Schizoid Personality Disorder

SCHIZOID PERSONALITY DISORDER

Clinical Picture

Schizoid personality disorder is characterized by a pervasive pattern of detachment from social relation-ships and a restricted range of emotional expression in interpersonal settings. It occurs in approximately 0.5% to 7% of the general population and is more common in men than in women. People with schizoid personality disorder avoid treatment as much as they avoid other relationships, unless their life circumstances change significantly (APA, 2000).

Clients with schizoid personality disorder display a constricted affect and little, if any, emotion. They are aloof and indifferent, appearing emotionally cold, uncaring, or unfeeling. They report no leisure or pleasurable activities because they rarely experience enjoyment. Even under stress or adverse circumstances, their response appears passive and disinterested. There is marked difficulty expe-riencing and expressing emotions, particularly anger or aggression. Oddly, clients do not report feeling distressed about this lack of emotion; it is more distressing to family members. Clients usually have a rich and extensive fan-tasy life, although they may be reluctant to reveal that information to the nurse or anyone else. The ideal rela-tionships that occur in the client’s fantasies are rewarding and gratifying; these fantasies, though, are in stark con-trast to real-life experiences. The fantasy relationship often includes someone the client has met only briefly. Nevertheless, these clients can distinguish fantasies from reality, and no disordered or delusional thought processes are evident.

Clients generally are accomplished intellectually and often involved with computers or electronics in hobbies or work. They may spend long hours solving puzzles or mathematical problems, although they see these pursuits as useful or productive rather than fun.

Clients may be indecisive and lack future goals or direc-tion. They see no need for planning and really have no aspirations. They have little opportunity to exercise judg-ment or decision-making because they rarely engage in these activities. Insight might be described as impaired, at least by the social standards of others: these clients do not see their situation as a problem and fail to understand why their lack of emotion or social involvement troubles oth-ers. They are self-absorbed and loners in almost all aspects of daily life. Given an opportunity to engage with other people, these clients decline. They also are indifferent to praise or criticism and are relatively unaffected by the emotions or opinions of others. They also experience dis-sociation from or no bodily or sensory pleasures. For example, the client has little reaction to beautiful scenery, a sunset, or a walk on the beach.

Clients have a pervasive lack of desire for involvement with others in all aspects of life. They do not have or desire friends, rarely date or marry, and have little or no sexual contact. They may have some connection with a first-degree relative, often a parent. Clients may remain in the parental home well into adulthood if they can maintain adequate separation and distance from other family mem-bers. They have few social skills, are oblivious to the social cues or overtures of others, and do not engage in social conversation. They may succeed in vocational areas, pro-vided they value their jobs and have little contact with others in work, which typically involves computers or electronics.

Nursing Interventions

Nursing interventions focus on improved functioning in the community. If a client needs housing or a change in living circumstances, the nurse can make referrals to social services or appropriate local agencies for assistance. The nurse can help agency personnel find suitable housing that accommodates the client’s desire and need for soli-tude. For example, the client with a schizoid personality disorder would function best in a board and care facility, which provides meals and laundry service but requires little social interaction. Facilities designed to promote socialization through group activities would be less desirable.

If the client has an identified family member as his or her primary relationship, the nurse must ascertain whether that person can continue in that role. If that person can-not, the client may need to establish at least a working relationship with a case manager in the community. The case manager then can help the client to obtain services and health care, manage finances, and so on. The client has a greater chance of success if he or she can relate his or her needs to one person (as opposed to neglecting impor-tant areas of daily life).