Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Schizoid Personality Disorder


Related Terms

  • Bipolar Disease
  • Personality Disorder

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

  • Avoidant personality disorder
  • Delusional personality disorder
  • Major depression
  • Paranoid personality disorder
  • Schizophrenia
  • Schizotypal personality disorder
  • Substance abuse

Factors Influencing Duration

The severity of the disorder, response to treatment, and specific job duties all determine the length of disability.

Medical Codes

ICD-9-CM:
301.20 - Schizoid Personality Disorder, Unspecified
301.21 - Schizoid Personality Disorder, Introverted Personality

Overview

Individuals with schizoid personality disorder are characterized by a lifelong pattern of social withdrawal in day-to-day living accompanied by lack of vitality, low energy, and decreased spontaneity and expressiveness. Individuals with this disorder are introverted, isolated, lonely, and uncomfortable with human interactions and may even be described by neighbors as a recluse. Their dress and mannerisms may seem eccentric, their facial expressions bland and unchanging. They often appear aloof and absent-minded, have few friends, and are not prone to small talk or social amenities.

These individuals will often find work on night shifts or at remote work sites, thus minimizing contact with other people. Their life histories may reflect solitary interests and success at noncompetitive, isolated, and lonely jobs that others find difficult to tolerate. Because they avoid relationships, their sexual lives may exist only in fantasy. Although they do not find pleasure in activities, they may become peripherally involved in health fads, philosophical movements, religious cults, and the metaphysical.

Incidence and Prevalence: In the US, 10% to 15% of the adult population are thought to have a personality disorder (Bienenfeld). The prevalence of schizoid personality disorder has been reported to be about 3.1-4.9%, but it is not clearly established.

Source: Medical Disability Advisor



Causation and Known Risk Factors

This disorder is somewhat more common in men than in women (Bienenfeld).

Source: Medical Disability Advisor



Diagnosis

History: The psychiatric interview and mental status exam are the primary diagnostic methods used by the practitioner. In a clinical interview, individuals may appear uneasy, with poor eye contact, and may be anxious to end the interview. Both Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) and DSM-5 criteria for this disorder specify a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of situations as indicated by the presence of at least 4 of the following patterns of behavior. The individual neither desires nor enjoys close relationships, including being part of a family. The individual almost always chooses solitary activities. He or she has little, if any, interest in having sexual experiences with another person and takes pleasure in few, if any, activities. The individual lacks close friends or confidants other than first-degree relatives. He or she appears indifferent to the praise or criticism of others, or shows emotional coldness, detachment, or unresponsiveness (flattened affect).

For the diagnosis to be confirmed, these behaviors cannot occur exclusively during the course of schizophrenia, a mood disorder (DSM-IV-TR) (a bipolar disorder or depressive disorder with psychotic features (DSM-5)), another psychotic disorder (DSM-5), or a pervasive developmental disorder (DSM-IV-TR) (autism spectrum disorder (DSM-5)), and the behavior cannot be due to the direct physiological effects of a general medical condition (DSM-IV-TR) (physiological effects of another medical condition (DSM-5)).

Physical exam: An exam is not helpful in diagnosing this disorder. Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech may assist in diagnosing this illness.

Tests: Psychological testing, such as the Minnesota Multiphasic Personality Inventory (MMPI or MMPI-2) may be helpful in differentiating this disorder from other personality disorders.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor



Treatment

Individual and group psychotherapy are used to treat schizoid personality disorder, with a treatment approach similar to that used in paranoid personality disorder. One of the more important goals of therapy is to make the individual comfortable in a social setting, either one-on-one with the therapist or in a group setting. Other goals are to improve coping skills, social interaction, communication, and self-esteem. After initial silence, the individual may gradually begin to participate in the group process. It is important for the group leader to protect the individual from criticism for not participating verbally in the group. Although the group leader needs to communicate concern and caring, the individual's privacy also needs to be respected. Encouraging these individuals to maintain their usual daily routines may help provide a sense of structure, reassuring them that their world will not fall apart if they begin to change. Medications are not generally useful, except as temporary aids in cases of extraordinary anxiety, but small doses of antipsychotics, antidepressants, and psychostimulants have been effective in some individuals who have an associated mental disorder.

Source: Medical Disability Advisor



Prognosis

Many individuals with schizoid personality disorder can contribute to society in a limited way, usually in the context of a restricted, well-defined environment. Progression to schizophrenia may occur, usually in the second or third decade.

Source: Medical Disability Advisor



Complications

Experiencing lifestyle changes in social settings, living arrangements, or the work environment can create additional stress that can complicate schizoid personality disorder.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations should be individually determined, based on the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of the restrictions/accommodations is to help maintain the worker's capacity to remain at the workplace without a work disruption or to promote timely and safe transition back to full work productivity.

Risk: Individuals with schizoid personality disorder may be best suited to performing familiar, structured, and predictable job tasks in a restricted environment. The potential for criticism from managers and interaction with coworkers may need to be minimized.

Capacity: Capacity is typically unaffected by this disorder. Once the individual is successfully engaged in his or her familiar role at work, no impairment of productivity is anticipated.

Tolerance: Tolerance is usually not a concern with this diagnosis. In many cases, involvement with activities in a structured, protected work environment is beneficial.

Source: Medical Disability Advisor



Maximum Medical Improvement

MMI is expected at 12 months of treatment or less.

Note: MMI is estimated under the assumption that the vagaries involved in psychiatric diagnoses have been taken into consideration.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual's behavior fit the criteria for schizoid personality disorder?
  • Has diagnosis been confirmed?
  • Have other psychiatric disorders or underlying medical conditions been ruled out?

Regarding treatment:

  • Is individual currently participating in psychotherapy?
  • Has trust been established with therapist? If not, what can be done to facilitate this relationship?
  • Has individual been involved in group therapy?
  • Did group therapy provide the individual with a social network and comfortable environment in which to overcome fears of closeness or feelings of isolation?

Regarding prognosis:

  • What is individual's current level of functioning?
  • Has individual learned to communicate thoughts and feelings directly to others?
  • Does individual do well when working by himself/herself?
  • Would accommodations help make the workplace a more appropriate and functional environment for this individual?

Source: Medical Disability Advisor



References

Cited

Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Association, 2013.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Bienenfeld, David. "Personality Disorders." eMedicine. 7 Jan. 2013. Medscape. 10 Jun. 2015 <http://emedicine.medscape.com/article/294307-overview#showall>.

Source: Medical Disability Advisor






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