Cluster A PD: Schizoid PD

Question 1

Cluster A

Answer 1

Odd or eccentric

Question 2

Individual characteristics of each PD

Answer 2

• Detached from social relationships
• Emotionally cold, indifferent to praise or criticism
• Prefers Solitary activities and rarely seeks intimacy
• Appears aloof, socially awkward, and unexpressive
• Lacks interest in sexual experiences and close friendships

Question 4

Criteria for Schizoid PD

Answer 4

• A pervasive detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts. Must show 4 or more of the following:
  1. Neither desires nor enjoys close relationships, including being part of a family
  2. Almost always chooses solitary activities
  3. has little, if any, interest in having sexual experiences with another person
  4. Takes pleasure in few, if any, activities
  5. Lacks close friends or confidants other than first-degree relatives
  6. Appears indifferent to the praise or criticism of others
  7. shows emotional coldness, detachment, or flattened affectivity
• B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition

Question 5

Diagnostic features

Answer 5

• Pervasive pattern of detachment from relationships
• Restricted emotional expression
• Onset in early adulthood
• Present across different contexts

Question 6

Differential diagnoses

Answer 6

• Psychotic disorders (schizophrenia, delusional disorder) - Schizoid PD must predate psuchotic symptoms and persist after remission
• Autism Spectrum disorder - ASD includes more severe social/communication impairments and repetitive behaviors
• Substance use disorders: rule out traits due to persistent substance use
• Personality change due to a medical condition - traits must not be due to a neurological or other medical condition
• Other PDs: Differentiate from schizotypal (no odd beleifs), paranoid (no suspiciousness), and loner without impairment

Question 7

Associated features

Answer 7

• Difficulty expressing anger
• Directionless lifestyle, may appear to “drift”
• Struggles with major life transitions
• May do well in isolated work environments
• Often co-occurs with schizotypal, paranoid, and avoidant PDs
• May experience brief psychotic episodes or depression

Question 8

Gender and prevalence

Answer 8

• Slightly more common in males
• Estimated prevalence: 4.9%
• Uncommon in clinical settings

Question 9

Cultural considerations

Answer 9

• Behavior may be misinterpreted in immigrants or those from unfamiliar cultures
• Cold or distant demeanor may reflect cultural norms or past trauma
• Important to avoid mislabeling cultural behaviors as pathological

Question 10

Early signs (risk factors)

Answer 10

• Childhood/adolescence: solitariness, poor relationships, underachievement
• May be teased or seen as “odd”
• Higher prevalence among relatives of individuals with schizophrenia or schizotypal PD