chaoticidealism ([info]chaoticidealism) wrote,
@ 2008-09-20 21:21:00
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Schizoid Personality disorder
Differential diagnosis: Schizoid Personality Disorder vs. Autism


SCHIZOID PERSONALITY DISORDER

A. A pervasive pattern of 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, 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 affectivity
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.

Technically, SPD and Asperger's cannot exist together because they are defined as mutually exclusive; if an Aspie fits criteria for SPD, he cannot be diagnosed with it because the SPD symptoms occur "during the [life-long] course" of a PDD. However, many Aspies do have schizoid traits. An asexual Aspie who does not find pleasure in socializing could also be diagnosed with SPD if the "during the course" criterion weren't present.

So you have to pick one or the other.

(I think it's possible to be an autistic person with schizoid traits. But as the descriptions stand currently, an Aspie who rejects socialization is only Aspie, not Aspie/Schizoid. Autism takes precedence in diagnosis.)

Differences:

--SPD is a personality disorder; and while personality has a large heritable component, it doesn't have a neurological aspect like Asperger's does. You're likely to see no real difference from NT in cognition, sensory processing, learning, or coordination. In fact, SPD has its onset by adulthood, as the personality becomes more set for a maturing individual. Asperger's is usually obvious by the toddler years--often, in infancy.

--AS has extra traits that SPD doesn't have--stims, special interests, odd speech, atypical nonverbal communication. If you have somebody who looks schizoid and has those traits, you can be pretty sure that he's autistic.

--Schizoid personality involves not wanting to socialize. Asperger's involves low social skill, regardless of desire. (Many SPD cases do involve low social skills due to lack of practice, but with practice, someone with SPD could get up to NT standard. The issue is that he sees no point in it. But low levels of skill also often lead to low levels of interest--part of why I think more Aspies have schizoid traits than average.)

--Schizoid personality has one trait that is almost never seen in a non-depressed Aspie, by definition: "Takes pleasure in few, if any, activities." That's because Aspie special interests and many stims are sources of great pleasure. I've described my special interests as "almost like falling in love".

--Not all Aspies are asexual. Most people with SPD are.

--Aspies can be extremely sensitive to praise or criticism; an SPD personality makes you rather indifferent to it.

--A significant number of Aspies are extroverted. SPD is extreme introversion.

Myth: Schizoid personality disorder is a kind of schizophrenia.

Truth: No. It's a personality disorder characterized by extreme introversion. While it is associated with an elevated risk of schizophrenia in some studies, SPD does not involve delusions or any other sort of psychosis, nor does it affect cognition.

Myth: Schizoid personality disorder means a "dangerous loner" with no morality. It's a recipe for a serial killer.

Truth:
SPD is probably one of the least troublesome psychological conditions it's possible to have, both for the person diagnosed with it and for society. It doesn't cause psychosis; nor does it impair one's judgment or morality. It may disrupt the typical "mirroring" sort of empathy, in that people with SPD would not immediately feel bad on seeing another person suffer; but it does not appear to affect the chances that the person with SPD would help the suffering individual--they may, in fact, be better at it because they are not emotionally involved in the situation and keep a cool head. (Emotional detachment, an SPD characteristic, is required of doctors, paramedics, police officers, etc.)
SPD is defined partly by flat affect, but that is not the absence of feeling; it's the absence of expressed feeling. Additionally: Not all cases of SPD involve flat affect. And some cases of Asperger's do.

There is indeed much speculation that SPD is not actually a mental illness. Unlike the other personality disorders, it seems to cause no direct distress. The only obstacle with SPD seems to be that schizoid individuals may be expected to connect more than they desire to do; and people around them--especially family--may expect more of them than they can give. Finding socialization boring and a waste of time can seem offensive to others who do not understand that this dislike is not personal.

All in all, I think SPD is really on the borderline when it comes to what is "mental illness" and what is not. It doesn't cause distress. It doesn't cause dysfunction. And while it is "deviant" (statistically off the norm), so is genius or saintliness. Introversion is simply a culturally disliked way of life; and mental illness shouldn't be defined by culture. It should be defined by asking questions like, "Does it hurt you? Does it hurt anyone else? Does it lower your ability to function?" And if the answer to those questions is "no", then it shouldn't be a mental illness.

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[info]energeia5
2008-09-21 02:29 am UTC (link)
That's well laid out...and yet still confusing. I agree with the "falling in love" with special interests...as in, I experience a physiological amp-up; it's not just mental. I like solitude a lot, though. And am pretty asexual.

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(Anonymous)
2008-09-21 11:17 am UTC (link)
Did you do this in reply to the same garbage I did on my blog, Chaotic? You've done a great job here. It means that the psych who originally DXed me with Aspergers erred slightly saying SPD as well - although he did specify one trait only (callous, vindictive etc which I suppose falls within point 7). I guess that's what he meant even though the DX was vague in it's description. I'll have to change my note on my website about the trait being commorbid with my Aspergers.

Timelord

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[info]shiva_dan
2008-09-21 12:20 pm UTC (link)
Well, all the criteria for SPD listed there would have described me (accurately, but incompletely) before puberty (although of course i had many other autistic characteristics too, probably more than now) - back then, i genuinely had no interest at all in socialising or having human relationships, and cared nothing at all for the welfare of other human beings - things which autistic advocates often describe as "false" stereotypes of autistic people, which i rather obviously find problematic, because they actually were true of me...

This all changed VERY dramatically at the age of 12, when i basically "fell in love" (albeit in a non-sexual way, i didn't develop anything resembling sexual feelings or attractions for at least another 4-5 years) with a classmate (who, looking back, probably wasn't entirely neurotypical himself). How he put up with my (frankly disturbing) obsession with him i'll never know... it was a very, VERY odd and awkward period of my life... but it did mark the really dramatic change in me from someone who basically didn't care about anyone other than myself to someone with a deep and passionate, whether fulfilled or not, need for love and friendship withother people.

More generally, i have issues with the label "personality disorder" in general - who gets to define what is an "ordered" and "disordered" personality? There's something very 1984 about that (thinking especially of the term "ownlife" used to disparage those who have solitary interests). Also i think that there are probably infinite neurological variations, and there isn't necessarily a sharp boundary between "personality" and "cognition, sensory processing, learning, or coordination" - in fact, i don't really know if "personality" is one definable entity.

Totally agreed with your last paragraph...

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(Anonymous)
2008-09-21 03:17 pm UTC (link)
Oh I've definitely got strong traits of it. Don't know if they are enough to give me another diagnosis, but it wouldn't bother me if they did. I've definitely got Aspergers as well/just on its own. Obsessional interests, poor motor co-ordination, difficulties in recognising and interpreting body language, difficulties in picking u[p tones of voice and taking a lot of things literally in real life (and online a lot of the time as well, but reading things gives me longer to process them). I also have poor judgement of distances and space and time and I can not think/judge as to what other people are doing or are likely to do. In a way the aspects of my personality that would point to the schizoid signs saved a lot of trouble for me. I was never likely to fit in at secondary school, for example, due to my lack of interest in fashion and the latest music, but I didn't care about fitting in. I still don't. I like other people and I need some contact and some relationships, but I don't fret that I know or speak to few people in real life.

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[info]energeia5
2008-09-21 04:02 pm UTC (link)
I wonder how strong a distinction can be drawn between neuorologically-based and personality-based "disorders". I suspect that increasing genetic knowledge will fuzz out this distinction a lot.

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(Anonymous)
2008-09-21 09:12 pm UTC (link)
I have no idea what this has to do with the price of fish but I always liked King Crimson

http://www.youtube.com/watch?v=76BPfz2wKpg&feature=related

Schisms and Isms eh, can't live with em, can't live without em.

Sula Wolf and Steppenwolf, I dunno?

At the end of it all they are all literary tropes rather than literal ones, to be sure (and there is pun hiding there)

From a serious point of view most of this Kraepelinian paragigm stuff is going to be not only yesterdays history, but thoroughly ridiculed in time to come because it is not logical, it is not scientific, it is not accurate, it is not pragmatic, it is not useful, it is not anything else but an easy ride for lazy clinicians.

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[info]shiva_dan
2008-09-21 09:20 pm UTC (link)
Is that you, Larry?

(Reply to this) (Parent)

Very Interesting Points
[info]jef22
2008-09-25 01:52 am UTC (link)
Let me start out by saying that I found your post very informative and extremely helpful in furthering my understanding of Autism as well as other disorders that have anything in common with Autism. As a graduate student studying Autism it is my understanding that a great deal of the behaviors and characteristics that an individual with Autism displays are neurologically based. From what you presented it sounds if there is no mention of a neurological basis for SPD. Is this the case. If so then I would be extremely interested to find out what the primary basis of SPD is.

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Re: Very Interesting Points
[info]chaoticidealism
2008-09-25 02:05 pm UTC (link)
What we know about SPD and its origins is that it is a sort of extreme personality; there are, for example, distinct similarities between people with SPD that can be detected when they take personality tests. Where your personality comes from is still up for grabs--but it's certainly some combination of genetics and environment.

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