Schizoid Personality Disorder vs. Avoidant Personality Disorder

Unlike many personality disorders, avoidant personality disorder didn’t come on the scene until about the 1960s with Millon’s work^{1 2}. It didn’t even appear formally until the DSM-III in 1980 when schizoid personality disorder was split into schizoid, schizotypal, and avoidant^{3 4 2} 🤯. And ever since, there’s been an argument about it².

History - Kretschmer

It all started with Kretschmer who described schizoid personalities as having three groups of characteristics^{3 4}:

1. Core: Unsociable, quiet, reserved, serious (humourless), eccentric
2. Hyperaesthesia: Sensitive, timid, shy with fine feelings, nervous, excitable, fond of nature and books
3. Anaesthesia: Insensitive, pliable, cold, kindly, honest, indifferent, dull-witted, silent

While the first group is the core of schizoid and runs “like a scarlet thread through the whole of schizoid characterology,” the second and third groups of features were noted to be on a continuum³. So sensitivity and insensitivity stand in opposition to each other, and schizoids move along the spectrum, making their position unstable^{3 4}. The tension between the two is what is distressing. It’s a conflict, just like the psychodynamic conceptualization.

Kretchmer stated, “The majority of schizoids are not either oversensitive or cold, but . . . they are over-sensitive AND cold at the same time AND. . . in quite different relative proportions³.” The sensitivity levels exist within the same turtle, it just depends on how comfortable/safe the turtle feels. When the turtle is out looking around and showing itself, we see the hyperaesthesia, but when it shuts itself in its shell, we see the anaesthesia.

Splitting Up Schizoid and Avoidant

Now, this is not what Millon decided. He decided that Kretchmer really meant hyperaesthesia and anaesthesia were two different personalities, avoidant and schizoid respectively⁵. And he basically noted that he was on the DSM taskforce and everyone else wasn’t, so they “don’t get it⁵.” Yet, this is in contrast to Gunderson’s view³: “In the absence of any clinical, empirical, or even widely accepted theoretical rationale for such a distinction, it is difficult to understand why this category [avoidant personality disorder] was established³.”

Akhtar chimed in and noted that the work of Fairbairn and Kernberg was ignored in splitting up avoidant and schizoid in the DSM, highlighting schizoids use lower level defenses, experience identity diffusion, and have a borderline organization (with more severe childhood trauma), while avoidants use higher level defenses, do not experience identity diffusion, and have a neurotic organization due to ego-syntonic anxiety (aka anxiety becomes intertwined with the personality)⁶. Akhtar later joined in again and suggested the DSM category of schizoid should be deleted and the DSM category of avoidant should be relabeled schizoid⁷…And some suggested schizoid just be deleted because they’re not common⁸, which I think is just rude, but everyone loves to overlook the schizoids 😠. Overall, the split of schizoid and avoidant has been chaotic, and everyone is still confused about it!

But what does the DSM say?

Briefly, the DSM-5-TR criteria for schizoid personality disorder involves social detachment and restricted emotional expression without psychosis or autism⁹. In contrast, the DSM-5-TR criteria for avoidant personality disorder involves social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, which leads to avoidance of social interaction/activities⁹. While both are socially isolated^{9 10}, avoidants desire relationships and feel deep loneliness, only moving away from closeness with others due to fear of embarrassment/rejection, while schizoids just don’t desire social intimacy as much, preferring aloneness and being content in it⁹.

Compare and Contrast of Schizoid and Avoidant

There’s clearly an overlap between schizoid and avoidant. They are both detached personalities¹⁰ who lean toward an avoidant/dismissive attachment style². They are introverted², socially isolated⁹, and can seem chilly, backwards, or socially awkward¹⁰. They can both be extremely sensitive and struggle in relationships involving intimacy². However, there’s a lot of differences between schizoid personality disorder and avoidant personality disorder, so I made a table…because yay, data!

Differences Between Schizoid and Avoidant

My Own Thoughts

Psychologists have argued about schizoid and avoidant personality for over 50 years, especially on how schizoid and avoidant personality disorders were presented in the DSM. But this also led to the question of whether or not they should be split up at all. I do believe that schizoid and avoidant are different personalities in the same way as Fairbairn and Kernberg⁶. I like how Kretschmer captures the tension of hyperaesthesia and anaesthesia of the schizoid,^{3 4} and I like how Akhtar argues avoidant is an anxious-phobic personality⁶. However, I personally think that the DSM criteria for both schizoid and avoidant personality disorders are too vague, somewhat misrepresentative, and simply not good enough. It may be a losing battle though…I mean, how can you put personality into a concrete box?

As the argument about schizoid personality disorder and avoidant personality disorder continues its half-century debate, let us know what you think Comment on YouTube or contact us here! If you want help to better understand your own schizoid-ness versus avoidant-ness (or the dynamics of someone you care about), therapy and/or psychological testing can help! If you’re in Virginia (or a PsyPact state), check out Quest Psychological and Counseling Services for available services. If you’re a provider stuck on a case, Quest also offers consultations for mental health professionals!

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