Schizoid Personality

   a personality disorder, in DSM (from 1952). When the patient is not psychotic or manifestly thought-disordered, yet withdrawn, unable to express hostility, and "autistic," DSM-I and DSM-II employed the concept "schizoid personality." Interest in the schizoid personality goes back to the turn-of-the century view that psychotic symptoms might represent accentuations of preexisting personality states. In 1908, as Eugen Bleuler was still calling schizophrenia "dementia praecox," he distinguished in the Zentralblatt für Nervenheilkunde between a latent form and an active. "Thus the arrival of a stressful event [ein Affekt] can convert a latent dementia praecox to a manifest form. The disease had previously existed but was just not visible" (p. 225). Ernst Kretschmer’s 1921 book put schizoid personality as such firmly on the map. (See also Psychosis: Emergence: Kretschmer’s constitutional psychoses.) In 1922, Bleuler had written about "Schizoidie" in the Zeitschrift für die gesamte Neurologie und Psychiatrie. But the train that leads to DSM’s version of schizoid personality begins with the German-Jewish geneticist Franz Kallmann (1897–1965), who in 1936, following his opposition to the Nazi laws on forced sterilization, emigrated to the United States, landing at the New York State Psychiatric Institute. On the basis of his research on twins, Kallmann said in 1953 that genetics predisposed to a schizoid personality, which in itself might lead to "involutional psychosis" (Heredity in Health and Mental Disorders, pp. 181, 183).

   In New York, Kallmann was a close friend of psychoanalyst Sándor Radó, and despite their obvious theoretical differences, Kallmann sparked Radó’s interest in what Radó called in the American Journal of Psychiatry in 1953 "schizotypal disorders." By schizotype, Radó meant the "underlying ensemble of psychodynamic traits which . . . is demonstrable in the patient during his whole life. This finding will identify him as a schizotype from birth to death. The ensemble of psychodynamic traits peculiar to the schizotypes may be called schizotypal organization." Radó thought that many genetic schizotypes never developed schizophrenia and that the stage of open psychosis itself was merely the third and final stage of the schizotype. (The second stage corresponded to Hoch and Polatin’s "pseudo-neurotic schizophrenia.") (See Schizophrenia: Recent Concepts [1949].) (Radó, "Disordered Behavior," in his collected works, The Psychoanalysis of Behavior, I, 274, 283–284.) In 1962, psychologist Paul E. Meehl (1920–2003) at the University of Minnesota introduced the concept of "schizotaxia." Writing in American Psychologist, he said, "I believe we should take seriously the old European notion of an ‘integrative neural defect’ . . . which I shall christen schizotaxia." He said this represented the only aspect of schizophrenia that could be inherited. The schizotaxic individual would carry the schizotypic personality around with him, without ever necessarily becoming schizophrenic. "He will be like the gout-prone male whose genes determine him to have an elevated blood uric acid titer, but who never develops clinical gout" (pp. 829–830). In this context in 1963, physiologist Seymour Kety (1915–2000) (who later became professor of psychiatry at Harvard) began his research in Copenhagen on children who had been adopted away and later developed schizophrenia, as opposed to adopted-away controls who remained normal; Kety and co-workers found that in some of the schizophrenics’ biological families there were individuals who were bizarre and eccentric, part of the "schizophrenia spectrum" as they put it, without having formal schizophrenia; in such persons, whom Robert Spitzer defined in DSM-III in 1980 as "schizotypal," there did seem to be a familial loading, suggesting a genetic basis. DSM-III therefore included two new personality diagnoses: "schizoid personality disorder," meaning roughly what DSM-I and -II had had in mind, and "schizotypal personality disorder," for subthreshold schizophrenia, or individuals who had sufficient "oddities of thought, perception, speech, and behavior" that there seemed to be a problem, yet who were not formally schizophrenic. These categories were not essentially changed in subsequent editions of DSM.