Schizoid psychopathy

Among the many personality disorders, schizoid psychopathy, a disorder that is accompanied by behavioral and emotional changes, is not uncommon. This problem requires special attention from psychiatrists and psychotherapists, as its roots are laid in early childhood, subsequently manifesting and worsening. Schizoid psychopathy cannot be treated with medication: it requires specific psychotherapy and social rehabilitation. [1]

Epidemiology

Schizoid psychopathy is present in 1-4.5% of people in the world. Loss of empathy, self-centeredness, superficial emotionality - all these are signs of a present psychopathological problem, which does not always become diagnosed. Moreover, experts note that some people, thanks to schizoid psychopathy, even manage to achieve certain professional success in some areas (mainly managerial positions, as well as lawyers, investors, politicians, etc.). However, the majority of patients still become criminals and end their life journey with a prison sentence.

The most frequent signs of schizoid psychopathy are found in men, almost three times more often than in women. It is noteworthy that European prisoners suffer from this disorder less often than North American prisoners.

The pathology starts in early childhood, but can manifest in both children and adults. [2]

Causes of the schizoid psychopathy

Schizoid psychopathy is a personality disorder characterized by withdrawal, "detachment," an inability to sympathize and empathize, little need for communication, a tendency to fantasize, and excessive immersion in one's own world.

From the outside, schizoid psychopaths look at least strange. Such people have no need for friends, or they have them, but not more than one or two. They are not interested in the real world, they are not able to solve everyday problems, but at the same time they can happily conduct long complex abstract monologues.

Why does schizoid psychopathy develop? Specialists voice several theories of the appearance of the disorder:

• as a consequence of the lack of necessary contact with parents in early childhood, lack of love and displays of warm feelings, rejection of love for oneself and others;
• as a result of not understanding one's own self and the extent of one's comfort, inability to establish relationships with people;
• due to thinking characteristics, including blurred thinking, difficulty in assessing the environment, inability to determine the emotional state of others and to create trusting relationships.

The involvement of a hereditary factor, as well as constitutional features of the CNS, is not excluded. [3]

Risk factors

Schizoid psychopathy is accompanied by inadequate development of emotional and volitional qualities of the patient. To put it differently, we are talking about the inconsistency and imbalance of manifestations of certain aspects of personality. The most likely risk factors may be:

• congenital disorders of the nervous system, encephalitis, birth trauma to the head;
• hereditary predisposition;
• improper parenting.

Schizoid psychopathy never appears in a mature healthy person: factors "native" to early childhood always push the disorder to form. These include:

• parental neglect of the child;
• physical punishment;
• lack of attention from loved ones;
• low material income;
• coming from a dysfunctional family.

Among additional significant points, experts emphasize lack of or too strict discipline, having many children, depressed parents, low social status and related social rejection.

Pathogenesis

The pathogenetic mechanism of the appearance of schizoid psychopathy is different. Personality imbalance can arise under the weight of genetic factors, features of intrauterine development, birth traumatization, violations during the early period of neonatal development.

Mental disorder reveals itself by excessive suggestibility, a tendency to fantasize and exaggeration, emotional lability, weakness. Improper upbringing, psychological traumas, etc. Play a major role in the formation of pathology.

The mechanism of development of the disorder may be that there are specific disturbances in the balance of nervous processes, signaling reactions, cortex and subcortex. The basis of psychopathy is a change in the type of higher nervous activity, the presence of internal conflict caused by the discrepancy between reality and one's own perception of one's social role, importance, material wealth, etc.

According to another theory, the nuances of upbringing of a child up to 5-6 years of age are of great importance. In this case, equally dangerous as indifference and dislike towards the child, as well as hyper-parenting. [4]

Symptoms of the schizoid psychopathy

Patients with schizoid psychopathy are characterized by reticence, secrecy, distance from reality, and autistic traits. They lack internal harmony and mental consistency, but they are full of eccentricity and behavioral-emotional paradoxicality. There is a combination of excessive sensitivity and emotional coldness, conscious "shutting off" from people. Patients are as if cut off from reality, have a tendency to symbolism, complex reasoning on theoretical topics. Volitional abilities are usually one-sided, emotional outbursts are sudden and lack adequacy. Objective reality is perceived distorted and quite subjective, there is no empathy, there are difficulties in establishing social ties.

The terms "original", "oddball", "strange" are often used in relation to such people. Mental activity is also bizarre, logical combinations are unexpected, statements are prone to categorical and extreme. Mistrust and suspicion are characteristic.

The ability to concentrate attention is directed only to objects of interest, and in relation to other matters the patients are absent-minded and inactive.

Other typical traits: suggestibility, gullibility, stubbornness, negativism.

Motor features: mannerism, caricaturism, flamboyance of gait, gestures, handwriting, speech.

Two types of schizoid psychopathy patients are distinguished:

• Some patients are over-sensitive, mistrustful, take everything around them personally. They like to be alone, inactive and uninitiative.
• Other patients are "closed", "cold", do not know how to empathize, love, are often cruel and inconsiderate.

Schizoid psychopaths are often driven not by the interests of society, but by internal motivations that defy logic, driven by their own "supervalue" projects. [5]

First signs

The first signs of schizoid psychopathy can be seen already in the way a young child builds relationships with other children, how he solves conflicts and disputes, whether he has the ability to concentrate on something, whether he shows interest in new information. Certain features can be noticed already in childhood:

• alienation, detachment from reality, some similarities to autism;
• fanciful gesticulation, motor coarseness and angularity, from affectation to gestural stinginess;
• characteristic "weirdo" handwriting, with differently scaled letters, curls, etc.;
• Inconsistent speech, overloaded with descriptions, aphorisms, unusual word combinations;
• Lack of speech and emotional correlation;
• a lack of logic in his actions;
• difficulties in building relationships with peers of the opposite sex.

Children with schizoid psychopathy have difficulty displaying their emotional state. They can be very worried, despite the external coldness and indifference, or stay in a falsely calm state, but suddenly demonstrate an affective attack. Patients are often deprived of the ability to build harmonious social relationships, but at the same time reverently take care of animals, can long admire plants and beautiful objects. Such people are most fascinated by the humanities, higher meaningful ideas, and so on.

Schizoid psychopathy in women

A woman with schizoid psychopathy is usually completely immersed in her inner world. She does not hide her cold attitude to people, avoids too frequent communication. Main traits:

• an inability to empathize;
• Lack of guilt for hurting another person;
• rejection of the values of others;
• self-centeredness;
• The inability to sense another person's condition or mood.

Such women are often called heartless. They are rude and cold, often do not want to create a family and have children, but do not refuse career growth, short-term intrigues and adventures. Characterized by an inability to compromise, vindictiveness and a tendency to offend and humiliate others.

Women suffering from schizoid psychopathy do not accept, or even deny any social norms. This may take the form of feminism, rejection of stereotypes, or take the form of promiscuity. As a rule, such patients are promiscuous, unable and unwilling to enter into close, long-term relationships.

Schizoid psychopathy in men

Men with schizoid psychopathy share a number of characteristics:

• are not inclined to empathy, and at the same time extremely sensitive (resentful, irritable);
• are often tactless and inconsiderate, interfering in other people's lives without thinking;
• overly pedantic;
• in public, they show a reticent demeanor.

A psychopathic man will show irritation whenever anything happens that he does not like. He never listens or hears other people's opinions, does not accept a situation that has arisen out of his own free will. Irritation can easily transform into aggression and then into violence.

Social norms and rules are not for psychopathic men. They always do as they see fit at the moment, and subsequently do not feel guilty for what they have done, do not show sympathy, pity, remorse. If you do not take measures, then over the years the manifestations of schizoid psychopathy in men only worsen.

Forms

There is no generally accepted classification of schizoid disorder at this time. Most often the pathology is conditionally divided into categories, depending on the dominant manifestations and personality traits.

In particular, schizoid-steroid psychopathy is often described, which is characterized by the desire to prove one's own importance in the eyes of others. To achieve the desired, the patient strives to be as original as possible, demonstrates superiority in every possible way, literally demands recognition, using theatricality and drawn behavior. Patients are characterized by posturing, superficiality of judgment, any means of attracting attention - for example, sobbing in public, sprawling gesticulation, clasping hands, etc. The emotional state of patients is variable, dominant egocentrism, unreasonable fantasizing, sometimes go in the course of hexing himself, deliberate demonstration of fainting and seizure states. The psyche resembles that of a child, immature.

Expansive schizoid psychopathy is accompanied by severe irritability, fits of rage. Such patients are resentful and suspicious, extremely selfish, while pedantic, thorough, stubborn, bossy. They like to pick on the little things, their mood often and without reason changes. From loved ones and coworkers require unambiguous submission and obedience. Being in a state of anger, practically do not stop at anything.

Inhibited psychasthenic psychopathy is characterized by strong indecisiveness, self-doubt, and constant doubts. Patients are overly shy, hypoactive, poorly adapted in society, they have low self-esteem. There is a desire for prolonged self-analysis, abstract thinking, pathological thinking.

Clinical manifestations of schizoid psychopathy can proceed by stages, which differ in severity and structure. Specialists speak of a sterile stage, a state of depression and depression, as well as a severe depressive stage, which has a complex psychopathological mechanism.

The sterile stage may recur many times throughout life. It is characterized by mild affective disorders without the development of decompensated psychopathy.

The state of depression and oppression, in contrast to the erased course, has more intense symptoms: moodiness, resentment, spitefulness, anger, frustration prevail, less often - aggression, but without ideatorial and motor retardation.

The severe depressive stage is always longer. In addition to affective disorders, neurotic and psychopathic manifestations are present. Sluggishness, apathy, joylessness, a feeling of fatigue and brokenness prevail. [6]

Complications and consequences

Although schizoid psychopathy is a relatively uncommon disorder, few patients seek medical help from specialists. It is more common for relatives and close people of psychopaths to make appointments with doctors when patients develop decompensated conditions - in particular, psychotic attacks, depressive disorders, toxic addictions (alcoholism, drug addiction, substance abuse). After the acute attack is controlled and the patient's condition normalizes, most patients stop consulting with the doctor - primarily because they do not consider themselves ill. As a result, the psychopathic disorder continues to worsen, and there is a risk of another acute attack.

It is known that it is impossible to cure schizoid psychopathy completely: it is impossible to fundamentally change a person's value system, reprogram life attitudes. However, psychiatrists and psychotherapists are able to mitigate the course of the disorder, improve social adaptation, and achieve stable compensation for the pathological state. In practical terms, the best result is noted against the background of the use of psychoanalytic methods, long-term deep psychotherapy. [7]

Diagnostics of the schizoid psychopathy

Schizoid psychopathy is clearly diagnosed by a triad of traits:

• there is a clear complex that disturbs the adaptation of the individual;
• The pathological properties inherent in the complex are constantly manifested, regardless of the environment;
• these pathological properties are irreversible.

It is not possible to make a diagnosis based only on partial deviations in the patient's normal behavior. The presence of only some features inherent in schizoid psychopathy does not give the right to diagnose a person. In such a situation, they talk about character traits, but not about pathology. Unlike a schizoid psychopath, people with an accentuated character are able to invest in social norms and adapt to social life.

The tests are performed as part of general clinical investigations:

• CBC, blood chemistry;
• urinalysis.

Instrumental diagnostics may include echoencephalography, angiography, ultrasound, and magnetic resonance imaging. [8]

Differential diagnosis

Schizoid psychopathy must be distinguished from the variant of normality, psychopath-like states, mild course of oligophrenia, neuroses, as well as from the so-called "related" psychosis - psychopath-like schizophrenia.

The main difference between psychopathy and psychopathology is the absence of psychotic symptomatology and the progressive tendency of the course.

Neuroses are distinguished from schizoid psychopathy by the following criteria:

Neuroses	Psychopathy
A part of the personality suffers	The whole person suffers
The patient understands the fact that he or she has a disease	There's a lack of understanding of the disease
The impact of the environment is significant	The influence of the environment is less

A condition similar to schizoid psychopathy can develop against the background of various psychiatric disorders, traumas, toxic lesions, infectious diseases. But in these cases, the clinical symptomatology has other, own manifestations, and the development of pathology correlates in time with the impact of this or that factor.

Treatment of the schizoid psychopathy

Schizoid psychopathy, as a congenital or early personality abnormality, suggests the use of compensatory mechanisms of therapy. Emphasis is placed on psychotherapeutic measures, social and labor adaptation.

The use of medications is not the main, but auxiliary value, and is prescribed individually. In periods of exacerbations, neuroleptics are used, in particular, Etaperazine, Stelazine, Neuleptil. In affective attacks, anxiety states, dysphoria, the reception of neuroleptics is supplemented with antidepressants - for example, Tizercin, which has sedative and thymoneuroleptic activity. If the patient has increased anxiety, psychoemotional tension and instability, phobic disorders, tranquilizers such as Elenium, Diazepam, Seduxen, Tazepam, etc. May be indicated.

Small doses of neuroleptics in combination with tranquilizers and antidepressants help to relieve affective tension.

A complete cure for schizoid psychopathy is impossible, but it is possible to improve social adaptation, normalize emotional status, and help the patient build a personal and social life. Within the framework of psychotherapy, cognitive techniques, the practice of realizing emotions and getting satisfaction from certain actions and events are used.

Medications

Symptoms	Medicinal product	Dosage (mg/day)	Side Effects
Disturbed perception and evaluation of reality	Neuroleptics: Flupenthixol, Haloperidol, Olanzapine	0,5-3 2-6 2-5	Weakness, fatigue, psychomotor retardation, hypotension
Impulsive, aggressive behavior	Antidepressants: Fluoxetine Sertraline	5-40 25-150	Headaches, nervousness, anxiety, tachycardia.
	Normotimics: Carbamazepine	400-600	Drowsiness, weakness, tremor, nystagmus, dysarthria
	Neuroleptics: Haloperidol Trifluoperazine	2-6 4-12	Weakness, increased fatigue, hypotension
Dysphoria, emotional lability	Normotimics, neuroleptics: Carbamazepine Chlorprothixene	400 15-50	Drowsiness, dry mucous membranes, increased sweating, hypotension, dizziness
Anxiety states	Antidepressants: Escitalopram	10-20	Nausea, digestive disorders, dyspepsia, fatigue, weakness
	Tricyclic antidepressants: Tianeptine	25-75	Abdominal pain, dry mouth, dyspepsia, headache, tachycardia
	Normotimics: Valproic acid preparations	300-600	Change in appetite, somnolence, tremor, peripheral edema, dyspepsia
	Neuroleptics: Chlorprothixene	15-30	Drowsiness, dry mucous membranes, increased sweating, hypotension, dizziness
	Anxiolytics: Clonazepam	1-4	Dry mouth, dyspepsia, jaundice, drowsiness

Prevention

Effective prevention of schizoid psychopathy is considered to promote the social adaptation of the child, conducting systematic explanatory conversations aimed at characterizing the behavioral generally accepted norms and rules. Adequate upbringing of the child, love and attention from close people plays an important role.

The main preventive measures are usually as follows:

• adequate sleep and regular rest, contributing to the timely recovery of the nervous system;
• adequate physical activity;
• taking up a hobby, i.e. An activity that brings pleasure and can relieve accumulated tension;
• normal family relations, without regular quarrels and scandals;
• regular psycho-emotional release (meetings with friends, walks, traveling);
• maintenance of normal social status and material well-being.

These methods are most effective if they are used in an integrated way. If a child or adult has any suspicious symptoms of mental disorders, it is recommended to necessarily contact a specialist - a psychologist, psychotherapist, psychiatrist. Self-treatment in this case is ineffective, and can even harm the sick person.

Forecast

Patients suffering from schizoid psychopathy are almost never referred to the VTEK for disability. During periods of seizures, they are given sick leave for temporary disability. If such attacks are prolonged or an intense state of decompensation develops, it is possible to establish the third disability group with individual labor recommendations.

It is not possible to cure the disorder completely. Mild or moderate schizoid psychopathy has a relatively favorable prognosis, provided a thoughtful choice of profession and the right approach from friends and family members. Patients have every chance for successful social adaptation, professional choice, and the formation of close and family relationships.