Ok, I'm a Schizoid... now what?

March 6, 2010 9:53 PM

I am very confident that I have SPD and that is causing me great internal psychological pain. How do I best act on this realization?

I am 25, male, and diagnosed (I believe correctly) Bipolar. I definitely have had at least 2 serious Manias, some serious depressions (which no one else ever has seen, and I keep to myself), and a slew of hypomanias and minor depressions.

I am happily medicated, and the bipolar mood elements and some of my anxiety has been almost completely eliminated due to meds. But even still I have always felt there is something else, more fundamental, not being addressed.

Concurrent with medication I have had a psychologist who I've seen regularly for years, but she has focused on functional inter-relationship skills and mood monitoring, not traditional psychoanalysis/personality analysis. She is moving to another state, so I am forced to find a new psychologist anyway.

I am somewhat familiar with the DSM, and while I know neither you are nor I are my doctor, and I cannot 100% accurately diagnose myself, I have just read the Wikipedia article linked above on SPD and I cannot believe how absolutely correct it has nailed my overt behaviors as well as my inner life in every.single.respect.

_{BTW - I take this seriously, so don't get off on tangents about mis-diagnosis etc, lets just take it as given that I am right and I have SPD, I've done my legwork on the differential of Asperger (which suspected I had years ago but ruled out), Depression etc... Avoidant personality is a possibility but that is still a PERSONALITY disorder that is not being addressed in my current treatment regiment}

I think my previous psychological course has been, in essence, helping me build up my defensive self, without addressing my underlying self, the self that feels unreal. I want to fix that. I want to have a girl-friend for once in my life.

Since I am changing doctors anyway, what is the best type of therapist to look for to peruse this new discovery with good chance of success? Also, anyone else with SPD that can comment on therapies (traditional or non traditional) that helped them? Thank you MentalFilter!

throw-away email ItHurtsToBeSane at gmail dot com

posted by anonymous to health & fitness (11 answers total)

...lets just take it as given that I am right and I have SPD...

No. We can't. You are not a psychiatrist, and you cannot diagnose yourself. (Ever hear of Med Student disease?)

If you are bipolar, and if you suspect you are schizoid, you should be seeing a psychiatrist and not a psychologist. And leave the diagnosis to trained professionals.
posted by Chocolate Pickle at 10:02 PM on March 6, 2010 [7 favorites]

Being yourself does not make you eminently qualified to diagnose yourself. It's not that you can't 100% accurately diagnose yourself. You can't, period. It is beyond your professional scope. You're not a doctor or therapist. The combined forces of Wikipedia and introspection has not made you a doctor or therapist. You do not have the years of schooling and practice undertaken by someone who is a therapist and thus qualified to diagnose you. The idea that a "successful" therapist would be one who matches your amateur diagnosis is not going to make things better.

I don't mean to be harsh and I am not saying that you are wrong. I am saying that the chances of you being right or wrong are as completely opaque to us as they are to you. "Lets just take it as given that I am right and I have SPD" would lead us to giving you irresponsible advice.

P.S.: Ask your current psychologist if she can recommend you to one of her colleagues rather than randomly trying to find a new one on your own.
posted by griphus at 10:22 PM on March 6, 2010 [1 favorite]

Oh, and to answer your question of "How do I best act on this realization?"

Mention it to your new therapist and let them do the work. Don't expect any sort of related immediate treatment. Don't expect to be told whether you are right or wrong right off the bat. And please don't tailor your sessions toward proving your speculation - it wastes everyone's time.
posted by griphus at 10:29 PM on March 6, 2010 [1 favorite]

The best type of therapist is one who specializes in this. I don't see your post as problematically self-diagnosing yourself but more of being self-aware and knowing what you want to work on. You have to talk to the therapist beforehand and tell them what you want to work on, and they will tell you if they think they will be a good match. It's important that you know what you want to focus on because it's a waste of time to make them sit there guessing.

A good place to start would be to talk to your current dr. (your therapist and/or whoever is prescribing your meds) about getting a referral to someone who specializes in personality disorders. It would probably be good to get their perspective on this anyway, as a mental health professional who should know you pretty well at this point.
posted by amethysts at 10:37 PM on March 6, 2010 [1 favorite]

All I have to add is please don't abandon a recommended new doctor who you like just because they are resistant to whipping out the DSM and giving you a quick diagnosis. Hopefully they will spend quite a bit of time getting to know you and they will take into consideration your past diagnosis before they are actually ready to diagnose you. It may be frustrating in the beginning but it will probably lead to a better outcome in the end.
posted by Procloeon at 10:56 PM on March 6, 2010

I want to fix that. I want to have a girl-friend for once in my life.
Is EXACTLY what makes me doubt you actually have schizoid personality disorder. Look again at the DSM criteria: "neither desires nor enjoys close relationships, including being part of a family" [emphasis mine] and consider it a bit.

It's easy to look at a set of criteria and say "ah! it's me!" because we really want there to be a concrete answer and a concrete solution to that kind of pain. But you are not an impartial or knowledgeable enough judge to decide that you have a personality disorder (seriously, why do you think psychologists and psychiatrists and therapists go to school to get degrees and extensive training, if we could just use Wikipedia?). On top of that, personality disorders aren't the kind of thing that we just use a little CBT magic and poof! you're good in a coupla weeks. Personality disorders are something that professionals don't take too lightly or hand out like Major Depression or ADHD. Really, I would suggest that you look into a new therapist who works well with bipolar disorder (if your current therapist doesn't give you some referrals, then ask her to), and let the therapist know you want to have some functional and happy relationships in your life, and allow the therapist to help you with those core issues.
posted by so_gracefully at 12:16 AM on March 7, 2010 [2 favorites]

As someone who has an indeterminate diagnosis for an unrelated physical problem, I can relate a bit with the frustration trying to name whatever is going on with you. Finally I realized that trying to give my disorder the appropriate name unproductive. It didn't really matter what long-dead scientist my disease was named after because regardless of what it was called I was still experiencing symptoms that needed to be dealt with.

My point is that paying attention to the symptoms is far more important that trying to categorize your experience under one disorder or another. If you attach a label to it, you might start to ignore symptoms that are inconsistent with that label. So my advice would be to make sure you find a professional who is willing to keep an open mind and isn't going to just blindly accept a previous diagnosis as fact.
posted by thorny at 12:29 AM on March 7, 2010

It's nice and orderly to believe there's this detailed complex map of the personality with all the twists and turns labeled and marked as healthy or diseased but it's largely a function of culture. The DSM you're familiar with is about to be replaced with a different one, which, several years down the line will be replaced with a still different one. Today's personality disorder can be tomorrow's transcendence of role programming. The important part, and the first step to becoming more (rather than less--which is what one wants to do when they see themselves as a collection of symptoms) is to accept who you are. You want a therapist who accepts who you are too.

Defenses are often seen negatively (e.g. calling someone defensive is usually meant pejoratively) but they exist for a reason. You need to accept that you developed them because you needed them at the time, and consider that you now want more than just protection. Relationships are scary (if you're doing them right.) You'll need to take risks and they'll naturally feel risky. This doesn't mean something is wrong with you. Pretending it's not risky by dissociating from the fear is called being counterphobic and, in our culture, often passes for bravery.

Since you seem to like researching this stuff, there's a paper called Some Thoughts about Schizoid Dynamics that I'd recommend if you can get behind the pay wall, which will change the way you look at "being" schizoid.

(IANYT, etc. Usual disclaimers apply.)
posted by Obscure Reference at 6:23 AM on March 7, 2010 [3 favorites]

You may or may not have it. However, since you have serious mental health issues, I'd wait until you get a proper diagnosis first.
posted by Ironmouth at 10:08 AM on March 7, 2010

I used to work in a psychiatric hospital, but am currently not licensed to provide diagnoses, nor can I provide diagnoses over the internet. Therefore, this is not a diagnosis. (my usual disclaimer).

Schizoid Personality Disorder is classified as a personality disorder. Personality disorders are generally considered to be long standing, difficult (or impossible) to "cure", and cannot be fully treated with meds. Mood Disorders (depression, bipolar, psychosis, etc) are considered to be more "situational" (for lack of a better word) and can be treated quite successfully with medication. Yes, mood disorders can stay with you for life, but they tend to be connected with brain chemistry and symptoms can be successfully managed or eliminated with meds. Therefore, the first thing to realize is that there isn't a medication for SPD like there is for Bipolar.

Your current therapist has been treating you appropriately in regards to the mood monitoring and relationship stuff. Bipolar will be with you for life, and while a bipolar individual can pretty much erase all of their symptoms with the right meds, you always have to be paying attention to yourself so that you can recognize a mood swing coming and take precautions. Sounds like you have a good handle on all of that and you're ready to dig a little deeper.

I can't tell you if you have SPD or not...there's a million points on the continuum for avoiding/having poor relationships/intimacy and you haven't given us (nor should you) enough info to find out where you are on that continuum.

I think my previous psychological course has been, in essence, helping me build up my defensive self, without addressing my underlying self, the self that feels unreal. I want to fix that. I want to have a girl-friend for once in my life.

You need to tell your next therapist exactly what you said above. Don't mention the SPD in the very beginning because it really doesn't matter what your diagnosis is. What does matter is what you want to improve about your life...and what you want to improve may not actually be a function of your bipolar disorder. It may be simply how you grew up. Tell your new therapist what aspects of your self you want to work on. They will know the right questions to ask. If that leads them to a diagnosis of SPD, so be it. But that diagnosis won't fix what you want to fix about yourself...you'll still need to do the exact same work to address the "self that feels unreal".

Regarding what therapist to find, your outgoing therapist should be able to refer you to colleagues. Look for one that treats personality disorders or long standing mental illnesses like bipolar, schizophrenia, etc. They will tend to do long term therapy for their patients (due to the nature of long term MI) and will most likely have the skills to "dig a little deeper". Psych hospitals will refer to them, so if you are truly lost call up a psych hospital and tell them that you are new to the area, you're looking for a therapist that treats long standing bipolar and personality disorders, and can they give you some names (be careful though...if they are a private facility they may try to get you to come in for an assessment to see if you need admission because they have to convert a certain amount of their phone calls into face to face assessments. You don't have to do that).

Good luck...and remember to focus less on the official diagnosis, and more on the parts of yourself you want to fix.
posted by MultiFaceted at 11:06 AM on March 7, 2010 [1 favorite]

You may not be schizoid even if you get it as a diagnosis, and even if you do get a diagnosis, it's not like a diagnosis of bipolar, in which there's medications to try. Furthermore, personality disorders are undergoing some overhaul for DSM-5 anyway, and will have "types" and "traits."

My psychologist gave me that diagnosis after I took the Minnesota Multiphasic Personality Inventory test, but I wasn't so sure because I felt anxiety was a larger part than disinterest, which I feel that I use to mask my anxiousness. I wasn't sure that I was being fully honest on the test, as it was over 500 questions and took some time to complete. Another therapist diagnosed me with avoidant personality disorder (with some borderline personality disorder traits), which fits in better with my Generalized Anxiety Disorder and agoraphobia.
posted by autoclavicle at 5:40 PM on March 7, 2010