These aloof, emotionally cold people (1% to 2%⁺ of population; ♂ > > ♀) typically display unjustified suspiciousness, hostility, hypersensitivity to slights, jealousy, and an inability for intimacy. They tend to be grandiose, rigid, unforgiving, sarcastic, contentious, and litigious and are thus isolated, disliked, and have few friends. They accept criticism poorly, blaming others instead. This disorder may be associated with chronic central nervous system (CNS) impairment, drug use (e.g., amphetamines), depression, obsessive-compulsive states, and a family history of schizophrenia. Psychotic decompensation sometimes occurs, requiring low-dose antipsychotics. Although 1% of the population, they rarely seek treatment. Therapy is of little value, but low-dose, limited side effect antipsychotics (e.g., risperidone) may help.

These people are seclusive, with little wish or capacity to form interpersonal relations, are indifferent to and derive little pleasure from social and sexual contacts, and yet prefer and can perform well at solitary activities (e.g., night watchman). They have a limited emotional range, experience little pleasure, daydream excessively, and are humorless and detached. They “may” have a family history of schizophrenia but do not seem to have an increased risk of developing schizophrenia themselves (6). “Loners” are not necessarily schizoid unless they have impaired functioning; be alert for mild PDD, Asperger syndrome, and schizotypal personality disorder. Treatment seems of little help.

In addition to having features of the schizoid (isolated, anhedonic, aloof), these people are “peculiar.” They relate strange intrapsychic experiences, display odd and magical beliefs as well as strange speech, reason in odd ways (e.g., ideas of reference), are frequently anxious, and are difficult to “get to know,” yet these features rarely and briefly reach psychotic proportions. It is found in 3% of the population (♂ > ♀), commonly occurs with major depression, and
is associated with an increased incidence of schizophrenia in family members (suggesting that this condition is part of the “schizophrenic spectrum” of disorders) (7). Biologic measures found in schizophrenia also occur (e.g., impaired eye tracking and atrophy of left superior temporal gyrus). Low-dose antipsychotic medication may reduce the more flamboyant symptoms.

Antisocial behavior begins in childhood or early adolescence (must have Conduct Disorder before age 15 years): aggressiveness, fighting, “hyperactivity,” poor peer relationships, irresponsibility, lying, theft, truancy, poor school performance, runaway, inappropriate sexual activity, and drug and alcohol use. As adults, they show criminality, assaultiveness, self-defeating impulsivity, hedonism, promiscuity, unreliability, and crippling drug and alcohol abuse. They fail at work, change jobs frequently, go AWOL and receive dishonorable discharges from the service, are abusing parents and neglectful mates, cannot maintain intimate interpersonal relationships, and spend time in jails and prisons (50% or more of prisoners). These patients are frequently, if temporarily, anxious and depressed (suicide, often impulsive, in as many as 5%) and are second only to patients with hysteria in the production of conversion symptoms. The behavior peaks in late adolescence and the early 20s with improvement in the 30s; however, the patients usually continue their antisocial patterns, and they rarely recover from the “lost years.” Men are involved more severely, earlier, and more frequently (3%⁺ of population); M:F = 3-5:1.