DSM-5 criteria The Diagnostic and Statistical Manual of Mental Disorders is a widely used manual for diagnosing mental disorders. DSM- 5 still includes<unk>  with the same criteria as in DSM-IV. In the DSM-5, SPD is described as 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 at least four of the following: # Neither desires nor enjoys close relationships, including being part of a family. # Almost always chooses solitary activities. # Has little, if any, interest in having sexual experiences with another person. # Takes pleasure in few, if any, activities. # Lacks close friends or confidants other than first-degree relatives. # Appears indifferent to the praise or criticism of others. # Shows emotional coldness, detachment, or flattened affectivity. According to the DSM, those with SPD may often be unable to, or will rarely express aggressiveness or hostility, even when provoked directly. These individuals can seem vague or drifting about their goals and their lives may appear directionless. Others view them as indecisive in their actions, self-absorbed, absent-minded and detached from their surroundings (). Excessive daydreaming is often present. In cases with severe defects in the capacity to form social relationships, dating and marriage may not be possible. ICD-10 criteria The Classification of Mental and Behavioural Disorders of ICD-10 lists<unk>  under ( F60.1). The general criteria of<unk>  disorder (F60) should be met first. In addition, at least four of the following criteria must be present: * Few, if any, activities provide pleasure. * Displays emotional coldness, detachment, or flattened affectivity. * Limited capacity to express warm, tender feelings for others as well as anger. * Appears indifferent to either praise or criticism from others. * Little interest in having sexual experiences with another person (taking into account age). * Almost always chooses solitary activities. * Excessive preoccupation with fantasy and introspection. * Neither desires, nor has, any close friends or confiding relationships (or only one). * Marked insensitivity to prevailing social norms and conventions; if these are not followed, this is unintentional. Guntrip criteria Ralph Klein, Clinical Director of the Masterson Institute, delineates the following nine characteristics of the<unk><unk>  as described by Harry Guntrip: *Introversion * Withdrawnness * Narcissism * Self-sufficiency * A sense of superiority *Loss of affect * Loneliness * Depersonalization * Regression The description of Guntrip's nine characteristics should clarify some differences between the traditional DSM portrait of SPD and the traditional informed object relations view. All nine characteristics are consistent. Most, if not all, must be present to diagnose a<unk>  disorder. More details about each of the characteristics can be found in the Harry Guntrip article. Millon's subtypes Theodore Millon restricted the term<unk> " to those<unk> es who lack the capacity to form social relationships. He characterizes their way of thinking as being vague and void of thoughts and as sometimes having a "defective perceptual scanning". Because they often do not perceive cues that trigger affective responses, they experience fewer emotional reactions. For Millon, SPD is distinguished from other<unk>  disorders in that it is "the<unk>  disorder that lacks a<unk> ." He criticizes that this may be due to the current diagnostic criteria: They describe SPD only by an absence of certain traits, which results in a "deficit syndrome" or "vacuum". Instead of delineating the presence of something, they mention solely what is lacking. Therefore, it is hard to describe and research such a concept. He identified four subtypes of SPD. Any individual<unk>  may exhibit none or one of the following: Subtype Features Languid<unk>  (including dependent and depressive features) Marked inertia; deficient activation level; intrinsically phlegmatic, lethargic, weary, leaden, lackadaisical, exhausted, enfeebled. Unable to act with spontaneity or seeks simplest pleasures, may experience profound angst, yet lack the vitality to express it strongly. Remote<unk>  (including avoidant features) Distant and removed; inaccessible, solitary, isolated, homeless, disconnected, secluded, aimlessly drifting; peripherally occupied. Seen among people who would have been otherwise capable of developing normal emotional life but having been subjected to intense hostility lost their innate capability to form bonds. Some residual anxiety is present. Depersonalized<unk>  (including schizotypal features) Disengaged from others and self; self is disembodied or distant object; body and mind sundered, cleaved, dissociated, disjoined, eliminated. Often seen as simply staring into the empty space or being occupied with something substantial while actually being occupied with nothing at all. Affectless<unk>  (including compulsive features) Passionless, unresponsive, unaffectionate, chilly, uncaring, unstirred, spiritless, lackluster, unexcitable, unperturbed, cold; all emotions diminished. Combines the preference for rigid schedule (obsessive-compulsive feature) with the coldness of the<unk> . Differential diagnosis While SPD shares several symptoms with other mental disorders, there are some important differentiating features: Psychological condition Features Depression People who have SPD may also suffer from clinical depression. However, this is not always the case. Unlike depressed people, persons with SPD generally do not consider themselves inferior to others. They may recognize instead that they are "different". Avoidant<unk>  disorder (AvPD) While people affected with APD avoid social interactions due to anxiety or feelings of incompetence, those with SPD do so because they are genuinely indifferent to social relationships. A 1989 study, however, found that<unk>  and avoidant<unk> es were found to display equivalent levels of anxiety, depression, and psychotic tendencies as compared to psychiatric control patients." There also seems to be some shared genetic risk between SPD and AvPD (see<unk> -avoidant behavior). Several sources to date have confirmed the synonymy of SPD and avoidant attachment style. However, the distinction should be made that individuals with SPD characteristically do not seek social interactions merely due to lack of interest, while those with avoidant attachment style can in fact be interested in interacting with others but without establishing connections of much depth or length due to having little tolerance for any kind of intimacy. Other<unk>  disorders<unk>  and narcissistic<unk>  disorders can seem similar in some respects (e.g. both show identity confusion, may lack warmth and spontaneity, avoid deep relationships with intimacy). Another commonality observed by Akhtar is preferring ideas over people and displaying intellectual hypertrophy, with a corresponding lack of rootedness in bodily existence. There are, nonetheless, important differences. The<unk>  hides his need for dependency and is rather fatalistic, passive, cynical, overtly bland or vaguely mysterious. The narcissist is, in contrast, ambitious and competitive and exploits others for his dependency needs. There are also parallels between SPD and obsessive-compulsive<unk>  disorder (OCPD), such as detachment, restricted emotional expression and rigidity. However, in OCPD the capacity to develop intimate relationships is usually intact, but deep contacts may be avoided because of an unease with emotions and a devotion to work. Asperger syndrome There may be substantial difficulty in distinguishing Asperger syndrome (AS), sometimes called<unk>  disorder of childhood", from SPD. But while AS is an autism spectrum disorder, SPD is classified as a "schizophrenia-like"<unk>  disorder. There is some overlap, as some people with autism also qualify for a diagnosis of schizotypal or<unk>  PD. However, one of the distinguishing features of<unk>  PD is a restricted affect and an impaired capacity for emotional experience and expression. Persons with AS are "hypo-mentalizers", i.e., they fail to recognize social cues such as verbal hints, body language and gesticulation, but those with schizophrenia-like<unk>  disorders tend to be "hyper-mentalizers", overinterpreting such cues in a generally suspicious way. Although they may have been socially isolated from childhood onward, most people with<unk>  displayed well-adapted social behavior as children, along with apparently normal emotional function. SPD also does not require impairments in nonverbal communication such as a lack of eye contact, unusual prosody or a pattern of restricted interests or repetitive behaviors. Simple-type schizophrenia Simple-type schizophrenia is a diagnosis in the ICD-10 but is not present in the current DSM-5 or the upcoming ICD-11. It is a form of schizophrenia characterised by negative symptoms and a lack of psychotic features. Both simple schizophrenia and SPD share many negative symptoms like avolition, impoverished thinking and flat affect. Although they may look almost identical, what distinguishes them is usually the severity. Also, SPD is characterized by a lifelong pattern without change, whereas simple schizophrenia represents a deterioration. Comorbidity SPD is often found to be comorbid with at least one of several disorders or pathologies. Sometimes, a person with SPD may meet criteria for an additional<unk>  disorder; when this happens, it is most often avoidant, schizotypal or paranoid PD. Alexithymia (the inability to identify and describe emotions) is often present in SPD. Sharon Ekleberry suggests that some people with<unk><unk>  features may occasionally experience instances of brief reactive psychosis when under stress. Substance use disorder Very little data exists for rates of substance use disorder among people with SPD, but existing studies suggest they are less likely to have substance abuse problems than the general population. One study found that significantly fewer boys
Schizoid personality disorder
Avoidant personality disorder
Histrionic personality disorder
Organic personality disorder
Haltlose personality disorder
Dependent personality disorder
Depressive personality disorder
Obsessive–compulsive personality disorder