassment. These individuals, in turn, develop attachment and social interaction problems, leading to loneliness and seclusion. Sexual and emotional abuse during childhood leads to a lack of self-worth and identity crisis. Research shows that emotional and sexual abuse leads to avoidance coping, social withdrawal, impaired social-emotional abilities, and low self-esteem, increasing the risk of ScPD. The emotional torture creates a gap between affected individuals and other people, leading to loneliness. People with ScPD feel that other people may not understand their painful experiences and maladjusted behaviours.
Social and cultural impacts and connections also cause ScPD. Social factors such as families affect a person’s personality through dysfunction. Broken family ties and difficulties in establishing social roles increase the risk of ScPD (Velikonja et al., 2019). Social norms require people to conform to the values of a larger social group, and narcissistic traits create maladaptive personalities. Every individual has a predictable role in society. Conforming to family and societal expectations of social roles leads to emotional well-being. The absence of social support systems such as community participation, employment, and extended family increases the risk of ScPD. For example, Loss of employment compromises the quality of life and a person’s ability to support their families, which lowers the quality of parenting care, exposing children to poverty and high risk of ScPD. Weak family attachments and supportive social networks lead to low self-esteem and poor coping abilities. A lack of opportunities for growth and a supportive social environment exposes people to a high risk of developing ScPD. A decline in social capital buffers the function of traditional social structures, increasing the risk of ScPD (Turner, Prud’homme, and Legg, 2020).
Moreover, most people face challenges navigating the prescribed traditional social roles and maintaining positive identities. Technological advancements have particularly undermined social cohesion, reducing reliance or trust on family and community systems for support. The resulting cultural narcissism has encouraged self-promotion and increased needed for autonomy and competitive success, leading to externalizing behaviour and elevating the prevalence of ScPD.
Socially-constructed gender roles, identities, and behaviours increased the risk of ScPD. Gender roles are premised on biological differences, strengthened by implicit and explicit social interactions, and perceived as gender identities. Females are believed to possess expressive traits such as emotional sensitivity, selflessness, and amiability, while males possess dominance, independence and assertiveness. This gendered socialization implies that nonconformity to role expectations leads to social invalidation, a major risk factor for ScPD. Another sociocultural factor associated with ScPD is socioeconomic status. People from socioeconomically disadvantaged environments are at a higher risk of developing ScPD than those from disadvantaged backgrounds. Socioeconomic disadvantage exposes children to early adversity and developmental trauma, increasing the risk of ScPD (Turner, Prud’homme, and Legg, 2020). Stressful events and daily hassles like unemployment lead to loneliness and social withdrawal.
Cultural values and institutions govern people’s lives and are directly related to well-being and mental health. Sociocultural contexts determine a persona’s social and behavioural characteristics through verbal, nonverbal, symbolic, and unconscious cues. Living in high-risk neighbourhoods increases the need for isolation and social withdrawal. Individuals with low socioeconomic status are more likely to reside in areas with limited public assistance, unemployment, and high crime rates, leading to emotional and behavioural problems. Furthermore, living in an individualist community increases the likelihood of ScPD. Research indicates that individualism affects a person’s self-concept, cognitive patterns, and attribution. Social expectations placed on people with individualistic ideas in collective societies lead to loneliness and social exclusion related to ScPD.
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Treatment of Schizoid Personality Disorder
ScPD is treated using medications and therapy. Psychotherapy is used to help individuals with ScPD develop social attachments and promote behavioural change. Various psychotherapy techniques used in ScPD treatment include cognitive behavioural therapy (CBT), interpersonal therapy (IPT), and dialectical behavioural therapy (DBT). CBT aims at helping ScPD patients recognize and change their negative perceptions about themselves and the external world (Devany and Poerwandari, 2020). CBT therapists aim at replacing clients’ negative thoughts with positive perceptions. Examining persons’ negative childhood experiences are important in determining the exact cause of ScPD. Since most ScPD patients are less likely to take medications for their disorder, CBT is an ideal treatment to erase their negative thoughts and social withdrawal. DBT focuses on changing a client’s disruptive behaviour. Interpersonal therapy is used to change patients’ social interactions. The therapy is premised on the notion that improving a person’s social skills can influence social interactions. IPT is often used in a group setting to provide patients with a support structure to improve their social skills.
There are no specific medications for treating ScPD. Antidepressants are often used to help patients with anxiety and depression.
In conclusion, schizoid personality disorder results from the interplay between biological, psychological, and sociocultural factors which affect a person’s social attachment and interaction abilities. Underdevelopment of socioemotional abilities leads to social withdrawal, loneliness, and lack of social interactions. Inability to recognize socioemotional stimuli leads to miscommunication and misunderstandings, making people with ScPD develop fear and seclude themselves to avoid complicated social interactions. A multidimensional approach such as psychotherapy is critical to ScPD treatment. Future research is needed to study the multidimensional aspects of ScPD and design evidence-based therapeutic models.
References Cui, L., Criss, M. M., Ratliff, E., Wu, Z., Houltberg, B. J., Silk, J. S., & Morris, A. S. (2020). Longitudinal links between maternal and peer emotion socialization and adolescent girls’ socioemotional adjustment. Developmental psychology, 56(3), 595. https://psycnet.apa.org/record/2020-11553-017