Schizoid Personality Disorder - Diagnosis - Akhtar's Phenomenological Profile

Akhtar's Phenomenological Profile

Salman Akhtar, M.D. provided a comprehensive phenomenological profile of Schizoid Personality Disorder in which classic and contemporary descriptive views are synthesized with psychoanalytic observations. This profile is summarized in the table reproduced below that lists clinical features that involve six areas of psychosocial functioning and are organized by "overt" and "covert" manifestations. Dr. Akhtar states that "these designations do not imply conscious or unconscious but denote seemingly contradictory aspects that are phenomenologically more or less easily discernible," and that "this manner of organizing symptomology emphasizes the centrality of splitting and identity confusion in schizoid personality."

Clinical Features of Schizoid Personality Disorder
Area	Features
Area	Overt	Covert
Self-concept	compliant stoic noncompetitive self-sufficient lacking assertiveness feeling inferior and an outsider in life	cynical inauthentic depersonalized alternately feeling empty, robot-like, and full of omnipotent, vengeful fantasies hidden grandiosity
Interpersonal relations	withdrawn aloof have few close friends impervious to others' emotions afraid of intimacy	exquisitely sensitive deeply curious about others hungry for love envious of others' spontaneity intensely needy of involvement with others capable of excitement with carefully selected intimates
Social adaptation	prefer solitary occupational and recreational activities marginal or eclectically sociable in groups vulnerable to esoteric movements owing to a strong need to belong tend to be lazy and indolent	lack clarity of goals weak ethnic affiliation usually capable of steady work quite creative and may make unique and original contributions capable of passionate endurance in certain spheres of interest
Love and sexuality	asexual, sometimes celibate free of romantic interests averse to sexual gossip and innuendo	secret voyeuristic interests vulnerable to erotomania tendency towards compulsive perversions
Ethics, standards, and ideals	idiosyncratic moral and political beliefs tendency towards spiritual, mystical and para-psychological interests	moral unevenness occasionally strikingly amoral and vulnerable to odd crimes, at other times altruistically self-sacrificing
Cognitive style	absent-minded engrossed in fantasy vague and stilted speech alternations between eloquence and inarticulateness	autistic thinking fluctuations between sharp contact with external reality and hyperreflectiveness about the self autocentric use of language

One patient with SPD commented that he could not fully enjoy his life because he feels that he is living in a shell. He furthermore noted that his inability distressed his wife. According to Beck and Freeman, "Patients with schizoid personality disorders consider themselves to be observers, rather than participants, in the world around them."

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