Schizoid personality disorder

This article describes schizoid personality disorder. It should not be confused with schizophrenia or antisocial personality disorder .

Classification according to ICD-10
F60.1	Schizoid personality disorder
ICD-10 online (WHO version 2019)

The schizoid personality disorder ( PLC ) is characterized by a withdrawal of emotional and interpersonal contacts. This manifests itself in an excessive predilection for fantasy and introspection , loneliness and an inward reticence . Those affected have only a limited ability to express feelings and show joy.

The term schizoid was in 1908 by Eugen Bleuler coined and literally "fission-like" (meaning ancient Greek σχίζειν schízein "split" and -oid "similar"). Bleuler leaned on schizophrenia because he suspected that he was dealing with a related illness. At that time, however, the term schizoid referred to a much larger range of personality traits - compared to its much narrower meaning today (see review ). Ernst Kretschmer then developed his own concept from this: Central to this is the disintegration of internal experience and external behavior, which leads to the schizoid being in a tense relationship.

Schizoid people tend to split the holistic function of personality: This means that they tend to separate thinking and feeling. Their thoughts often seem unrelated to real feelings or behavior. Those affected increasingly turn their attention to their inner world of thought and withdraw there. This interrupts contact with the outside world as well as with one's own body and emotional life. However, the relation to reality is retained and hallucinations or delusions do not occur (unlike, for example, in a schizophrenic psychosis ).

description

Outside view

A deep contact disorder affects the people concerned. Emotional reference and attention to the environment are considerably reduced, the spontaneous ability to experience and the direct addressing of feelings are greatly inhibited. Your emotional relationship with people and things appears unusually relaxed and noncommittal. A lack of “emotional authenticity”, the general flattening of emotions ( affects ) and a lack of expected emotional reactions to other people's feelings are often striking . Deep-seated distrust with a tendency to barely open up or to reveal themselves intimately keeps those affected at a distance from other people.

While on the one hand the desire for intimate togetherness with others or a fellow human being may exist, on the other hand communication and emotional expression are blocked. As a result, a strong sense of inner conflict arises within the schizoid person . Some of these affected people appear rigid and wooden, others in turn extremely friendly and trustworthy. When put under pressure (e.g. by living too closely together), they often react abruptly and in a strange way. They then withdraw completely unexpectedly for outsiders, isolate themselves and avoid any contact for a while. Both perfect self-control and a sudden breakout are mostly sides of these personalities.

Changes and new things initiated from outside are usually seen as a danger from which one has to protect oneself - preferably through withdrawal or control. People with a schizoid disorder often develop a high level of intuitive abilities to compensate , with which they want to protect themselves and at the same time gain superiority and control. These trained skills help schizoid people to cope with everyday life, but closer social contacts quickly put a strain on them.

Outwardly, many of those affected usually show a "smooth" surface without any visible emotional resonance. Gestures or facial expressions (e.g. a smile or a nod) are rarely returned and one's own feelings are not revealed. Even when directly provoked, they find it extremely difficult to express internal aggression or hostility . Schizoid personalities can therefore appear passive and poor in feeling in such situations - even if this often does not correspond to their real emotional state. Therefore, they often have problems reacting appropriately to important or unpleasant life events.

To outsiders it sometimes seems as if schizoid people tend to live without direction and “let themselves drift” with regard to their goals. The people concerned can also seem lost in their own mind and detached from their surroundings - absorbed in excessive daydreaming or as if "in the fog". In their interpersonal dealings, some schizoids pay too little attention to fine, subliminal details. They also overlook social cues and then unintentionally violate the usual social rules. This can cause others to perceive their behavior as inappropriate, socially awkward, or superficial.

Inside view

Schizoid people usually experience themselves as uninvolved observers of the world around them - but not as participants. While many usually like to lead isolated lives, they can get tired of "standing outside and looking in." The thought of being an inadequate eccentric can trigger schizoids when it becomes clear how different they are from others. Many become particularly aware of this when they directly observe others, watch films, or read books about relationships.

In their treatment, some describe the feeling of living "inside a bowl" or "under a bell jar" and having missed the connection. They complain that “life passes by” and they have to watch the others from a distance. In such situations, people with SPS can admit painful feelings about being loners who do not fit into society. Even if they don't really want to be around others, then they may believe that they should strive for a more conventional life.

School and job

As far as the prerequisites exist, schizoid personalities often develop a high degree of intellectual sophistication. Many schizoids are "head people" and tend to emphasize the intellect with a retreat into thinking ("escape into the intellect"). Although this makes them more receptive to mental stimuli than to sensual pleasures , some still have a pronounced sense of aesthetics and beauty .

In addition to thinking that tends towards the abstract, which often enables new perspectives, self-irony is also mentioned as a strength as a frequent resource. Schizoid traits in the clinically normal area are also related to creativity . In a first study, people with a schizoid tendency showed a better ability to think divergent .

Professionally, schizoid people are increasingly inclined to theoretical fields of work and activities that are carried out alone or in constant small groups. This also includes service professions in which the opportunities for interaction between customers and providers are limited and are formalized to a greater degree by social norms. Where the professional activity is possible alone and socially isolated, extremely good performance can occasionally be achieved.

Sometimes they perform poorly in school that is not in line with their intellectual abilities. However, there are also those affected with high compensatory skills who - according to some authors - even choose occupations in which less formalized social relationships play a major role. Here, too, the authors perceive a certain “emotional inauthenticity”.

diagnosis

Disease value

The behaviors described are only considered a personality disorder (PS) if they are chronic, inflexible and extremely pronounced. In milder forms, one speaks of a schizoid personality style. Even normal loners can show schizoid behavioral traits, but these traits only become pathological when they are rigid and inappropriate and lead to suffering or impairment.

The following possible negative consequences of fully developed schizoid PS have been observed so far:

• significantly lower quality of life ,
• an unfavorable influence on the mental functioning level over 15 years (lower GAF values )
• and one of the lowest levels of "life success" of any personality disorder (defined as social status, wealth, and successful intimate relationships).

Certain schizoid traits (such as emotional detachment) are also a significant risk factor for serious suicide attempts.

According to ICD

The ICD-10 lists the PLC under F60.1. At least four of the following characteristics or behaviors must be present:

1. If anything, few activities are enjoyable ;
2. shows emotional coolness, detachment, or flattened affectivity ;
3. reduced ability to express warm, tender feelings for others or anger;
4. appears indifferent to praise or criticism from others;
5. little interest in sexual experiences with another person (taking age into account);
6. almost always preference for activities to be carried out alone;
7. excessive use by fantasies and introspection ;
8. has no or does not wish to have close friends or trusting relationships (or at most one);
9. clearly lacking feeling for current social norms and conventions . If they are not followed, it is unintentional.

According to DSM

According to DSM-5 , it is a profound pattern that is characterized by aloofness in social relationships and a limited range of emotional expression in the interpersonal area. It starts in early adulthood and the pattern shows up in different situations. At least four of the following criteria must be met:

1. Has neither desire nor pleasure in close relationships , including being part of a family.
2. Almost always chooses solitary ventures.
3. Has little, if any, interest in sexual experience with another person.
4. Few, if any, activities bring joy ( anhedonia ).
5. Has no close friends or confidants other than first degree relatives.
6. Appears indifferent to praise and criticism from others.
7. Shows emotional coldness, aloofness or limited affectivity.

The symptoms must not be better explained by another disorder (e.g. schizophrenia , bipolar disorder, or depressive disorder with psychotic characteristics, another psychotic disorder, or an autism spectrum disorder ).

Demarcation

A major problem with diagnostics is the overlap with other personality disorders or diseases. Some symptoms can include B. resemble the negative symptoms occurring in schizophrenia simplex (e.g. impoverished thinking and flattened affect ). The schizoid PS, however, is a constant pattern over a long period of time, while schizophrenia represents a sudden decline in previously inconspicuous people.

Other personality disorders

In contrast to the schizoid PS, it is above all the fear of shame and the negative value judgment of others that makes contact more difficult for those affected with anxious avoidance personality disorder (ÄVPS). However, there are also clear similarities. Therefore, some believe that the PLC and AVPS are different variants of the same fault.

People with schizotypic PS show significantly more abnormalities in behavior, language and perception than schizoids, e.g. B. magical thinking , bizarre beliefs and strange ways of speaking. Both personality disorders are also increasingly combined with the SPS and then represent a comorbidity .

autism

It can also be difficult to differentiate from Asperger's Syndrome (AS), which begins in childhood , as some autistic people (up to 26%) also meet the criteria for schizoid PS. Social communication (facial expressions, gestures, eye contact, etc.) can be noticeable in both Asperger's syndrome and SPS. An essential difference, however, is that schizoid people usually appear reserved, reserved and closed (or even “secretive”) and tend to be reluctant to talk about themselves; d. H. so an attempt is made to avoid self-revelation.

In stark contrast, people with Asperger's are often very open-hearted, honest and direct, and sometimes unintentionally intrusive. There is often little fear of giving others an insight into one's inner workings. This is shown very well in the open - and sometimes naive - personal portrayal of autistic people in their autobiographies and in public interviews. You often want contact with other people, but have problems perceiving complex feelings in the other person or reacting to them appropriately.

Further distinguishing features are the social interaction, which is less affected in schizoid people, hardly any stereotypical behavior and a stronger restriction of affect. In contrast to autism, normal emotionality and inconspicuous social behavior can usually be observed up to puberty. In contrast, restricted, repetitive behavior and a lack of reciprocity in social exchange are more typical of Asperger's. With AS, however, the lack of reciprocity is less based on indifference or disinterest, but more on eccentric determination in pursuing a certain special topic - regardless of whether the other interlocutors are interested or not.

criticism

The concept of schizoid PS in ICD and DSM is generally seen as an advancement. Nevertheless, some criticize that it is too anemic, unrealistic and too independent of the social context.

Ernst Kretschmer originally described a smooth transition from health to illness in his constitution theory (1921): from schizothymes (healthy) - through schizoids (borderline case) - to schizophrenics (pathological). According to him, typical of the schizoid character were the "living within oneself" and weak contacts. Unlike today, however, he mainly emphasized the oscillation between two opposing poles of properties: On the one hand, schizoids are indeed over- sensitive ( hyperesthetic ), i.e. H. easily vulnerable and irritable, sensitive, moody, nervous, eccentric. Paradoxically, they would also be insensitive ( anesthetic ), i.e. hypothermic, harshly rejecting contacts, colorless and indifferent. Here, behind a dull, difficult-to-penetrate behavioral mask, a deep, cozy responsiveness is hidden.

From 1980, however, the definition of the schizoid PS was strictly limited to the insensitive characteristics - the hypersensitive characteristics, on the other hand, were assigned to the schizotypic and anxious-avoidant PS . As a result, Kretschmer's schizoid character was in a sense broken up into three separate personality disorders. Experts criticize the fact that with this artificial separation the very heart of the schizoid was removed - the ambivalence (inner turmoil due to contradicting efforts).

Salman Ahktar and Otto Kernberg doubt z. B. on the DSM criterion “has no desire for close relationships”. They see this as a mere surface phenomenon, because behind it there is a high level of emotional sensitivity to the reactions of others. Ahktar therefore calls for a return to Kretschmer's holistic concept and criticizes the DSM because it misunderstands the importance that social relationships have for schizoid people. But the current diagnostic criteria also remain one-dimensional and are limited to an indifferent and disinterested facade. Not taken into account are z. B. ambivalent and changeable behavior, the psychodynamics of the resulting internal conflicts and strong hypersensitivity to rejection and affection alike.

Akhtar's model

Salman Akhtar (psychiatrist and psychoanalyst) was dissatisfied with the previous diagnostic criteria and the conception of the schizoid personality disorder. As an alternative, he therefore developed his own comprehensive phenomenological profile, which takes into account classic psychoanalytic and current descriptive observations.

Its model is summarized in the table below. The first column describes six psychological functional areas. Each area contains certain traits and behaviors that are further divided into two groups - directly visible and hidden . However, both groups are not subtypes and the terms do not refer to conscious or unconscious processes. Instead, according to Akhtar, they stand for more or less easily recognizable, seemingly contradicting aspects that are simultaneously present within a person. In addition, "this type of symptom classification emphasizes the central importance of division and confusion of identity for the understanding of the schizoid personality".

Akhtar's profile is controversial as it has not yet been verified in systematic empirical studies . Since this is a general model, naturally not every feature applies to every individual case.

Area	Visible features (overt)	Hidden features (covered)
Self-concept	obedient and cooperative stoic , endures indifferently avoids competition and rivalry self-sufficient, not dependent on anyone not assertive considers himself an inferior outsider	cynical fake, not authentic depersonalized or depersonalized feels alternately empty, robot-like or full of vengeful fantasies of omnipotence hidden feelings of grandiosity
Relationships	withdrawn aloof and aloof little close friends emotionally "impervious" Feelings of others "roll off" Fear of closeness and intimacy	very sensitive and sensitive deep curiosity about others love hungry Envy of the casual spontaneity of others strong longing for contact with others Enthusiastic among selected confidants
Social adjustment	Preferably alone in work and leisure hardly sociable, only in selected groups prone to esoteric movements due to strong need to belong rather sluggish and indifferent	no clarity about own goals weak ethnic roots mostly able to work consistently quite creative, could make special and original contributions passionate perseverance in certain areas of interest
Love and sex	hardly any interest in sex no interest in romance rejects sexual gossip and frivolities from	secret voyeuristic interests Tendency to erotomania prone to compulsive perversions
Values ​​and ideals	idiosyncratic moral and political views Penchant for spirituality , mysticism and parapsychology	moral unevenness occasionally noticeably immoral, prone to bizarre crimes later, however, selflessly and self-sacrificing
Way of thinking	absent-minded in fantasies deepens blurred and artificial language Eloquence alternates with unclear expression	autistic thinking style (intensive reflection on one's own soul life) fluctuates between "self-examination" and sharp contact with the outside world self-centered use of language

frequency

It is assumed that 0.4 to 0.9% of those affected in the population are affected. This means that the disorder is relatively rare compared to other personality disorders: It accounts for around 3.8% of all personality disorders diagnosed. Overall, schizoid patients are rarely found in clinics. On the other hand, personality disorders related to schizophrenia such as schizoid personality disorder are very common among the homeless . Women and men are affected roughly equally often.

Subtypes

Many basically schizoid people maintain a committed, interested and affectionate social style and therefore do not correspond to the cliché that is drawn by the diagnostic systems. It is therefore sometimes suggested to differentiate between the following subtypes (based on the perception of those affected): the classic and, alternatively, the secret schizoid . The secret schizoid his is investment despite outwardly seems quite interested in interpersonal relationships, can be largely covered thereby schizoid traits in handling and dubbed. But even with this subtype in social interaction, an emotional inaccessibility and sometimes inadequate reactions are quickly noticed as the essence of the essence, although formally a perfect and even elegant social style can be mastered.

Theodore Millon limited the term "schizoid" to personality disorders with the inability to establish social relationships. He described four prototypes of the PLC, which, however, rarely appear pure in reality:

Carrier subtype (with depressive features)	Phlegmatic, lethargic temperament; too low activation level; listless, tired, leaden, dull and limp. Hardly vital or energetic, slowed down; emotionally but not empty. Often has few interests; prefers simple, repetitive and dependent lifestyles.
Rapt subtype (with avoidant-schizotypic features)	Distant and distant; inaccessible, lonely, isolated, homeless, cut off, drifting aimlessly on the fringes of society, often employed in jobs with low income and status. In severe cases, schizotypic characteristics, observable among chronically institutionalized patients and in rehabilitation centers.
Depersonalized subtype (with schizotypal features)	Detached from yourself and the others; the self becomes the disembodied or distant object; Body and mind are decoupled from each other, separated. Look at yourself from the outside. Scattered, often staring into space, inattentive.
Affectless subtype (with compulsive features)	Passionless, unresponsive, unresponsive, indifferent, cool, indifferent, unmoved, temperamental, lackluster, unexciting, serene, cool; all feelings diminished. Combines schizoid apathy with the emotional constriction of compulsive PS.

According to him, the cognitive style of schizoid persons is characterized by "faulty checking in perception". He suspected that this created difficulties in registering emotions in oneself and others in detail. They do not perceive signs of emotions, which leads to a lack of emotional responsiveness. Millon also criticized that the diagnosis of schizoid PS is defined purely negatively; H. It only states which features are missing, but not which ones are present. That would make the SPS appear like a “personality disorder without personality” or as a “deficit syndrome” or “vacuum” and make research very difficult. In his opinion, schizoid and histrionic personality disorder are in many ways the exact opposite of each other.

causes

Originally, Kretschmer and Bleuler assumed hereditary causes, while psychoanalysts blamed a disturbed mother-child relationship for the development of a PLC. Today psychologists suspect a multifactorial causation: According to this, a schizoid personality structure arises when an innate high degree of sensitivity and irritability were combined with forms of severe emotional neglect , brusque maternal care or chaotic social conditions. In many cases, one of the parents has mental disorders or was unable to understand their child. The infant and toddler lack sufficient protection to develop their first independent contact with the immediate environment - such attempts were either not answered at all and could not develop further, or the reaction to them was so strong that it was not the joy of the answer, but the The fear of them remains in the memory as a lasting experience. So far, however, no reliable empirical studies are available.

Twin studies estimate the heredity of SPS at around 55–59%, so that a genetic predisposition could also be the cause. In contrast to the schizotypic PS, however, no clear evidence of a relationship to schizophrenia has been found to date. Other observations also suggest that biological factors are involved in the development of SPS. For example, a connection with reduced body weight was observed and preterm birth and prenatal malnutrition were identified as risk factors. Even after a head injury , schizoid behaviors often develop suddenly (e.g. being very lonely).

course

The prevailing belief is that this personality disorder begins in early childhood or adolescence. The first signs of this can be lonely, lonely behavior and poor school performance despite good potential. This otherness can contribute to teasing and poor peer relationships. Due to poor social skills and a lack of desire for sexual experience, people with SPS sometimes have few friendships and rarely marry. Schizoid patients are therefore often childless and tend to live alone or with their parents.

Little is otherwise known about the course, as this personality disorder has hardly been researched in the last few decades. Furthermore, the willingness to be examined and treated in the context of scientific studies is probably often too low.

In general, it can be said that personality disorders are not expected to improve over time without treatment because they are persistent, long-standing behavior patterns. Under favorable conditions, however, such as when trust can be gained during therapy, the schizoid traits can under certain circumstances soften, so that plasticity and thus a certain change occurs.

treatment

As a rule, people with moderate schizoid features seek treatment. In doing so, those affected often suffer from their inability to establish and enjoy close relationships with others.

psychotherapy

Treatment is through psychotherapy , and people with schizoid personality disorder often find it difficult to establish a closer relationship with the therapist. Rainer Sachse advises patience and warns against trying to “emotionalize” the schizoid patient in therapy. Both behavioral change strategies and psychodynamic methods are used.

However, cognitive behavioral therapy could pose problems, at least initially. Because with this form of therapy a crucial step is to identify typical automatic thoughts . This usually works well for other personality disorders. With schizoid personality disorder, on the other hand, it is often difficult to identify any spontaneous thoughts at all and there is more of a mental emptiness. One explanation for this could be that thoughts are associated with feelings. Because schizoid people may have fewer feelings, they also report fewer thoughts than people with other personality disorders. This reflects the lack of thought and apathetic view of schizoid people. When automatic thoughts are present, they typically deal with a penchant for loneliness and a feeling of being a distant observer.

Medication

Psychotropic drugs should be used in addition if severe depression , anxiety , depersonalization or particularly severe, psychosis-related episodes occur.

Attempts can also be made to directly treat those symptoms of schizoid PS that are similar to the negative symptoms of schizophrenia . These include B. apathy , social withdrawal, impoverishment of speech and thought, indulgence and joylessness , restricted emotional life and avolition (reduced stamina and willpower). Therefore, atypical neuroleptics (such as olanzapine , sertindole etc.) could be promising. A causal treatment with drugs is not known.

See also

• Schizoid character after Lowen
• Alexithymia (emotional blindness)

literature

• Peter Fiedler , Sabine C. Herpertz: Personality disorders. 7th edition. Beltz Verlag, 2016, ISBN 978-3-621-28013-6 .
• Rainer Sachse : Clarification-oriented psychotherapy of schizoid and paranoid personality disorder . Hogrefe, 2017, ISBN 978-3-8017-2844-1 .
• Dirk Nordmann: Schizoid: When closeness becomes a problem - an experience . Verlag der Ideen, Volkach 2014, ISBN 978-3-942006-14-9 .
• Fritz Riemann : Basic forms of fear : A depth psychological study. Reinhardt, Munich 2011, ISBN 978-3-497-03749-0 .
• The schizoid personalities . In: Francois Lelord . The normal madness . Structure Verlag, 2008, ISBN 978-3-7466-1687-2 .
• Harry Guntrip: Schizoid Phenomena, Object-Relations and the Self . International Universities Press, 2001, ISBN 0-8236-8310-9 .
• Jeffrey Seinfeld: The Empty Core: An Object Relations Approach to Psychotherapy of the Schizoid Personality . Jason Aronson, 1991, ISBN 0-87668-611-0 .
• Gerhard Dammann , Otto F. Kernberg : Schizoidie and schizoid personality disorder: Psychodynamics - Diagnostics - Psychotherapy. Kohlhammer, 2018, ISBN 978-3-17-033467-0 .

Web links

Wiktionary: schizoid  - explanations of meanings, word origins, synonyms, translations

• Volker Faust on schizoid personality disorder
• Mind and Present: Schizoid - The Fear of Loss of Self and The Schizoid Personality Disorder
• Schizoid Personality Disorder.de

Individual evidence

1. ↑ ^{a b} Guido Pliska: Gottfried Benn and the schizoid. 2009. doi: 10.1007 / s00115-009-2859-1 : “The key to schizoid temperaments is held by those who have clearly grasped that most schizoids are not either overly sensitive or cool, but that they are overly sensitive and cool at the same time, and in very different mixing ratios. "(Ernst Kretschmer)
2. ↑ Schizoid character structure (Wikipedia) and Chapter 5 from Alexander Lowen : Bioenergetik. 2011, ISBN 978-3-644-41361-0 .
3. ↑ Ronald Laing : The Divided Self. 1994, ISBN 3-462-02375-6 , Chapter 5: The Inner Self in the Schizoid State.
4. ↑ ^{a b} Philip Manfield: Split self / split object: understanding and Treating borderline, narcissistic, and schizoid disorders . Jason Aronson, 1992, ISBN 0-87668-460-6 , p. 207 “Not all schizoids keep away from people. It is not people that schizoids avoid, but emotional intimacy, self disclosure, and emotions both positive and negative. "
5. ↑ ^{a b c d e f g} DSM-5 : Descriptive text and criteria for schizoid PS. 2015, ISBN 978-3-8017-2599-0 , pp. 894f.
6. ^ ^{A b} Karl Koehler, Henning Saß : Diagnostic and statistical manual of mental disorders ( DSM III ) . 1984, ISBN 3-407-86104-4 , section Schizoid Personality Disorder, p. 322 .
7. ↑ ^{a b c} The Schizoid and Schizotypic Personality Disorder. In: Aaron Beck : Cognitive Therapy of Personality Disorders. Beltz, 1995, ISBN 3-621-27155-4 , pp. 105-119.
8. ↑ ^{a b} Schizoid Personality Disorder (Chapter 3) . In: Sharon Eklery (Ed.): Integrated treatment for co-occurring disorders - personality disorders and addiction . Routledge, 2009, ISBN 978-0-7890-3693-3 , pp. 31–45 ( limited preview in Google Book search).
9. ↑ ^{a b} Sabine Herpertz: 4.2 Schizoid personality disorder . Thieme Verlag, 2003. doi: 10.1055 / b-0034-12065 . Medicine in Text (Blog): Schizoid Personality Disorder. Quote: "Many schizoids are intellectual people - they prefer to occupy themselves with theoretical things than drive a nail into the wall."
10. ^ ^{A b} Mathias Berger (Ed.): Mental illnesses. Clinic and Therapy. 4th edition, 2012. ISBN 978-3-437-22483-6 . Chapter 21.6.5: Schizoid Personality Disorder. Quote: "Many schizoid patients have an impressive self-irony and tolerate therapeutic interventions that are brought forward with a certain 'wink'."
11. ↑ ^{a b} See keyword schizoid. In: Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology. 1999, ISBN 3-86047-864-8 , p. 462.
12. ↑ Adrian Furnham: The Bright and Dark Side Correlates of Creativity: Demographic, Ability, Personality Traits and Personality Disorders Associated with Divergent Thinking . In: Creativity Research Journal . tape 27 , no. 1 , 2015, p. 39-46 ( tandfonline.com ).
13. ↑ Stefan Röpke: The schizoid PS: Farewell to a diagnosis? (Slides 13-14). “In a Norwegian study, schizoid people showed less contact with family and friends, less subjective well-being, less life satisfaction, less support and more negative life events.” See Cramer et al. (2006): Personality disorders and quality of life. A population study.
14. ↑ JP Hong, J. Samuels, OJ Bienvenu, FC Hsu, WW Eaton, PT Costa, G. Nestadt: The longitudinal relationship between personality disorder dimensions and global functioning in a community-residing population. In: Psychological medicine. Volume 35, Number 6, June 2005, pp. 891-895. PMID 15997609 .
15. ^ Simone Ullrich: Dimensions of DSM-IV PDs and Life Success. 2007. (full text). doi: 10.1521 / pedi.2007.21.6.657 .
16. ↑ Y. Levi-Belz, Y. Gvion, U. Levi, A. Apter (2019): Beyond the mental pain: A case-control study on the contribution of schizoid personality disorder symptoms to medically serious suicide attempts . In: Comprehensive Psychiatry . tape 90 , p. 102-109 , doi : 10.1016 / j.comppsych.2019.02.005 ( elsevier.com ).
17. ↑ ^{a b c} Wolfgang Tress: Personality disorders: guideline and source text. Schattauer Verlag, 2002, ISBN 3-7945-2142-0 , pp. 83f.
18. ↑ Appendix B - Criteria Lists and Axes Intended for Further Research. In: DSM-IV-TR . 2003, ISBN 3-8017-1660-0 , pp. 831 f.
19. ↑ Peter Fiedler , Michael Marwitz: Self-insecure and fearful-avoiding personality disorders . In: PSYCH up2date . tape 10 , no. 03 . Thieme Verlag, 2016, p. 215–234 , doi : 10.1055 / s-0042-103824 ( thieme-connect.de - see section on differential diagnostics ).
20. ↑ Tony Attwood : A Whole Life With Asperger's Syndrome. All questions - all answers. TRIAS, Stuttgart 2008, ISBN 978-3-8304-3392-7 , p. 109.
21. ↑ Fritz-Georg Lehnhardt, Astrid Gawronski et al .: Diagnostics and differential diagnosis of Asperger's syndrome in adulthood . In: Deutsches Arzteblatt International . tape 110 , no. 45 , 2013, p. 755–763 , doi : 10.3238 / arztebl.2013.0755 ( aerzteblatt.de [PDF]).
22. ^ ^{A b c} Salman Akhtar : Schizoid Personality Disorder: A Synthesis of Developmental, Dynamic, and Descriptive Features . In: American Journal of Psychotherapy . tape 41 , 1987, pp. 499-518 , PMID 3324773 ( google.de ).
23. ↑ Peter Fiedler : Personality disorders . 6th edition. Beltz, 2007, ISBN 978-3-621-27622-1 , pp. 137 : "The current diagnosis of" schizoid PS "takes away - if you will - the schizoid described by Kretschmer its ambiguity: The second side of the character that he ascribed to the supposed schizoid (namely sensitive, easily vulnerable, moody and erratic) has been valid ever since as a proportion of the schizotype PS. "
24. ↑ DSM-5 Clinical Cases: "Oddly isolated" (Case 18.2). 2013, ISBN 978-1-58562-463-8 . For the separation of schizoid and anxious PS, see WJ Livesley, M. West: The DSM-III Distinction between schizoid and avoidant personality disorders. In: Canadian journal of psychiatry. Revue canadienne de psychiatrie. Volume 31, Number 1, February 1986, pp. 59-62. PMID 3948107 .
25. ^ Adrian J. Connolly: Personality Disorders in Homeless Drop-In Center Clients. ( Memento of the original from June 17, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 2008. doi: 10.1521 / pedi.2008.22.6.573 : "Cluster A personality disorders (paranoid, schizoid, schizotypal) were found in almost all participants (92% had at least one diagnosis)." 
26. ^ Secret Pure Schizoid Cluster Disorder. In: James F. Masterson, Ralph Klein: Disorders of the Self. Brunner / Mazel, New York 1995, ISBN 0-87630-786-1 , pp. 25-27.
27. ↑ ^{a b} Theodore Millon: Personality Disorders in Modern Life. 2nd Edition. Wiley, 2004, ISBN 0-471-23734-5 , p. 371 The Schizoid Personality (Chapter 11) .
28. ^ Paul H. Blaney et al: Oxford Textbook of Psychopathology . Oxford University Press, 2014, ISBN 978-0-19-981184-7 , pp. 649 ( limited preview in Google Book search).
29. ↑ Johannes Hebebrand et al .: Low body weight in male children and adolescents with schizoid personality disorder or Asperger's disorder . 1997, doi : 10.1111 / j.1600-0447.1997.tb09906.x .
30. ↑ To a loner through head injury? In: Medizin.at , 2014.
31. ^ Willem HJ Martens: Schizoid personality disorder linked to unbearable and inescapable loneliness. In: The European Journal of Psychiatry. 24, 2010. doi: 10.4321 / s0213-61632010000100005 .
32. ↑ Simone Hoffner: The schizoid personality disorder. Results of an empirical study on the classification of schizoid disorders and first attempts to validate the interview on the diagnosis of schizoid disorders IDS. Dissertation . University of Heidelberg, 1999, pp. 6-25. ( Summary ) (SPS as a fundamental disruption of the emotional relationship to the world).
33. ↑ Thomas Suslow, Volker Arolt: Schizophrenia- related personality disorders. 2008, doi: 10.1007 / s00115-008-2589-9 : "There is a considerable lack of studies on neuropsychological and neurobiological characteristics and psychosocial risk factors of paranoid and schizoid personality disorder."
34. ↑ Rainer and Meike Sachse: Clarification-oriented psychotherapy of schizoid and paranoid personality disorder . Hogrefe 2017, ISBN 978-3-8017-2844-1 , Chapter 2, p. 13.
35. ↑ Schizoid Personality Disorder (Chapter 3, pp. 45-56) . In: Sonny Joseph: Personality Disorders - New Symptom-Focused Drug Therapy. 1997, ISBN 0-7890-0134-9 .

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