Schizoid personality disorder: Process and outcome in psychotherapy

Abstract

Schizoid personality disorder (SzPD) is characterised by flattened affect, limited capacity to express feeling, indifferent or disinterested attitude towards others with preference for solitary activities. It's east researched and hence most confusing personality disorder, both in terms of assessment and management leading to dropout or low engagement in the treatment process. The authors have attempted to propose a working model for SzPD ensuing their endeavour in management of a case. It's single case study design of a male presented with aimless behaviour, decreased social interaction, poor hygiene, daily alcohol consumption and feeling of boredom. CBT was initiated for depressive symptoms and alcohol dependence with occasional use of substances. The process and response to therapy indicated underlying psychopathology in personality after 13 sessions. Once diagnosis of SzPD was confirmed various techniques were used in therapy with total more than 65 sessions before termination was introduced. The outcome was significant reduction in alcohol intake, identifying triggers and its consequences. The sequel of social withdrawal and benefit of social interaction in occupational functioning. It's helpful to validate patient's unpleasantness and avoidance associated with social involvement as a milestone to build insight into the resulting consequences. The intervention helps in accepting as well as altering one's actions and appraisal of events. The indifferent attitude and limitation of establishing rapport in SzPD can induce burn-out in clinician. Briefing-debriefing sessions with a fellow clinical psychologist is beneficial to stay objective.