Schizoid personality disorder is a condition in which people avoid social activities and consistently shy away from interaction with others. People with the disorder are generally loners with a profound inability to connect with others and form personal relationships.

To others, people with schizoid personality disorder may appear aloof, dull or humorless, and they're often ignored in social settings. People with schizoid personality disorder show a flattened or restricted range of emotions, and can appear indifferent to what's going on around them. However, their inner life can be rife with a deep emotional need, sensitivity and confusion about the world around them.

The cause of schizoid personality disorder is unknown. Some therapeutic approaches and medications may help relieve some symptoms of schizoid personality disorder.

People with schizoid personality disorder are loners. Generally they:

• Choose activities that don't require interaction with others
• Prize solitude and independence
• Are often unable to respond to normal social cues in social settings
• Harbor little desire for sexual experiences with others
• Can appear dull or indifferent to others
• Are followers rather than leaders in groups

Some tendencies can appear in childhood and continue through adolescence and into early adulthood.

People with schizoid personality disorder may appear detached and aloof to outsiders, but some experts believe that they're actually quite sensitive and experience a deep longing for intimacy. However, people with schizoid personality disorder either are incapable of initiating and maintaining a personal relationship or find themselves suffocated or anxious in the company of others. Thus they retreat into their inner worlds and view their environs with great confusion or seek relationships for security, but break away repeatedly.

Often, people with schizoid personality disorder populate the fringes of life — choosing to work a midnight shift, for example. They may live in the basement of their elderly parents' homes or in some cases become homeless, refusing outreach services.

Signs and symptoms of schizoid personality disorder include:

• Emotional coldness or aloofness
• Indifference to praise or criticism and the feelings of others
• Close friendships with no more than one or two people, including family members
• Social withdrawal, or continual avoidance of social activities
• Flattened emotions or lack of expressivity
• Inability to experience pleasure (anhedonia)
• General feeling of discomfort or restlessness (dysphoria)
• Having little to say
• Lack of motivation or persistence (avolition)
• Tendency toward underperformance in school or work settings

The schizophrenic spectrum
Schizoid personality disorder is considered part of the "schizophrenic spectrum" of disorders, which includes schizotypal personality disorder and schizophrenia. These conditions all have similar symptoms, such as an incapacity for social relations and emotional inexpressiveness. The main distinction is that people with schizoid personality don't usually experience the perceptual distortions, paranoia or illusions characteristic of schizotypal personality or the psychotic episodes of schizophrenia.

Although their speech lacks enthusiasm, what people with schizoid personality disorder say is rarely abnormal or odd, as in the conversational patterns of people with schizotypal personality disorder.

When to see a doctor
Because personality tends to become entrenched with age, treatment for a personality disorder has the possibility of being more effective if it begins as early as possible.

People with schizoid personality disorder tend to shun interaction with medical professionals and are likely to seek help only at the urging of relatives or teachers or intervention by the legal system.

If you suspect someone may have schizoid personality disorder, be on the lookout for signs and symptoms such as consistent emotional detachment and social isolation. You might gently suggest that the person seek medical attention, starting with a primary care physician or mental health professional.

The exact causes of schizoid personality disorder are unknown, although a combination of genetic and environmental factors — particularly in early childhood — are thought to contribute to development of all personality disorders.

A person with schizoid personality disorder may have had a parent who was cold or unresponsive to emotional needs, or might have grown up in a foster home where there was no love. Or, because people with schizoid personality disorder are often described as being hypersensitive or thin-skinned in early adolescence, a person with schizoid personality disorder may have had needs that others treated with exasperation or scorn.

A family history — such as having a parent who has any of the disorders on the schizophrenic spectrum — also increases the chances of developing the disorder.

Personality development is affected by genetic tendencies as well as environmental factors, particularly during childhood. Factors that increase the risk of developing schizoid personality disorder include:

• Having a parent or other relative who has schizoid personality disorder, schizotypal personality disorder or schizophrenia
• Experiencing a childhood environment of neglect or scorn
• Suffering child abuse or mistreatment
• Having an emotionally detached parent

People with schizoid personality are at an increased risk of:

• Developing schizotypal personality disorder, schizophrenia or other delusional disorder
• Drug addiction, particularly to psychedelic drugs
• Alcohol addiction
• Major depression
• Anxiety disorder
• Panic disorder
• Social phobia
• Other personality disorders

Further, because people with schizoid personality disorder may have trouble interpreting and responding to social stimuli, they may have trouble warding off the predatory behavior of other people. As a result, they may be more prone to victimization than are most other people.

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down your key personal information, including any major stress or trauma in your past or present. Also make note of any recent life changes.
• Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications, vitamins, supplements or other natural remedies you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot. In addition, talking with someone who knows you well will help your doctor diagnose your condition.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For schizoid personality disorder, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are possible causes for my symptoms or condition?
• How will you determine my diagnosis?
• Is my condition likely temporary or chronic?
• What treatments do you recommend for this disorder?
• What are the side effects of medications commonly used for this condition?
• Would you recommend including my family in talk therapy sessions?
• How much improvement can I expect if I follow your recommended treatment plan?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• How much distress do your symptoms cause you?
• Have you noticed that your symptoms get worse in certain situations? If yes, what are those situations, and how do you handle them?
• How satisfied are you with your performance at work and school?
• Do you have close relationships with family members or friends?
• What do you prefer to do in your free time?
• Have you ever thought about harming yourself or others? Have you ever actually done so?
• Have your family members or friends expressed concern about your behavior?
• Have any of your close relatives been diagnosed with or treated for mental illness?
• Do you drink alcohol or use drugs? If so, how often?

What you can do in the meantime
While you're waiting for your appointment, it may be helpful to ask friends or family members if they have felt concerned about your behavior. You'll also want to find out about your family's medical history, including any history of mental illness. If you have fantasies about hurting yourself or someone else, go to an emergency room or call 911 or your local emergency number immediately.

There are no laboratory tests for schizoid personality disorder, and diagnosis usually comes after an in-depth interview with your doctor. During this interview, the doctor will ask questions about symptoms and mental well-being, and take a medical, psychiatric and social history. A physical examination can help rule out other conditions, and a mental health professional will likely be consulted for further evaluation.

To be diagnosed with schizoid personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. Criteria for schizoid personality disorder to be diagnosed include four or more of the following characteristics:

• Neither desires nor enjoys close relationships, including being part of a family
• Almost always chooses solitary activities
• Has little, if any, interest in sexual experiences with another person
• Takes pleasure in few, if any, activities and rarely experiences strong emotions
• Lacks close friends or confidantes other than first-degree relatives
• Appears indifferent to praise or criticism
• Shows emotional coldness, detachment or flattened emotions

In addition, the symptoms must not occur exclusively during a bout of schizophrenia, a mood disorder with psychotic features, another psychotic disorder or a pervasive developmental disorder (such as autism or Asperger's syndrome). Also, a diagnosis of schizoid personality disorder may not be appropriate should symptoms be due to the direct physiological effects of a general medical condition.

Further complicating a diagnosis is that the symptoms of schizoid personality may resemble autism or Asperger's syndrome.

Schizoid personality disorder can be difficult to treat because people with the disorder are inclined to go their own way and prefer not to come in contact with medical professionals. Further, they sometimes settle into complacency about their emotionally impoverished existence.

When they do come into treatment — either by family insistence or by the legal system — they can have trouble communicating with a therapist and react in a bland, detached manner. However, when a doctor shows respect for their personal space and private thoughts, people with a schizoid personality can respond effectively to treatment.

• Medications. There's no specific drug treatment for schizoid personality. However, doctors may prescribe medications to help alleviate some symptoms, as well as associated conditions such as anxiety and depression. For example, the psychological inability to experience pleasure can be treated with bupropion (Wellbutrin). Risperidone (Risperdal) or olanzapine (Zyprexa) can help with flattened emotions and social problems.
• Psychotherapy. Cognitive behavior therapy — which focuses on adjusting the thinking and behaviors that cause problems — can help a person with schizoid personality disorder develop social skills and increase sensitivity to interpersonal cues. For example, a person with schizoid personality disorder might learn appropriate ways to react when faced with certain stimuli, such as being introduced to someone at a party. The goal of treatment is to be supportive and practical, and to alleviate social anxiety and isolation.
• Group therapy. Treatment can be more effective when people with the disorder can interact with others in practicing new interpersonal skills. Group therapy may also offer people with schizoid personality disorder a support structure and increase social motivation. However, group therapy isn't effective for everybody.

Because schizoid personality disorder originates with the family and childhood environment, early intervention may help diminish the development of problem behaviors.