301.21 Schizoid Personality Disorder

DSM-IV-TR diagnostic criteria:

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood (age eighteen or older) and present in a variety of contexts, as indicated by four (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 affect

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition. It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

I don't know if I was actually diagnosed with Schizoid Personality Disorder. The doctor involved would not share the diagnosis with me, and would not answer my questions. Later, a social worker told me that the diagnosis was Schizo Personality Disorder, seemingly surprised that I did not know. She had an accent, so I am not sure if she mispronounced the term, or if I heard it wrong. Also, I don't know if she said 'schizo' because the actual word on the paper was difficult to read or it was unfamiliar to her, or if Schizo Personality Disorder was an actual diagnosis at that time. I thought it sounded like a cool diagnosis, until I read the diagnostic criteria many years later.

In reading about Schizoid Personality Disorder (various sources) what strikes me is that (some) professionals write about such people as if they are cold and inhuman at the core and therefore cannot be trusted. If they appear to be friendly or engaging, if they appear to be relating to others, it's not real, because these people ultimately remain detached and invest nothing emotionally. Starting from that perspective, I can't see how diagnosis can be helpful. If anything, it is stigmatizing and judgmental, and without insight into human adaptations to unusual circumstances, or into the survival instinct itself.

Although not evident in the DSM diagnostic criteria, it is now understood that many with schizoid personality disorder actually do want close relationships. If such people admit that they seek connection and closeness, how can they trust professionals who may treat them with suspicion? And how could the professionals have been so wrong in the first place as to assume they didn't want closeness and connection? In reading what the professionals say, I admit that I question whether I really always do remain (ultimately) detached internally. But it seems to me that when I seek relationships, I am very open to the possibility of closeness, and I offer everything I possibly can - I do take enormous emotional risks. The problem is often that I don't think others want or can achieve the kind of intimacy that I potentially can because of the life experiences I have had that have led me to crave such intimacy.

I will go through the criteria one at a time.

1. neither desires nor enjoys close relationships, including being part of a family

The first part has never been true. The more intimate the relationship, the better I regard it. I still think of the efforts to understand another person, and the moments of connection or semi-connection, and the efforts the other person has put in, as valuable. I have always been seeking intimacy, and make every effort to remain as open as possible when I have a chance for it.

In 1989, I still cared very much about my family. However, during my hospitalization, I felt abandoned by my family. I was in an 'unhealthy' hospital, and no one on the outside seemed to believe me. But if the doctor had talked to me for a longer period of time, he would have learned more about the family situation, including that I had experienced a severe degree of neglect for many years. Through the years, the development of an alternative family has been very important to me.

2. almost always chooses solitary activities

When I lived with family in Winnipeg, it was not like I had a choice. I was completely isolated. While my brother stayed with us, I did talk with him. I also spent time with my stepmother, and babysat her son's child. If the doctor had observed me in the hospital itself, he would have seen that I almost always spent time with other patients, listening to their problems.

3. has little, if any, interest in having sexual experiences with another person

bwahahahaha!

4. takes pleasure in few, if any, activities

This could be related to depression which was unrecognized (the doctor thought it was schizoid rather than depressive), but it could also be that I was isolated and there were few activities open to me, and he didn't pick up on the history of moving. At this time, though, dancing was an extreme kind of pleasure, and which still stands out to me when looking back upon all the pleasure experienced in my lifetime. It could also be that this was a way that I could access emotion, and remain 'human' when I was surrounded by people who did not understand how isolated I was and who misunderstood my motives and experience.

5. lacks close friends or confidants other than first-degree relatives

Again, this would have been about isolation, and circumstances, including a long chain of events and unresolved depression and eating disorder issues.

In 1989, I was 23 years old. I hadn't gone to university, and I was unemployed, and aside from a couple of brief efforts to get back into life, for the majority of the time from 1982-1989 I didn't leave the house. I didn't have anything to share about my situation which those I had known would have understood. I was now a 'loser'. I did have a few experiences that were extremely uncomfortable in which I tried to explain my situation. Within the family itself, it was understood that when talking to relatives it was better that I try to fudge the details - I understood that the truth of my situation was something that must be hidden.

I suppose in 1989 I couldn't point to my relationships with my first long-term boyfriend (which began in 1992 and lasted 7 years) or GK (1999) then, or any of my other internet relationships. I couldn't say that the majority of these relationships were about exploring psychological and emotional complications, and intimacy. To dismiss the endings of my past relationships as 'a pervasive pattern of detachment' seems unfair when my family kept moving all over the place, and I had no control over the moves. 'Desensitization' is 'positive' if it results in conquering a phobia, I guess, but 'negative' if it is an adaptation to constant change and upheaval, and lack of personal control over circumstances. But again, it could be related to perception: how a conscious style of communication is perceived by another.

6. appears indifferent to the praise or criticism of others

Not at all true, either in 1989, or now. When I say now that I'd prefer to be alone than to have relationships that are built on false pretenses, it doesn't mean that rejection, criticism or praise don't have effects. It doesn't mean that I don't really want someone to like the way I express myself. I am not indifferent to the fact that a lot of people probably think on my site I am making a fool out of myself - it's a sign of my courage that I keep expressing myself in spite of how unsure I am of myself. I want someone to like me. I want to know what people think - even if it's unflattering. I want feedback, period. I feel starved of it. For most of my life, an ongoing theme has been that I don't think people offer each other enough feedback. I want people to like me, and it hurts if they don't, but if they don't, I don't want to change in order to please them.

One thing that occurs to me is that those who 'appear indifferent to praise or criticism' might not actually value feedback coming from a person they do not respect.

7. shows emotional coldness, detachment, or flattened affect

In depression, people can become numb after emotional overload. But to miss that I am empathetic would be weird. To find out why in describing some of the events of my life I might seem detached, it might have been necessary to talk to me further. In trying to be rational, and even helpful (offering relevant information), I may have put in effort to remain calm, so as to get enough said.

FWIW: The psychiatrist's affect was far flatter than mine.

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition. It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

I guess this doctor did not see that a Mood Disorder might have been a better diagnosis. If he had talked to me for more than a short time, he might have at least wondered somewhat.

If the diagnosis had actually been 301.22 Schizotypal Personality Disorder: the doctor might have thought I had unusual beliefs and eccentric behaviour - but he did not get to know me long enough for an explanation, and if he had talked to the two adults in my life at the time, he may have discovered that they fit the criteria themselves. I did not experience cognitive or perceptual distortions - if anything the nurses on my ward did. For example, one had quoted me as saying, 'I have the right to control what goes in my own body!', when I had desperately cried out, 'Don't I have the right to control what goes in my own body?' when told I could be strapped down and medicated if I continued to refuse meds.

Schizoaffective Personality Disorder seems less likely as there is more focus on manic or unstable mood, and more focus on perceptual distortion. Unless the doctor took into account the scene (with the admitting doctor) in which I was admitted to the emergency room. I was crying uncontrollably at that time, after having been taken to the hospital by the police - and this was an extremely rare occurrence which had resulted from the way this was done by my father. I had on a few occasions tried to discuss the situation with him, saying I would go voluntarily to a hospital if he worked out the details, but he just one day let me know I had 5 minutes because the police were on the way. In comparison, I would have seemed calm/stable when the psychiatrist spoke to me. However, another factor may have been that at that time I did occasionally experience 'highs' when dancing - I don't know if I discussed that with him. I did very strongly feel that I hadn't had enough time to explain anything in enough detail. If it seemed that I was delusional or experiencing perceptual distortions, the doctor might have had a different opinion if he had talked to me longer.

OK, basically I am stabbing in the dark, because I was not allowed to know the diagnosis. In each of the three diagnoses above, I want to know what would have led the doctor to think the criteria fit me. I feel as if an attack has been made on my identity and personal integrity. The doctor would not discuss the diagnosis with me. He would not tell me what meds he was prescribing, or why. He did at one point try to put me in my place by saying that he was the doctor here, and in effect, who did I think I was to question him? And when I refused treatment, which as far as I could see only consisted of hospitalization and the taking of meds which I was not allowed to know the name or effects of, he actually called me "stupid". And I wonder, did he think that if I tried to tell anyone, they would never believe me?