This is a continuation of the exposition of schizoid personality disorder as articulated by Theodore Millon. Since adolescence or early adulthood at least 3 of the following have been present to a notably greater degree than in most people and were not limited to discrete periods nor necessarily prompted by stressful life events:
1. Affectivity deficit (e.g., exhibits intrinsic emotional blandness; reports weak affectionate needs and an inability to display enthusiasm or experience pleasure).
2. Mild cognitive slippage (e.g., evidences impoverished and obscure thought processes inappropriate to intellectual level; social communication often tangential and irrelevant).
3. Interpersonal indifference (e.g., possesses minimal “human” interests; is satisfied with and prefers a peripheral role in social and family relationships)
4. Behavioral apathy (e.g., ease of fatigability, low energy and lac of vitality; displays deficits in activation, motoric expressiveness and spontaneity).
5. Perceptual insensitivity (e.g., reveals minimal introspection and awareness of self; impervious to subtleties of everyday social and emotional life).”
Originally, “asocial personality” was proposed for the syndrome in the DSM-III. It was then replaced with “introverted personality,” but this label was dropped due to objections by Jungians. The term “asocial” was reempted by the ICD-(, since the label “antisocial personality” would result in obvious confusion. Objectors to the use of the term “schizoid” were worried that it would be confused with schizotypal personality disorder. The following text and criteria were discussed at an intermediate stage in the development of the concept among the DSM-III committee members.
“The essential features are a profound defect int he aability to form social relationships and to respond to the usual forms of social reinforcements. Such patients are characteristically “loners,” who do not appear distressed by their social distance and are not interested in greater social involvement. Affectionate needs are markedly limited and there appears to be little capacity for experiencing pleasure.
Deficits in stimulus-seeking are notable and these patients frequently maintain solitary interests and hobbies. The characteristics introversive pattern frequently covaries with a general lack of vitality and motor spontaneity. Habits of speech typically are slow and monotonous with few rhythmic or expressive gestures. A pervasively bland emotional tone characterizes daily life as does a lack of self-reflection and introspection.
At least 3 of the following are characteristic of the patient’s long term functioning and are not limited to discrete periods:
A. Social relationship deficits (e.g., has few friends or close bonds with others).
B. Interpersonal indifference (e.g., has minimal desire for social involvement and is unresponsive to praise or criticism).
C. Anhedonia (e.g., exhibits weak affectionate needs and is unable to readily experience pleasure or enthusiasm.
D. Behavioral apathy (e.g., displays low energy, motivation, or stimulus-seeking behavior).
E. Minimal self-reflection (e.g., rarely examines self-motives or personal relationships).”
This list attempted to cover multiple clinical domains, such as the affective, the behavioral, the cognitive and the interpersonal. The DSM-III-R and DSM-IV provided an even more comprehensive portrayal of relevant clinical domains. The ICD-10 was revised in order to correspond with the multiaxial system of the DSM-IV. Theodore Millon paraphrases the diagnostic category of the schizoid in the ICD-10 in the following manner:
“few activities give pleasure; displays detachment, emotional coldness, or flattened affect; has limited capacity to express warm or tender affects, as well as to express angry feelings; seems indifferent to either praise or criticism; has little interest in having sexual experiences with another person; chooses solitary activities almost always; excessively preoccupied with fantasy and introspection; neither desires nor has close friends or confiding relationships; shows marked insensitivity to prevailing norms and conventions.”
Discussing the DSM-IV’s categorization of the syndrome, he notes that “its conception of the schizoid [has] a primary focus on two clinical domains. the primary are as in the interpersonal sphere; some five different criteria are enumerated, notably a deficiency in the desire to be part of a family or other close group; a preference for choosing solitary activities (ones that do not include interaction with others); minimal or limited interest in having sexual experiences; the presence o few or no close friends or confidants; a seeming indifference to the praise or criticism of others.”
This is the first domain, which is the interpersonal realm. The second realm is the mood domain: “Two criteria are noted, specifically a reduced ability to experience pleasure in both physical and interpersonal realms; and a tendency to exhibit emotional coldness, flattened affectivity, as evident in limited facial expressions, minimal so cial gestures, and a failure to experience strong feelings.” Millon faults the DSM-IV for failing to include domains such as cognitive style, intrapsychic structural features and self-image, as it is limited entirely to the interpersonal and mood domains.