Cognitive therapy is used to treat schizoid personality disorders. This classic Socratic Method modestly tries to make the schizoid patient stop believing that the world is hostile to him.
Indeed, the main characteristics of this disorder are the lack of interest in social relationships and low emotional expressions during them. It is a disorder that begins in the early stages of adulthood. According to DSM5, it manifests as four of the following symptoms:
First, do not desire or seek intimate relationships. Including within the family circle
Do not have close friends or confidants beyond the close family circle
Being indifferent to compliments or criticisms from others
Finally, be emotionally cold. Showing detachment and poor affect
As can be seen, people with schizoid disease therefore show very little interest in being in contact with others (except perhaps those from the closest family circle). These people generally spend most of their time alone. They engage in tasks that do not involve interaction with others.
Their affect is also very limited. They often seem slow and lethargic. Their way of speaking is also slow and monotonous. If asked about their emotions, it seems that intense emotions such as “pleasure” or “hate” are foreign to them.
Their environment usually ends up ignoring them or leaving them behind. This implies that the patient loses all opportunity to improve their social skills, largely due to a lack of practice.
The subtypes of Schizoid Personality Disorder
Some authors have proposed to classify schizoid personality disorder into subtypes. For example, according to Millon and Davis (1996) these subtypes are:
The discontented: the discontented schizoid is an individual devoid of passions, insensitive, not very affectionate, cold, little concerned with the others, without spirit, difficult to move or unperturbed. As its name suggests “nothing concerns it”. He remains an ice cube in all the circumstances of his life
The distant: the distant subject is almost impossible to access. He likes to be isolated and alone, homeless and aimless. He vaguely takes care of certain activities which do not interest him much
Phlegmatic: These are very lazy people with very low activity levels. They are inherently lethargic, tired and weak. They often feel exhausted and often neglect themselves. Their life is marked by a lack of initiative and action
The disinterested: disinterested in others and in himself. He feels outside of his own body, which he perceives a bit like a distant object. For him, the mind and the body are separate or dissociated
How does this disorder develop?
Schizoid disorder develops from a combination of genetic and environmental reasons. Regarding their environment, they generally grew up in families where they felt rejected or different. They end up seeing themselves as “inferior” to other family members.
Therefore, they begin to develop the idea that they are different and strange. They then think that the people around them are all rude or that they will reject them.
Cognitive therapy for the treatment of schizoid personality disorder tells us that people with this disorder have certain beliefs in common. For example, in consultation with a therapist, they may formulate sentences such as: “I am unsuitable”, “I am a sucker”, “I am weird”, “I am alone” or “people are cruel”, ” people disappoint me.”
Subsequently and on the basis of these beliefs, they develop a whole series of assumptions that keep them in false security. “If I talk to other people, they will notice how weird I am and they will reject me.” “If you don’t fit in, you can’t have friends,” etc.
The role of Cognitive Therapy
Since the therapeutic relationship itself takes place in an interpersonal setting, it is likely that the subject with schizoid disorder will experience difficulty in receiving therapy. It is also quite normal to have doubts about whether or not to continue treatment.
Indeed, the therapist, who does not suffer from a problem of social relations, may think that the objectives are not very ambitious but for a schizoid patient, this may represent a maximum effort in terms of sociability. It is therefore necessary to adapt to the patient and not the other way around.
Thus, cognitive therapy in the treatment of schizoid personality disorder will fundamentally work on the dysfunctional beliefs and assumptions of the patient. Through techniques such as Socratic questioning, verbal reassignment or behavioral experiences, the therapist will try to make the schizoid understand that the “hostile world” in which he believes is only in his mind.
Using the technique of “Padesky’s prejudice metaphor” (1993), the patient is asked to list all possible information that contradicts his beliefs. For example, “I am not normal” or “I am weird”. The goal is for the person to see that they are not 100% weird. That is to say, despite her disorder, she sometimes behaves socially like others.
To do this, therapist give him a duty. The patient should then write down everything they do as a “normal person”. For example, we could read: I made coffee for my mother, I spoke with a neighbor while standing in line at the supermarket, or I am coming for cognitive therapy.
It is common for these patients to discontinue cognitive therapy before it is completed. It is therefore interesting to give him a summary report so that he can continue his personal work. It will underline the points that will be the most beneficial.