Asociality

In schizophrenia, asociality is one of the main 5 "negative symptoms", the others being avolition, anhedonia, reduced affect and alogia. Due to a lack of desire to form relationships, social withdrawal is common in people with schizophrenia.[27][28][29] People with schizophrenia may experience social deficits or dysfunction as a result of the disorder, leading to asocial behavior. Frequent or ongoing delusions and hallucinations can deteriorate relationships and other social ties, isolating individuals with schizophrenia from reality and in some cases leading to homelessness. Even when treated with medication for the disorder, they may be unable to engage in social behaviors such as maintaining conversations, accurately perceiving emotions in others, or functioning in crowded settings. There has been extensive research on the effective use of social skills training for the treatment of schizophrenia, in outpatient clinics as well as inpatient units. Social skills training (SST) can be used to help patients with schizophrenia make better eye contact with other people, increase assertiveness, and improve their general conversational skills.[30]

Asociality is common amongst people with avoidant personality disorder (AvPD). They experience discomfort and feel inhibited in social situations, being overwhelmed by feelings of inadequacy. Such people remain consistently fearful of social rejection, choosing to avoid social engagements as they do not want to give people the opportunity to reject (or possibly, accept) them. Though they inherently crave a sense of belonging, their fear of criticism and rejection leads people with AvPD to actively avoid occasions that require social interaction, leading to extremely asocial tendencies; as a result, these individuals often have difficulty cultivating and preserving close relationships.[31]

People with AvPD may also display social phobia, the difference being that social phobia is the fear of social circumstances whereas AvPD is better described as an aversion to intimacy in relationships.[32]

Schizoid personality disorder (SzPD) is characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy. Affected individuals may simultaneously demonstrate a rich and elaborate but exclusively internal fantasy world.[33]

It is not the same as schizophrenia, although they share such similar characteristics as detachment and blunted affect. There is, moreover, increased prevalence of the disorder in families with schizophrenia.[34]

Schizotypal personality disorder is characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and often unconventional beliefs. People with this disorder feel extreme discomfort with maintaining close relationships with people, and therefore they often do not. People who have this disorder may display peculiar manners of talking and dressing and often have difficulty in forming relationships. In some cases, they may react oddly in conversations, not respond, or talk to themselves.[35]

Asociality has been observed in individuals who have been diagnosed with autism spectrum disorder (ASD).[22]

Those with ASD may display profoundly asocial tendencies, due to difficulties with socialization and interpersonal relationships. Other causes for asocial behavior include limited social expressiveness and low sensitivity to social cues, emotions, and pragmatic use of language. One suggestion is that individuals with autism lack the mirror neurons that allow neurotypical individuals to mimic the behavior of others.[36]

Asocial tendencies become acutely noticeable in children with ASD from a young age due to deficits in crucial social development skills. These skills include social and emotional reciprocity, eye-to-eye gaze, gestures, normal facial expressions and body posture, and sharing enjoyment and interests with others.

Some children with ASD want to be social, but fail to socialize successfully, which can lead to later withdrawal and asocial behavior, particularly in adolescence.[22]

Asociality can be observed in individuals with major depressive disorder or dysthymia, as individuals lose interest in everyday activities and hobbies they used to enjoy, this may include social activities, resulting in social withdrawal and withdrawal tendencies.[37]

Social skills training can be adapted to the treatment of depression with a focus on assertiveness training. Depressed patients often benefit from learning to set limits with others, to obtain satisfaction for their own needs, and to feel more self-confident in social interactions. Research suggests that patients who are depressed because they tend to withdraw from others can benefit from social skills training by learning to increase positive social interactions with others instead of withdrawing from social interactions.[38]

Asocial behavior is observed in people with social anxiety disorder (SAD), who experience perpetual and irrational fears of humiliating themselves in social situations. They often have panic attacks and severe anxiety as a result, which can occasionally lead to agoraphobia. The disorder is common in children and young adults, diagnosed on average around 13 years of age. If left untreated, people with SAD exhibit asocial behavior into adulthood, avoiding social interactions and career choices that require interpersonal skills. Social skills training can help people with social phobia or shyness to improve their communication and social skills so that they will be able to mingle with others or go to job interviews with greater ease and self-confidence.

Traumatic brain injuries (TBI) can also lead to asociality and social withdrawal.[39]

Social skills training (SST) is an effective technique aimed towards anyone with "difficulty relating to others," a common symptom of shyness, marital and family conflicts, or developmental disabilities; as well as of many mental and neurological disorders including adjustment disorders, anxiety disorders, attention-deficit/hyperactivity disorder, social phobia, alcohol dependence, depression, bipolar disorder, schizophrenia, avoidant personality disorder, paranoid personality disorder, obsessive-compulsive disorder, and schizotypal personality disorder.

Fortunately for people who display difficulty relating to others, social skills can be learned, as they are not simply inherent to an individual's personality or disposition. Therefore, there is hope for anyone who wishes to improve their social skills, including those with psychosocial or neurological disorders. Nonetheless, it is important to note that asociality may still be considered neither a character flaw nor an inherently negative trait.

SST includes improving eye contact, speech duration, frequency of requests, and the use of gestures, as well as decreasing automatic compliance to the requests of others. SST has been shown to improve levels of assertiveness (positive and negative) in both men and women.

Additionally, SST can focus on receiving skills (e.g. accurately perceiving problem situations), processing skills (e.g. considering several response alternatives), and sending skills (delivering appropriate verbal and non-verbal responses).[40]

Metacognitive interpersonal therapy is a method of treating and improving the social skills of people with personality disorders that are associated with asociality. Through metacognitive interpersonal therapy, clinicians seek to improve their patients' metacognition, meaning the ability to recognize and read the mental states of themselves. The therapy differs from SST in that the patient is trained to identify their own thoughts and feelings as a means of recognizing similar emotions in others. Metacognitive interpersonal therapy has been shown to improve interpersonal and decision-making skills by encouraging awareness of suppressed inner states, which enables patients to better relate to other people in social environments.

The therapy is often used to treat patients with two or more co-occurring personality disorders, commonly including obsessive-compulsive and avoidant behaviors.[41]

In order to cope with asocial behavior, many individuals, especially those with avoidant personality disorder, develop an inner world of fantasy and imagination to entertain themselves when feeling rejected by peers. Asocial people may frequently imagine themselves in situations where they are accepted by others or have succeeded at an activity. Additionally, they may have fantasies relating to memories of early childhood and close family members.[42]