The Detached Patient: Contrasting Dynamics of Schizoid and Avoidant Personality Styles

Although the concept of the “detached personality” is well-established, controversy persists regarding how best to conceptualize and diagnose dysfunctional detachment in clinical settings.  Recent editions of the Diagnostic and Statistical Manual of Mental Disorders, International Classification of Diseases, and Psychodynamic Diagnostic Manual include two variants of the detached personality: schizoid and avoidant.  This presentation 1) traces the evolution of these two personality styles, 2) describes the conceptual and theoretical underpinnings of schizoid and avoidant personalities, and 3) discusses research and clinical writing bearing on these contrasting expressions of detachment.  Underlying dynamics and expressed behaviors in schizoid and avoidant personalities are contrasted to illuminate core features of these two manifestations of detachment, followed by discussion of challenges and opportunities in clinical work with schizoid and avoidant patients.

Learning Objectives 

1. Describe the evolution of dysfunctional detachment in the diagnostic manuals
2. Discuss barriers to research on dysfunctional detachment
3. Contrast dimensional and symptom-focused conceptualizations of detachment
4. Identify the underlying dynamics and expressed behaviors associated with schizoid and avoidant personality styles
5. Evaluate research evidence bearing on schizoid and avoidant personalities
6. Apply this research evidence to enhance clinical work with schizoid and avoidant patients