Making diagnoses can be tricky business. In the medical world, even with all the lab tests and imaging currently available, physicians frequently have a hard time pinpointing the best label (never mind the best treatment) for a set of symptoms. Diagnoses are even squishier in the mental health world, where labels are based primarily on how an individual behaves and feels; lab tests and imaging are rarely used.Elsewhere in this blog I’ve documented how the diagnoses for our son Nathan changed over time. In his late teens, the notion that he had Aspergers took hold. Psychological tests at his high school qualified him as “autistic-like”; the psychiatrist who finally provided an official Aspergers diagnosis said of Nathan, “He has it, in spades!”
Nathan has been through a few mental health professionals since then. All of them seemed to be on board with the Aspergers diagnosis, although the emphasis of their treatment was on Nathan’s depression, which had reached crisis levels (0r depths).
Nathan started seeing his latest psychologist (Dr S) last July. I gave my input in the first session, and subsequently sat in the waiting room during their monthly sessions. By February’s appointment, I decided it was time to ask Dr S about his impressions, and whether there were adjustments we should make in supporting Nathan’s journey through life.
Dr S asked me what I saw as Nathan’s challenges. I replied, “Blah blah blah his depression, and blah blah blah Aspergers…”
Dr S interrupted me. “Oh, I don’t see any signs of Aspergers. I think Nathan has schizoid personality disorder. Have you ever heard of it?” I shook my head. He then showed me the diagnostic criteria for this scary-sounding label.
“Wow, that does seem to fit him!” I said.
Dr S turned to Nathan. “Are you curious about this?”
Nathan grimaced. “Not really.” He declined to read the diagnostic criteria.
Dr S told me two major things about schizoid personality disorder. First, it would be pointless to try to get someone with Schizoid PD to socialize if s/he doesn’t want to. Second, he said people with Schizoid PD rarely hold jobs.
I left his office trying to wrap my head around this new framework for Nathan’s condition. My new task was to find out more about Schizoid PD. I also wondered how common it is for the diagnosis to be switched with Aspergers or autism spectrum in general. The following is what I have found.
First, it helps to know what a personality disorder is. This summary from the Mayo Clinic is in plain language (compared to the others I found):
A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and to people. This causes significant problems and limitations in relationships, social encounters, work and school.
In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you. And you may blame others for the challenges you face.
Among the better-known personality disorders are the paranoid, narcissistic, and antisocial personality disorders.
Like all personality disorders, Schizoid PD doesn’t become evident until the teen years or early adulthood. It is more common in males, and is thought to affect 1 – 5% of the population.
Here is a summary of Schizoid PD symptoms, copied from this link to Psychology Today:
The schizoid personality rarely feels there is anything wrong with him/her; symptoms are an indifference to social relationships and a limited range of emotional expression.
Takes pleasure in few, if any, activities
- Does not desire or enjoy close relationships, including family
- Appear aloof and detached
- Avoid social activities that involve significant contact with other people
- Almost always chooses solitary activities
- Little or no interest in sexual experiences with another person
- Lacks close relationships other than with immediate relatives
- Indifferent to praise or criticism
- Shows emotional coldness, detachment or flattened affect
- Exhibits little observable change in mood
It is important to know that Schizoid PD is not schizophrenia, and it isn’t schizoaffective disorder. Both of those involve psychotic symptoms such as hallucinations and delusions. People with Schizoid PD are in touch with reality. That being said, there does seem to be a relationship between Schizoid PD and schizophrenia: they turn up in the same families, and individuals with Schizoid PD may be more likely to develop schizophrenia than the general population. Another condition, called schizotypal personality disorder, has similarities to Schizoid PD but (from what I gather) involves more fear and eccentric behavior.
Other informative links about Schizoid PD are from Wikipedia (lots of detail here!) and the Mayo Clinic. It was disturbing in the latter link to read that one of the risk factors for Schizoid PD is “having a parent who was cold or unresponsive to emotional needs.” I immediately thought of the times I was understated or annoyed in reacting to Nathan’s many meltdowns. Ah, parental guilt! The Wikipedia entry softens this somewhat by saying that the link to parental aloofness is a hypothesis, not a certainty.
Speaking of guilt, I found a website called Out of the FOG, which provides support for family members of someone with a personality disorder. FOG stands for Fear, Obligation, and Guilt – common reactions for those dealing with such a person. Anyway, if you follow the OOTF link above, you’ll see a list of 30 traits that are common in people with Schizoid PD, and toward the bottom of the page is the official diagnostic criteria from the DSM (Diagnostic & Statistical Manual of the American Psychiatric Association).
It appears there are no really great treatments for Schizoid PD. Psychotherapy may help, if the individual decides s/he wants to make progress in coping with society. Medications can be prescribed for some of the symptoms that go along with the disorder, such as depression and anxiety.
As for a diagnosis switching between Aspergers and Schizoid PD, it seems to be a fairly common occurrence. A book about Aspergers published in 2007 that I found on our bookshelf says that some researchers believe Aspergers and Schizoid PD might be the same thing. This article by Barbara Nichols from October 2013 talks about the differences but also says some believe Schizoid PD may be on the autism spectrum. The controversy continues. (The nifty diagram (with teeny-tiny print) at the top of this post was taken from this article).
Internet forums are a good way to find out what others have to say. Here are links to three forums on the topic of Aspergers vs Schizoid PD. This one from Wrong Planet gets into other diagnoses besides Schizoid PD that may come up in the Aspie community. The explanation given by Anasthasia in this Psych Forum is one of the clearest I’ve come across. Among other things, she says that an Aspie struggles with reading social cues; a Schizoid can read them but doesn’t care to. This thread in a forum on CosmoQuest gets off-topic, but was notable to me for posing the idea that Schizoids can change their sociability with a lot of will power, but Aspies are wired differently and therefore cannot.
One last link about the differences: for those of you who watch the BBC “Sherlock” series (with Benedict Cumberbatch), here is someone of the opinion that Sherlock has Schizoid PD, not Aspergers.
Which diagnosis do I think fits Nathan better? I’m still a little confused, but the balance is tipping towards Schizoid PD. Sadly, I won’t be able to ask Dr S any follow-up questions: he passed away suddenly 13 days after Nathan’s February appointment. Nathan, who dislikes almost everyone, seemed to be fine with Dr S and their sessions. He expressed surprise but no other emotion on learning of his therapist’s passing.
Have a look at her blog http://climbingthecindercone.com/2014/04/15/aspergers-or-schizoid-personality-disorder/