Cognitive therapy in schizoid personality disorder

When we think of a patient with schizoid personality disorder, characters like “Heidi’s hermit grandfather” or “the typical strange computer neighbor who doesn’t leave his house” may come to mind.

This is because The fundamental characteristic of the disorder is detachment in social relationships and little emotional expression and variation. in interpersonal contexts. It is a disorder that begins in the early stages of adulthood and is manifested by four of the following symptoms or characteristics according to DSM5:

Does not desire or enjoy intimate relationships, including being part of a family.He almost always chooses solitary activities.Shows little or no interest in having sexual experiences with another person. Enjoys few or no activities.He has no close friends or confidants apart from his first-degree relatives.He appears indifferent to the praise or criticism of others. He appears emotionally cold, with detachment or with flat affectivity.

As we see, schizoid people show very little interest in having contact with others, except for the closest people in their family context. Even so, the pattern is to spend most of the time alonedoing tasks that do not involve interaction with others.

His affection is very restricted. They seem slow and lethargic. Their speech, if it appears at all, is also slow and monotonous and if asked about their emotions, they rarely declare that they have any intense emotion such as “enjoyment” or “hate.” The environment finally ends up being ignored or left aside. This implies that the patient remains degenerated in terms of social skills, largely due to lack of practice.

Subtypes of schizoid personality disorder

Some authors have proposed subtypes within schizoid personality disorder. For example, Millon and Davis (1996) presented the following:

Disaffected. The disaffected schizoid is an individual lacking passions, unresponsive, showing little affection, cold, caring little for others, spiritless, difficult to move, or unperturbed. As its name indicates “nothing affects it”. He remains like an iceberg in the face of the circumstances of his life.Far. It is a distant subject, which is almost impossible to access. He likes to keep himself isolated and alone, homeless and aimless. He seems busy only in some activities that do not interest him much.Languid. They are very lazy people with a very low activation level. Inherently phlegmatic, lethargic, tired and weak. They often feel exhausted and neglect everything related to themselves and their lives due to lack of initiative and action.Depersonalized. Disinterested in others and himself. He feels it outside his own body or as a distant object. Perceives the mind and body as split or dissociated.

How does schizoid personality disorder develop?

schizoid disorder can develop from a combination of genetics and environment. Regarding the environment, usually They grow up in homes where they feel rejected or different. They end up seeing themselves as “less” than the other members of the family and, therefore, they generate the idea that they are different, strange, that the people around them are unpleasant or will reject them.

From cognitive therapy for schizoid personality disorder We can find different beliefs harbored in the minds of these patients: “I am a misfit.”“I am half a person”, “I am strange”, “I am lonely”, or “people are cruel”, “people disappoint”.

Therefore, from these beliefs, a series of assumptions are developed that keep them in a false security: “if I talk to other people, they will notice how strange I am and reject me”, “if you don’t fit in, you can’t have friends”. “, etc.

Cognitive therapy in schizoid personality disorder

Since the therapeutic relationship is already an interpersonal context, It is likely that the subject with schizoid disorder will have difficulties when participating in therapy. It is also very normal to feel ambivalent throughout the process about whether or not to continue in treatment.

The reason is that the therapist, who does not have this problem with social relationships, may think that the objectives are very brief or “lazy”, but he has to understand that For a schizoid patient, they are practically the greatest achievement in terms of sociability that they will achieve in their entire life. So you have to adapt to the patient and not the other way around.

From cognitive therapy in schizoid personality disorder fundamentally working with the person’s dysfunctional beliefs and assumptions that we have mentioned previously. Through techniques such as Socratic questioning, verbal reattribution or behavioral experiments, we will try to make the schizoid person realize that “the hostile world” that resides in their mind is only in their mind.

Through the technique of “Padesky’s prejudice metaphor” (1993) The patient is urged to collect as much information as possible that contradicts his beliefs of “I am not normal” or “I am strange.”. The goal is for the person to see that they are not 100% strange, that is, that despite their disorder, they sometimes do things at the level of other people.

To do this, it is sent as homework a log in which you must write down everything you do as a “normal person”. For example, some notes could be: I made my mother’s coffee, I talked to a neighbor in line at the supermarket, I come to cognitive therapy, etc.

As it is usual for these patients to abandon therapy before it is completed, It is advisable to anticipate this and design a summary report to provide to the patient. in case you want to continue your personal work, pointing out those points where you could benefit most from improvement.

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