The Treatment of Schizoid Personality Disorder Using Psychodynamic Methods

Abstract

The aim of this study was to establish what is known about the treatment of schizoid personality disorder using psychodynamic psychotherapies, by conducting a systematic review of the literature. The limitations of this approach are set out, followed by an account of the development of the use of the term in descriptive psychiatry and the psychodynamic literature. The inclusion criteria used were studies in English and of adults, that had a methodology, had confirmed a diagnosis of schizoid personality disorder in the subject during the study, that used any type of psychodynamic approach, and that measured the outcome. Search terms included "schizoid", "psychotherapy", "therapy", "psychodynamic", "psychoanalysis", "trial", "efficacy", "effectiveness", "method", "methodology", "qualitative", "result", "measure", and "outcome". Mesh headings were also used. Databases searched were AMED, the BMI, Embase, Medline, Psychinfo, and CINAHL. Data extraction was performed using critical appraisal tools from the critical appraisal skills programme (Solutions for Public Health). The literature search located two qualitative studies of single psychotherapy cases; one using the Assimilation of Problematic Experiences Scale to analyse data from a therapy using a mix of cognitive behavioural therapy and clarification oriented psychotherapy, and one using the Referential Activity Scale in combination with the Core Conflictual Relationship Theme method. One prospective cohort study using group psychotherapy was also found. All three described positive results in the patient or patient group. These studies were critically reviewed. The literature search found few studies with any methodology at all and an incidental finding was that there were few comprehensive descriptive single case studies in the psychodynamic literature. Potential reasons for the low number of studies are discussed. What needs to be researched to be able to answer the question with any authority is explored, with reference to the validity of the condition, genetics, temperament and attachment. A researchable, evidence based model of the development of the condition is proposed. The future use of qualitative research to uncover testable hypotheses about environmental influences on the development of the condition is recommended. The main finding of the review is that at present the existing literature is inadequate to draw conclusions about the treatability of this condition with psychotherapy.