Transcription
So, what I uh hope to do is to talk a little bit about um the dynamics of interpersonal detachment. Um, uh one's um either inability or unwillingness to connect with other people. And and much of it uh the talk will focus on um two uh personality disorders, really two personality styles: um schizoid personality style and avoidant personality style. And I want to say, although I'm going to be talking um, you know, at least in part about schizoid personality disorder and avoidant personality disorder, I want us to think about these personality styles as dimensions, as continua, not necessarily as categories. Uh, and and I'm going to try to frame um much of my talk in that way. We're really talking about uh a personality styles or or detached personality styles more so than personality disorders.
Um, and I would be happy to answer questions or to address questions uh regarding the, you know, the newer dimensional approaches to conceptualizing personality pathology and how they um may improve upon the traditional categorical um diagnostic approaches, uh if that's something that that you'd like to talk about. Um, I have some I have some thoughts in that area as well. And and and do feel free if if there's a question to somehow, you know, I don't know how we're set up here, um but indicate that if something is not clear. I'm absolutely happy to to to say a little bit more, uh and and if you let me know, uh I I would be um be thrilled to answer any question you may have. So, um let's go ahead and make sure that's working.
I wanted to uh put my discussion of detachment in context and say a little bit about how I began to study this phenomenon. I st have studied interpersonal dependency and dependent personality disorder for I it I guess it's 40 years now, since the early 1980s really, when I was a graduate student. And uh it took us a little while to understand the dynamics of interpersonal dependency. Um, what I'm showing you here is a review paper um that I published in in 1992. And and indeed it took us about a year or I should say a decade um to feel as though we had a real understanding of interpersonal dependency. And and one of the things that we found over the course of this decade of work and that work has continued for all of these years is that many of our stereotypes regarding dependency are are are simply not true. Uh, for example, dependent people are are are typically conceptualized by clinicians and by researchers as well as being passive and timid and compliant, and sometimes they are, but it's also true that um dependent men are at increased risk for perpetrating uh partner abuse, domestic violence. And people find that very surprising, and we did too, but there is such a thing as active dependency. Um, dependent people do indeed choose to be um passive and compliant much of the time, but that's because they believe this is the best way to strengthen um important relationships. When they believe that a relationship may be at risk of failure, they can become quite active.
So, in the course of studying dependency over these years, and I'm actually a little embarrassed that it took us this long to do it, we finally realized, and this is 20 years into the research program, that maybe it would make sense to look a little bit at the converse of dependency, interpersonal detachment. And that's what we began um in the early 2000s. And much of that work in the early 2000s centered around um the development and the utilization of um a measure that we created to assess both dependency and detachment called the Relationship Profile Test. And that's what stimulated M um much of the research that that that I'll that I'll talk about today. So I wanted to say a little bit about how, you know, I I I hope to proceed.
As I was preparing this uh talk, I I thought it might be useful to do a literature search. We had done them in the past, but hadn't done it in recent years, um just to see how frequently interpersonal dependency is studied and also to see how frequently uh interpersonal detachment is studied and what we found did not surprise me. Um, we found that dependency is studied far more often. I was able to locate over 2,000 uh published works on interpersonal dependency. This was about a month ago. I was only able to locate 400 published works on interpersonal detachment. So one thing that we need to address and that that is where I'll I'll want to begin in a moment, uh is why is detachment neglected? Why is it not uh studied as frequently as interpersonal dependency? After that, we'll go on to talk about how detachment has been conceptualized in the diagnostic manuals and the way that these conceptualizations have evolved over time. We'll take a few minutes to look at the underlying dynamics of two forms of detachment, um schizoid personality style and avoidant personality style, and then some recent empirical work that we've done contrasting these two personality styles. And I'd like to finish by offering some suggestions about the implications of this research for our understanding of detachment and um where we may be headed in the future.
So, why dependency but not detachment? I think there are two reasons for this historically, and one of those reasons is empirical. Now I don't know, and I didn't label this picture, I purposely did not label this picture. I don't know if this person looks familiar to you. I think you've probably heard of the work that he did. I will show you another that might help. This is work from the early 1950s. This was a series of studies by a researcher named Harry Harlow, and the phenomenon that he was studying came to be known as contact comfort. And I'm hoping, but I don't know, that maybe this looks familiar. Does this look at all familiar, or you've never seen this before? Okay, that's helpful. Um, Harlow was interested in understanding how it is that ultimately he was interested in understanding how it is that people bond to their um caregivers, but um he could not use people in the types of experiments that he was doing, so he used monkeys instead. And as you can see in this picture, Harlow raised um monkeys um uh separate from their mothers, their real mothers, and he raised them with what he called two surrogate mothers. The one on the right, the one where the monkey is um is uh covered with terry cloth is uh warm; there is a a hot water bottle inside there, but she provides no food. The surrogate mother on the left is not covered with terry cloth, is not warm and comfortable to cling to, but that surrogate mother on the left provides food. At the time, people believed that children bonded to mom um really for biological reasons, because it was reinforced, because because Mom fed them. But what Harlow found was was that uh monkeys spent um the vast majority of their time on the terry cloth mother, the mother that provided what he called contact comfort. And um even when they were feeding, as you can see, um they would they would still be hanging on to the the um terry cloth mother, but they go over there for um to get um to bottle feed.
When um Harlow—Harlow was not a particularly nice man, by the way—when um Harlow wanted to see how monkeys reacted when they were frightened, he put into the cage one of those little mechanical dogs um that makes noise and walks across the stage. And I think kids find them scary. I found them scary when I was a kid, uh and the monkey finds them scary too, but who does the monkey run to when the monkey is scared? It runs to the mother that provides contact comfort, not the monkey that um provided food and biological gratification. Uh, I think what Harlow did not expect to find was that these monkeys who were raised in the presence of surrogate mothers but not their real mothers, they never developed normally. They never developed um proper social skills. They uh were never accepted into their peer group. Um, they had difficulty reproducing. They had difficulty finding a partner who was willing to reproduce, and they looked depressed, as this monkey in fact does look depressed and apathetic.
Around the same time as Harlow was doing his work, there was work going on um elsewhere, and it was work that was conducted by actually a psychoanalyst named René Spitz, who coined the term—and it's kind of a funny term—hospitalism. Uh, and what Spitz—what did was Spitz studied um children uh and here or some uh who were orphaned uh during World War II, uh raised in orphanages. And at that time, um even though the children's biological needs were being met and they were fed and they were changed, they were warm, the um staffing limitations of the orphanages—and remember this is during and after World War II—the staffing limitations of the orphanages were such that the children didn't have the opport opportunity to bond to the same caregiver day after day and week after week. They were fed, they were taken care of, but it was a different caregiver every day, so they never had the opportunity to bond. And what he found was, well, what he found was similar to what um Harry Harlow had found with monkeys, uh and perhaps even worse. I this is a bit of an odd figure, but it's the figure, one of the figures from Harlow's early studies. What he found, which is actually a bit shocking, was that even though the um infant's biological needs were needs were met completely, really nearly 40% of them died by the end of the second year. So being deprived of the ability to bond to a caregiver can be deadly. Well, and you may hear this and you say, well, so what? It's not World War II anymore. We're not talking about monkeys. But in fact, this um problem—I think the word I'm looking for—um reproduced itself in the 1990s as the Soviet Union broke up and some countries that were in uh uh had been a part of the Soviet Union uh now were independent nations. And uh in particular Romania, uh we found a situation similar to what Spitz had found during World War II, that we have children raised in orphanages, to some degree their biological needs are being met as well as they could be, but these Romanian children developed all sorts of health problems, and when they were adopted in the United States and elsewhere, they were both physically compromised and psychologically compromised.
All of this combined to convince the psychological world that the need to belong, the need to bond, is a fundamental motivation, and that makes um interpersonal detachment, as one sees in schizoid or avoidant personality disorder, a little bit mysterious. Are these people missing that fundamental drive to relate to other people, or is something else going on? So the other um area that's been influential in shaping our understanding of detachment over the years is not empirical but cultural. Much of this work has been done in the United States, certainly not all of it, but much of it has been done in the United States, and and as you may know, the United States has a long history of um emphasizing and valuing and um encouraging autonomy, independence, and self-reliance. It goes back, as you can see, it goes back well over a hundred years, but it's still with us today. The person on the left is Teddy Roosevelt. Uh, talk about being self-reliant. Did you know that in 1912 he was giving a speech, uh he there was an assassination attempt, he was shot uh as he began to speak, but he continued for another 45 minutes, finished his speech rather than being taken to the hospital. And at the end of the speech he said, "I will walk to the hospital to receive my treatment." That's our culture of independence. If you're familiar with Geert Hofstede and his dimensions of culture, um America falls uh is among the most uh individualistic cultures that there is. I thought it might make sense to see where Poland falls on this dimension. I guess I'm I don't know if I'm happy to report, but at any rate I'm reporting um that you are much more balanced than we are with respect to individualism, uh however you are quite high on what they call uncertainty avoidance. Uh, apparently, if Hofstede is correct, uh uh uh Polish culture does not like to change too quickly. Maybe he's not right, but that's what he thinks.
So all of this has been actually one of that one of the reasons why um there is relatively little writing on detachment and much more writing on interpersonal dependency. But no one denies that there are people in the world who um have difficulty relating to others. No one in no one denies that there is such a thing as a detached personality style. It's really a question of how we understand it. So how has the detached personality evolved over time? The first kind of formal diagnostic label that was given to the detached personality, and this predates the diagnostic manuals, it predates the Diagnostic and Statistical Manual of Mental Disorders, and it also predates the International Classification of Diseases, or at any rate the version of the International Classification of Diseases that includes mental health conditions, which some of the earliest versions of the ICD do not. Uh, but by ICD-6, um it's it was in there. The concept of the schizoid personality can probably be traced to the work of Bleuler, as far as we can tell. This is about the first uh reference to what would eventually be called schizoid personality disorder. So Bleuler says, schizoid—that was the term—is a tendency to direct attention toward one's inner life and away from the external world. When exaggerated, this tendency may lead to a schizoid personality. I believe that's about the first time that that that term was used. And Bleuler's work was very influential at the time, and it uh played a key role in um shaping the diagnostic uh criteria for schizoid personality disorder in the uh first edition of the DSM, the DSM-I. And in the DSM-I, this is how the schizoid personality was described: "The schizoid personality: inherent traits in such personalities are avoidance of close relations with others, inability to express directly hostility or even ordinary aggressive feelings, and autistic thinking. They says these qualities result in coldness, aloofness, emotional detachment, fearfulness, avoidance of competition, and daydreams revolving around the need for omnipotence." I'm not sure about the daydreams part, but that does go to show you the psychoanalytic influence in the DSM-I and the DSM-II, which gradually faded over time.
So, schizoid personality was there in DSM-I and the DSM-II. Um, criteria were not terribly different. I mean, they you know, they they changed a bit, but they didn't change fundamentally. Where modern work uh really began and where where where the changes in our understanding of of um a detached personality began was in DSM-III in 1980. It came out just before I began graduate school. I learned diagnosis um using the DSM-III. And in the DSM-III, for the first time, the detached personality was divided into two separate categories, two separate syndromes: schizoid personality disorder and avoidant personality disorder. And um notice when we look at the descriptions in um DSM-III how they take um great how they make great effort to distinguish the two disorders and um accentuate their differences. So they say the schizoid person is reserved, withdrawn, and seclusive. Individuals with this disorder are usually humorless and dull and without affect in situations where an emotional response would be appropriate. So that's schizoid personality disorder in DSM-III. Avoidant personality disorder in DSM-III, they say, "Avoidant patients are sensitive to rejection, humiliation, or shame, devastated by the slightest hint of disapproval. Unlike individuals with schizoid personality disorder who have no desire for social relations, those with avoidant personality disorder yearn for affection and acceptance." So what we're starting to look at it seems is um one type of detached person who is detached because basically they're very shy and and afraid of um embarrassing themselves in public, the avoidant person, and we have another form of detachment. So says the diagnostic manual, um schizoid personality, where people have simply lack the desire to connect.
Those qualities have carried through to the current diagnostic criteria. There's no need to go into these in detail, and of course you have access to them as well. And this is this is the DSM-5. It's the DSM-5 TR, this is the current um version, but I want to highlight a couple of symptoms um because uh they turn out—well, I don't want to give it away yet—but um uh evidence provides great support for some of these symptoms, but it also doesn't support others at all. Um, so among the important things to look at here um in the description of schizoid personality disorder in the current diagnostic system, uh schizoid people, number one, "neither desire nor enjoy close relationships." So they say, okay, they don't want to be in contact with people. Number three, "has little if any interest in having sexual experiences with another person." Is that true? The diagnostic manuals think it is. And then let me go down to the bottom, number six and number seven. They say schizoid people "appear indifferent to the praise or criticism of others," and then they "show emotional coldness, detachment, or flattened affect." What I want to notice here here in number six and seven is they're not saying that schizoid people are indifferent to praise or criticism; they're saying they appear indifferent. They're not saying the schizoid people are emotionally cold; they're saying that they look emotionally cold. That's two different things. When we look at avoidant personality disorder, um uh this the same reason, um let's see what they say and then let's see how the evidence supports or or doesn't support that. Um, so number one, they "avoid activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection." That is the essence of avoidant personality disorder um in the diagnostic manuals. Number three, they "show restraint within intimate relationships because of the fear of being shamed or ridiculed." In other words, the diagnostic manual believes that avoidant people aren't only worried about being rejected by strangers in a public place, at a party; they're actually worried about rejection in intimate relationships as well. And then number six, down toward the bottom here, they "view themselves as socially inept, personally unappealing, or inferior to others." In other words, they have a negative self-concept, or so the diagnostic manual believes, and um that in in the DSM as a characteristic of avoidant personality disorder. It does appear to be schizoid personality disorder, notwithstanding this symptom. Number six does appear to be one of the key characteristics that distinguishes avoidant personality disorder from social anxiety disorder: the negative self-concept, the internalization of a p of a a self-concept, a perception of oneself as unlikable, which people with um social anxiety disorder do not seem to show. They're shy and they're afraid of rejection, but they don't see themselves so negatively. So that's that's sort of where the the diagnostic uh manuals leave us, um and what we see is, and I want to stay close to what we know now, I don't want to speculate too much, what we know is is that um avoidant and schizoid people appear different. That avoidant people appear to be um externally focused; they appear to be self-conscious in a bad way; um they're they're hypervigilant; they're sensitive to um uh negative interpersonal cues; in fact, they over perceive um negative interpersonal cues in social situations, and they're visibly anxious. And that's so that's how they look. Schizoid people appear to be focused on their inner world rather than what's going on around them. So they tend to look—they're described by others as being disengaged, unresponsive, and um they they appear withdrawn, and they appear withdrawn. So that that's that's that's what the symptoms tell us; that's what the diagnostic manuals tell us. But let's look, let's go to the source, and let's let's um see if we can maybe get a get a better look at what's going on inside the um detached person, inside the detached person's mind, um how do they experience the world? And there are a couple of places where there's good information, interesting information in this area. One one of those places is the Psychodynamic Diagnostic Manual, which unlike the um International Classification of Diseases and unlike um the Diagnostic and Statistical Manual, is a little bit more willing to uh perhaps speculate about um internal states, but they have a very insightful description of a schizoid personality disorder, and note how different this is from the way the DSM describes schizoid personality disorder. So let me read what the Psychodynamic Diagnostic Manual has to say. They say, "Schizoid individuals are often seen as loners and tend to be more comfortable by themselves with others. At the same time, they may feel a deep yearning for closeness and have elaborate fantasies about emotional and sexual intimacy. They can be startlingly aware of features of their inner lives that tend to be unconscious in individuals with other kinds of personality, and they consequently may be perplexed when they find that others are unaware of aspects of themselves that to the schizoid person seems obvious. Although some schizoid people seem content in their isolation, there's often a longing for intimacy that their avoidant defenses conceal." So the uh PDM is arguing that that symptom in the in the um the DSM-III and the DSM-5, "has no interest in having sexual experiences with another person," may not be...
Correct. There is a really wonderful article that I recommend. Um, here's the cover, and and and I had forgotten to mention when I started, I'm certainly happy to make the slides available to everyone, um, after uh the talk. And if that would be helpful, and if you let me know, I'll send it, so you'll be able to get this, um, if you're interested. But this is a a um really fascinating um and revealing first-person account. It's written by Peter Chadwick. Peter Chadwick is a uh psychologist, is a clinician, uh, and um he decompensated into schizophrenia um several decades ago. And he believes that prior to his decompensation into schizophrenia, he suffered from schizoid personality disorder. And this is what he has to say about himself: he says, "My attachments to people were very slender. I was so obsessed with the life of the mind and the use of intellect for defense and self-justification that the life of relationships was secondary to me. I was also a person who had no commitments other than to the life of the mind, so I became a nomadic type, a loner, a recluse. Even at the height of my anguish in 1979, the thought never crossed my mind for a moment to ask anyone to help me. This was the price of being a totally self-contained reasoning entity." To me, this is actually very moving. It's not that surprising; I would have expected that a schizoid person might say this. But he goes on, and this quote to me is a bit surprising. So he goes on to say, "Although I was not a cold person, I had lost count of the number of people who had said I often was far away, not aware, miles away, or remote." And these do tend to be the everyday descriptions of schizoidism in people known to me who have fitted this category. For me, the inner life was more prepossessing than the outer. In the terms of Guilford, I was a cognitive and emotional introvert, not extrovert.
Now here's the surprising part to me. He says this: "This made psychology, psychiatry, and psychoanalysis suit me far better than my previous subject at university, which had been geology." Now think about that for a moment. Why would this person, who has difficulty connecting with others, sees himself as spending most of his time meandering around in his own mind, believe that he is meant to be a therapist? It's not crazy. There haven't been that many surveys of the personality styles of psychotherapists, as you probably know, and that's mostly because psychotherapists don't want to be studied. But what we do know is the most common personality style among male therapists is schizoid. There hasn't been as much written about the inner lives of people with avoidant personality disorder. I wish there were. I'm looking for that article that that that would parallel um Chadwick's article. The best I can find is this, and it's and is a very, it's really a lovely narrative um investigation of the lived experience of avoidant personality disorder, um, and it contains very interesting quotes, but they're quotes from lots of different people. That's that's that's that's the difference here. And so I wanted to read you uh a couple, and and this this is a study of um 15 avoidant patients who really were uh, you know, encouraged and and and supported in in describing what it it was like to be them in the world. So what do they say? Um, they say that they, and I'm quoting here, they say that they spend most of their time putting on a mask and following the templates of behaving rather than revealing the real me, or what they sometimes call the sick me. They describe this following the templates of behaving as being being quote difficult and demanding work. It's draining to walk around in the world presenting this false self. One person says, one of the people, one of the patients says, "I notice you spend incredible amounts of energy, you just spend your entire consciousness trying not to make a fool out of yourself and appear normal." So he says, and I'll stop there. I think one of the takeaways is is that it's a very painful experience to be detached, regardless of whether you're schizoid, uh you have a schizoid personality style or an avoidant personality style.
One thing that we do know uh regarding the inner world of uh avoidant people is what happens in the moment, in other words, what happens when the avoidant person is in a stressful social situation. That is so negative, and and it's a four-step process. Um, avoiding people enter into um social situations with an expectation that they will be shamed, they will be embarrassed. They are therefore sensitive; they're on the alert, they're on the lookout for negative social cues. And evidence in fact does confirm that they over-perceive um negative social cues; they perceive negative social cues where they don't even exist. So they believe that people around them don't like them, which makes them anxious. To the extent that they get anxious, they have less cognitive capacity available to deal with this the the moment, to deal with the situation. Their cognitive capacity is taken up dealing with their anxiety and other negative emotions, which leads to what one might call a self-fulfilling prophecy. If the avoidant person is that anxious in social situations and spending all of their mental energy dealing with their anxiety and their feelings of shame, this impairs their interpersonal functioning, which really ensures that the situation is going to come out badly and reinforce every belief that they had about themselves. So that's what we know; that's what the diagnostic manuals are telling us, and that's what the people who experience these disorders are telling us. What does the evidence say? As I had mentioned, um avoidant personality disorder and schizoid personality disorder first became separate syndromes, separate categories um in the DSM-III in 1980. And when that happened, um a few studies were conducted, not very many, I I would say five, six, seven studies, depending on how you count them, um looking at the differences between these two disorders. And here are three of I think the um the best. Um, and these initial studies, they produced mixed results. Um, the first two, the studies by Cast and Troll, um produced results that that that really suggested that schizoid and avoidant personality disorders were quite distinct. For example, they found minimal comorbidity between schizoid and avoidant personality disorders in clinical samples. They they even, they found minimal comorbidity at the the syndrome level. They also found minimal comorbidity at the symptom level; that is, that schizoid people tended not to have a lot of symptoms of avoidant personality disorder; avoidant people tended not to have a lot of symptoms of schizoid personality disorder. Suggests that really they're looking pretty distinct here. On the other hand, Overholser found, in some ways, the opposite. Um, he found that um on various external criteria, um like anxiety, uh like depression, um like psychosis proneness, that schizoid and avoidant people looked uh very similar; they were indistinguishable. So the initial studies um produced mixed results, and that is what eventually got us interested in studying this phenomenon too.
So I wanted to tell you about a few um studies that we've conducted in our in our lab. Um, mostly they're quite recent. This is the oldest of the three. Um, this is the first study that we did, and it was it was conducted in 2015 or was published in 2015. And I want to say um before I describe the the three studies, these are all student-driven studies, uh which I love. Um, my job was mainly to sort of hang around and give them little bits of advice and stay out of their way and not mess things up too much. So I take no credit for this, um, but my student Daniel Whenaric uh did his dissertation uh contrasting um schizoid and and avoidant personality traits. And I must say I I I really believe this is the first um well-done study contrasting the uh traits of of these two personality styles, really the first well-designed studies. He used an array of measures. Um, he chose these measures based on his reading of the theoretical literature, the clinical literature, and also the DSM, the diagnostic manuals. And so, as you can see, uh he compared schizoid and avoidant um patients, or excuse me, um this happened to be a a a non-clinical sample. Um, he compared uh schizoid and avoidant people on on measures of attachment style, defense style, empathy, internalized shame—remember uh that statement regarding avoidant personality disorder and their their negative self-concept, it's going to come come back—need to belong, rejection sensitivity, and social anhedonia. Social anhedonia meaning the um inability to experience pleasure from social interactions. And that's what he did. It was a mixed sample of um college students, in fact, in this first study, uh and we we selected schizoid and avoidant um uh participants using the International Personality Disorders uh Screening uh Module, and we selected people who scored high on on schizoid uh personality traits or or um avoidant personality traits. And um we conducted uh regression analysis, seeing which of these traits from that list that I had just shown to you and read to you were uniquely predictive of schizoid traits. And of all of those variables, the one that is uniquely predictive of schizoid traits is social anhedonia. Schizoid people seem to not get pleasure from social interaction. You get a very different pattern when we look at um avoidant people, and here there are two traits that are uniquely predictive of avoidance as a personality style: one is need to belong, a desire to be liked, and second, internalized shame. So aha, in fact, the DSM was right about that, that that second that second um part, the shame part. So that was a study that began us, you know, started to get us thinking.
The other two investigations that we've done in this area are more recent. Um, this too was is student-driven, student-driven. My student Shannon Thompson, um, and um her uh interest in studying this topic was not to replicate um our earlier results, but to see um how schizoid and avoidant people differ um with respect to their self-representation, literally with respect to the qualities of their self-representation. And one of the things that she was determined to do was to study the self-representation using something that a little bit different from a traditional questionnaire, self-report measure, because of really because of the constraints that go along with those kinds of measures, uh and some of the self-presentation effects that can perhaps bias people's um self-reports. So she used a measure that some of you might be familiar with; it used to be called, it was developed by by Sydney Blatt at Yale University in the 1970s. It used to be called, literally used to be called the Parental Representation Scale because he initially used it to assess the qualities of maternal images and paternal images, but it quickly became clear to Blatt and to the rest of the world that um this measure could be used to study other sorts of internalized mental representations as well, not just those of parents. Because the way the Parental Representations measure—now we call it the Object Relations Inventory—the way the um Object Relations Inventory works is um you simply ask a participant to describe themselves in as many words or as few words as they like; that is literally the only instruction that they get in the traditional administration of the Object Relations Inventory. You hand the person a piece of paper that says at the top, "Describe yourself." That's it. Now we collected these data online, so uh she adapted that method, uh and instead of describing themselves on a piece of paper, they describe themselves in the text box, in a text box. And and here too again, um I mean as as you might expect, self-descriptions range from very brief and and kind of concrete self-descriptions to very long, nuanced, elaborate self-descriptions. And you can score these self-descriptions on a huge array of dimensions. This is not a complete list, not at all; these are just examples. I'll show you the list in a moment; it's so long you can't read it; it fills fills the slide. Um, but just to give you an example. So now you're looking at this open-ended self-description, and you can score this open-ended self-description for content variables, for example, the degree to which the description reflects benevolence, the degree to which it the description is characterized by warmth versus coldness, the degree to which you present yourself as being a nurturant person. All of these are scored on dimensions on as continuing. In addition to content, you can score these self-descriptions for their structure, which sounds, I mean, it takes a minute to get used to. Okay, what does that mean? Um, when I say you can score them for structure, you can you can score reliably the degree of ambivalence in the description, the degree to which the person says things about themselves that reflect or that suggest they like some things, they don't like others, the degree to which there's this sort of inconsistency as they move through their self-description. You can score it for conceptual level; conceptual level as Blatt might score from concrete operational to much more elaborate, nuanced, and adult-like complexity. And and and you can score um these these uh descriptions for what we call self-reflectivity, um like psychological mindedness, self-awareness, you know, introspective capacity. And so uh we we scored um 200 uh so odd um self-descriptions for all of the Object Relations Inventory scoring dimensions. See what I mean? I wasn't kidding; it's a long list, and and it's hard to fit it all uh onto a slide, which is why I I showed you um examples. Um, but here are there's 29 dimensions here, and um in order to facilitate um data analysis, we we conducted um a factor analysis to see whether these all these separate dimensions um clustered into um um factors—sorry, I didn't mean to do that—clustered into a smaller number of factors. And and in fact, did um that um all of those dimensions of the person's self self-description um coalesced into three factors um that we called positive self-regard, self-complexity, and self-efficacy or agency. And now we're ready to take a a look inside the the world of schizoid and avoidant patients using their open open-ended um self-descriptions. And and here's what we found, and I'll I'll and and here's really the key part of it. Um, when you examine the correlations between schizoid and avoidant trait severity, number of traits, number of symptoms, and scores on these three factors, you'll see that there are significant relationships between two of these three factors and avoidant personality scores. Avoidant people, or I say it differently, there is a negative correlation between the degree to which you are avoidant, a negative correlation between the degree to which you are avoidant and the degree to which you see yourself in a positive light, or to say that better, I didn't say that well at all. Uh, avoidant people uh have a negative self-view; schizoid people do not. And focused comparison of effect sizes uh yields the result you would think; those two correlations differ from each other. And the same is true of self-efficacy; avoidant people see themselves as not having power and agency; schizoid people don't show that. So these are these personality styles are starting to look pretty different.
Here's the last study. This one is actually in press; it hasn't come out yet. It's in press in the um Journal of Personality Disorders, and I'm I'm I'm proud of the fact that my student here, Fasa, or uh this was her master's thesis. She did a great job; it's really a great job um that she did on that, um, and um she was interested in contrasting schizoid and avoidant um individuals on uh the Alternative Model of Personality Disorder, which is in the DSM-5 and the DSM-5-TR. She was interested in comparing schizoid and avoidant people on the five trait domains that comprise the Alternative Model of Personality Disorder; those five trait domains being negative affectivity, detachment, antagonism, disinhibition, and psychoticism. So she did, again with a sample of about 200 people, again um using the International Personality Disorders Examination Screening Inventory and treating these dimensions as continua. And you can see that the only um area, the only trait domain where there was a difference, a significant difference in the magnitude of correlation was in in in negative affectivity. Um, both avoidant and schizoid people uh show high levels of negative affectivity, relatively high levels of negative affectivity, but that relationship is stronger, significantly stronger for avoidant people. In this study too, um we did uh a regression analysis to see which, if any, um of the Alternative Model of Personality Disorder traits were uniquely predictive of avoidance; which AMPD traits were uniquely predictive of avoidance. And there were three: detachment, which of course is completely unsurprising; negative affectivity, which which makes sense I guess; and disinhibition, but um in the reverse direction; in other words, um avoidant people or or I'll say it this way, avoidance is inversely related to disinhibition, or to put that more clearly, avoidant people are inhibited; they show high levels of inhibition, restraint. Again, quite a different pattern for uh schizoid personality disorder. And here now there are two unique predictors: detachment, again of course, but also antagonism, antagonism in reverse; in other words, high levels of schizoid personality traits are associated with low levels of antagonism, or perhaps they're associated with high levels of agreeableness, which is considered to be the converse of antagonism in in the in the AMPD. So schizoid people, surprisingly enough to me, look detached but agreeable, you know, and that's where we are. So I think we can say a few things about the nature of detachment and and about the possibility that there may be two separate um variants of detachment. I don't think that we can answer that question conclusively yet, but but but here's what we know. We know that schizoid and avoidant personality styles have overlapping qualities, but they have some important differences as well. To summarize, just in very general terms, um what I think the the three studies taken together combined um suggest is that avoidant personality disorder is characterized by a negative view of the self and also by a what I would call a broad, decontextualized pattern of negative emotional experience, which is reflected in their high scores on negative affectivity. Schizoid people, in contrast, show social anhedonia; they they seem not to get pleasure from interacting with others, and the low antagonism or high agreeableness um that we were just talking about a moments ago. So so there clearly there are some differences. What's nice about this is that these findings generalize across measure; they also generalize a little bit across population, and that we have found um converging findings in um college students and in community adults, which the second two studies involve community adults. I think my apologies that I I forgot to mention that. So the findings generalize across measure and population, and they also generalize across method. It's nice to see um results that you obtain by self-report; you also obtain when you use something that's a little bit more of a free-response type of of of measure, the Object Relations uh Inventory. And that doesn't happen that much.
This is a a bit of a a sidebar, um, but I've been interested, and I'm happy to answer questions about this too. I've been interested in in in trying to understand why we get such modest correlations when we assess the same construct using two different methods. So I've in recent years been developing what I call a process-focused model of test score validity and interpretation; that we need to focus on the processes that are engaged by different measures to really appreciate um the full meaning of our results. But in any case, in the present context, the fact that we get converging findings using very different measures or measures that tap very different psychological processes in the respondent is persuasive to me. But there is still a question that's unanswered, and that is, so what do we think? Are these two disorders separate disorders, or maybe they are subtypes of a single broader detached personality? There's a bit of evidence out there that may help us address this question, probably not today, but that may help us address this question in the future. Here's one of those pieces of evidence; it's one of the few studies I've ever been able to find that studies personality disorder features um across adulthood. I know we were all brought up to believe that um personality disorders are stable across adulthood, that they don't change. That's not true. Um, when uh Gutierez and his colleagues studied um personality disorder symptom patterns in um participants from from their 20s through their 50s, he found a lot of things; they found a lot of things, but one thing that they found that's particularly relevant for us is, between age 20 and age 50, people show a modest but significant increase in schizoid traits; from their 20s to their 50s, people show a modest but significant decrease in avoidant traits. Okay, that speaks to the possibility that we're looking at two separate disorders. But I want to turn to one of my favorite um uh theorists, clinicians, Nancy McWilliams, who always has something insightful to say, and she sure does. Now, in her article entitled "Some Thoughts about Schizoid Dynamics," and this is what she has to say: she says, "The DSM differentiates between schizoid and avoidant pathology, postulating that avoidant personality disorder includes a wish to be close while schizoid personality disorder represents an indifference to closeness. Yet..."
I have never seen a person, among patients or otherwise, whose reclusiveness was not originally conflictual. And I think what she's saying is is that schizoid people, however they got there, have come to accept their social isolation as a fact of life, but that avoidant people are still struggling, struggling with it.
If she's right, maybe there is an alternative to the two separate syndromes conclusion. Maybe schizoid and avoidant personality styles exist on a continuum. At one end of this continuum are schizoid people; at the other end of the continuum are avoidant people.
If this is true, we have a situation that's somewhat similar to what we know about narcissism—that perhaps there are well-defended, detached people and poorly defended, detached people. That schizoid people are well-defended; they're no longer ambivalent, they're no longer conflicted. And that avoidant people are poorly defended, as indicated by their anxiety and um, their ongoing struggles.
So, time, I think time will tell. Time will begin to sort this out. And that's where we are. Thank you. And I tried to do it for you too. I don't know if I got it right.