Schizotypal Disorder: Definition, Signs, Symptoms, Causes, Risk Factors, Diagnosis, Treatment and Outlook

It is a mental disorder characterized by severe social anxiety, thought disorder, paranoid ideation, derealization, and transient psychosis.

This disorder also often features unconventional beliefs.

If you have schizotypal personality disorder (STPD), your behavior and gestures may seem strange to others.

While schizotypal personality disorder is on the schizophrenia spectrum , people with schizotypal personality disorder generally do not experience psychosis .

What are the signs and symptoms of schizotypal personality disorder?

People with this disorder feel extreme discomfort to maintain close relationships with people, mainly because they think that their peers harbor negative thoughts towards them, so they avoid close relationships.

Peculiar speech mannerisms and strange dress styles are also symptoms of this disorder. People with schizotypal personality disorder may react strangely in conversations, not respond, or talk to themselves.

They often interpret situations as strange or having an unusual meaning for them; paranormal and superstitious beliefs are common.

Such people often seek medical attention for their anxiety or depression rather than their personality disorder.

The term “schizotype” was first coined by Sandor Rado in 1956 as an abbreviation for “schizophrenic phenotype.” Schizotypal personality disorder is classified as a group A personality disorder (“strange or eccentric disorders”).

Symptoms of schizotypal personality disorder include:

  • Strange thought or behavior.
  • Unusual beliefs.
  • Discomfort in social situations.
  • A lack of emotion or inappropriate emotional responses.
  • Strange speech that can be vague or difficult.
  • A lack of close friends.
  • Extreme social anxiety
  • Paranoia.

People with schizotypal personality disorder tend to lead lonely lives. If you have intense social anxiety, it may be difficult for you to build relationships. You can blame others for your discomfort in social situations.

People with schizotypal personality disorder generally do not have psychotic symptoms. Hallucinations, delusions, and loss of contact with reality are the hallmarks of psychosis.

Delusions are fixed and false beliefs. A reference idea is an incorrect interpretation of accidental incidents and external events that the person believes have a particular and unusual meaning.

This meaning can be in general or for the person experiencing the reference idea.

Causes

Unlike other personality disorders, schizotypal personality disorder appears to exist with a continuum of disorders that are part of the schizophrenia spectrum.

Patients with schizotypal personality disorder share qualities with schizophrenic patients in the cognitive, phenomenological and biological domains, but they do not develop psychosis.

Furthermore, schizotypal personality disorder appears more frequently in relatives of patients with schizophrenia than in relatives of controls.

For example, schizotypal personality disorder occurred significantly more often in high-risk adoptees (those with schizophrenic mothers) compared to low-risk adoptees (from mothers with non-schizophrenic spectrum disorders or without disorder).

Research indicates that schizotypal patients with predominantly negative symptoms may be closer to the schizophrenia spectrum.

Schizotypal patients who have relatives with schizophrenia have been found to show more negative symptoms, such as inadequate communication, strange communication, and social isolation, than schizotypal patients without schizophrenic relatives.

Within a group of schizophrenic patients, negative symptoms in probands were correlated with negative schizotypal symptoms in relatives.

Although positive symptoms were also correlated with corresponding symptoms in relatives, the connection with negative symptoms was statistically more significant.

Adding to the evidence that negative symptoms may be more closely related to the spectrum of schizophrenia.

Cognitively, patients with schizotypal personality disorder have problems in areas such as working memory, verbal learning, and attention.

Deficits have also been demonstrated in the representation of context, episodic memory, and delayed recall. These deficits are often similar, but not as severe, to those seen in schizophrenic patients.

Genetic

Schizotypal Personality Disorder is widely understood as a “schizophrenic spectrum” disorder.

Rates of schizotypal personality disorder are much higher in family members of people with schizophrenia than in family members of people with other mental illnesses or in people without family members who are mentally ill.

Technically speaking, schizotypal personality disorder can also be considered an “extended phenotype” that helps geneticists track the genetic or family transmission of genes that are involved in schizophrenia.

But there is also a genetic connection of schizotypal personality disorder with mood disorders and depression in particular.

Social and environmental

There is now evidence to suggest that parenting styles, early separation, history of trauma / abuse (especially neglect in early childhood) can lead to the development of schizotypal traits.

Childhood neglect or abuse, trauma, or family dysfunction can increase the risk of developing schizotypal personality disorder.

Schizotypal personality disorders are characterized by common attentional impairment in various degrees that could serve as a marker of biological susceptibility to schizotypal personality disorder.

The reason is that an individual who has difficulty assimilating information may find it difficult in complicated social situations where interpersonal cues and thoughtful communications are essential for quality interaction.

This can eventually cause the individual to withdraw from most social interactions, leading to asociality.

Which are the risk factors?

Schizotypal Personality Disorder tends to run in families. You may be at risk if you have a relative with:

  • Schizophrenia.
  • schizotypal personality disorder.
  • Another personality disorder.

Environmental factors, especially childhood experiences, may play a role in the development of this disorder. These factors include:

  • Abuse.
  • Negligence.
  • Trauma.
  • Stress.
  • Having an emotionally detached parent.

Comorbidity

Schizotypal personality disorder usually coincides with major depressive disorder, dysthymia, and generalized social phobia.

Furthermore, schizotypal personality disorder can sometimes coincide with obsessive-compulsive disorder, and its presence appears to adversely affect the outcome of treatment.

The personality disorders that occur most frequently with schizotypal personality disorder are schizoid, paranoid, avoidant, and borderline.

Some people with schizotypal personality disorders develop schizophrenia, but most do not.

Although the symptomatology of schizotypal personality disorder has been studied longitudinally in various community samples, the results received do not suggest a significant probability of the development of schizophrenia.

There are dozens of studies showing that people with schizotypal personality disorder score similar to people with schizophrenia on a wide range of neuropsychological tests.

Cognitive deficits in patients with schizotypal personality disorder are very similar to those in patients with schizophrenia, but more slightly quantitative.

A 2004 study, however, reported neurological evidence that “did not fully support the model that schizotypal personality disorder is simply an attenuated form of schizophrenia.”

In the case of methamphetamine use, people with schizotypal personality disorders are at great risk of developing permanent psychosis.

When to see a doctor

People with schizotypal personality disorder are likely to seek help only at the urging of friends or relatives.

If you suspect that a friend or family member may have the disorder, you can suggest that the person seek medical attention, starting with a primary care physician or mental health provider.

People with schizotypal personality disorder may seek help from their primary care provider for other symptoms such as anxiety, depression, or outbursts of anger or from substance abuse treatment.

Getting ready for your date

You will likely start by seeing your primary care physician.

Bring a family member or friend, if possible. With your permission, someone who has known you for a long time may be able to answer questions or share information with your doctor that you don’t think you should mention.

Here is information to help you prepare for your appointment. Before your appointment, make a list of:

Any symptoms that you or your family noticed, and for how long. Key personal information, including traumatic events in your past and top current stressors.

Diagnosis

Most people with schizotypal personality disorder are diagnosed in early adulthood.

If your doctor suspects you have it, they will start by doing a physical exam to check for physical conditions that could be causing your symptoms.

They will also ask about your symptoms and if other family members have personality disorders.

Your doctor can refer you to a psychiatrist or psychologist for a psychiatric evaluation. You will likely be asked about:

  • When your symptoms started.
  • How your symptoms affect your daily life.
  • How you feel in social situations.
  • Your experiences at school and work.
  • Your childhood.

The psychiatrist or psychologist may ask if you have ever thought about harming yourself or others. They can also ask if your family members have commented on your behavior. Your answers will help them develop a diagnosis.

After a physical exam to help rule out other medical conditions, your primary care provider may refer you to a mental health provider for further evaluation.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

In the DSM-5 of the American Psychiatric Association, schizotypal personality disorder is defined as a “generalized pattern of social and interpersonal deficits marked by acute discomfort and reduced capacity for close relationships.

As well as cognitive or perceptual distortions and behavioral eccentricities, beginning in early adulthood and present in a variety of contexts. ‘

At least five of the following symptoms must be present:

Reference ideas, strange beliefs or magical thinking, abnormal perceptual experiences, strange thinking and language, paranoia, inappropriate or restricted affect, strange behavior or appearance.

Lack of close friends and excessive social participation anxiety that does not diminish and stems from paranoia rather than negative self-judgments.

These symptoms should not occur only during the course of a disorder with similar symptoms (such as schizophrenia or autism spectrum disorder).

International Classification of Diseases, Tenth Revision (ICD-10)

The World Health Organization International Classification of Diseases, Tenth Revision (ICD-10) uses the name schizotypal disorder (F21).

It is classified as a clinical disorder associated with schizophrenia, rather than a personality disorder as in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

The definition of the International Statistical Classification of Diseases and Related Health Problems is:

A disorder characterized by eccentric behavior and abnormalities of thinking and affect that resemble those seen in schizophrenia, although no definite and characteristic schizophrenic abnormalities have occurred at any stage.

There is no dominant or typical alteration, but any of the following may be present:

Inappropriate or restrained affect (individual appears cold and distant), behavior or appearance that is strange, eccentric, or quirky, poor relationship with others, and a tendency to withdraw socially.

Weird beliefs or magical thinking, which influence behavior and are inconsistent with subcultural norms, suspiciousness or paranoid ideas, obsessive reflections without internal resistance.

Unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization, vague, circumstantial, metaphorical, overly elaborate or stereotyped thinking, manifested by strange speeches or in other ways, without gross inconsistencies.

Occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and illusion-like ideas, generally occurring without external provocation.

The disorder has a chronic course with fluctuations in intensity. Occasionally evolves into overt schizophrenia. There is no definitive beginning and its evolution and course are generally those of a personality disorder.

Diagnostic guidelines

This diagnostic rubric is not recommended for general use because it is not clearly demarcated from either simple schizophrenia or schizoid or paranoid personality disorders, or possibly autism and Asperger’s syndrome as currently diagnosed.

If the term is used, three or four of the typical characteristics listed above should have been present, continuously or episodically, for at least 2 years.

The individual must never have met the criteria for schizophrenia itself. A history of schizophrenia in a first-degree relative adds additional weight to the diagnosis, but is not a prerequisite. It includes:

  • Borderline schizophrenia.
  • Latent schizophrenia.
  • Latent schizophrenic reactions.
  • Prepsychotic schizophrenia.
  • Prodromal schizophrenia.
  • Pseudoneurotic schizophrenia.
  • Pseudopsychopathic schizophrenia.
  • Schizotypal Personality Disorder.

Excludes:

  • Schizoid personality Disorder.
  • Asperger syndrome.

Subtypes

Theodore Millon proposes two subtypes of schizotypal.

Anyone with schizotypal personality disorder can exhibit any of the following somewhat different subtypes.

Note that Millon believes that it is rare for a personality with a pure variant, but rather a mix of a primary variant with one or more secondary variants:

Subtype

Tasteless schizotypal.

Description

A structural exaggeration of the passive separation pattern. It includes schizoid, depressive and dependent characteristics.

Personality traits

Sense of strangeness and not being; openly monotonous, slow, expressionless; internally bland, sterile, indifferent and insensitive; obscured, vague and tangential thoughts.

Subtype

Thymus schizophilia.

Description

A structural exaggeration of the active separation pattern. It includes avoidance and negative functions.

Personality traits

Cautiously apprehensive, vigilant, suspicious, wary, shrinking, muffles excess sensitivity; alienated from oneself and others; Intentionally block, reverse, or disqualify your own thoughts.

Differential diagnosis

There is a high rate of comorbidity with other personality disorders.

McGlashan et al. (2000) stated that this may be due to overlapping criteria with other personality disorders, such as avoidant personality disorder, paranoid personality disorder, and borderline personality disorder.

There are many similarities between schizotypal and schizoid personalities. Most notable of the similarities is the inability to initiate or maintain relationships (friendly and romantic).

The difference between the two seems to be that those labeled schizotypal avoid social interaction due to a deep fear of people. Schizoid individuals simply do not feel the desire to form relationships, because there is no point in sharing their time with others.

Both simple schizophrenia and schizotypal personality disorder can share negative symptoms such as apathy, poor thinking, and flat affect.

Although they may seem very similar, the severity usually discourages them. Furthermore, schizotypal personality disorder is characterized by a lifelong pattern without much change while simple schizophrenia represents a decline.

Treatment

If your doctor diagnoses you with schizotypal personality disorder, your doctor may prescribe medication or therapy to treat it.

Medication

Schizotypal personality disorder is rarely considered as the main reason for treatment in a clinical setting, but it often occurs as a finding comorbid with other mental disorders.

There are no medications designed to treat schizotypal personality disorder specifically. However, some people with this condition benefit from taking medications.

When patients with schizotypal personality disorder are prescribed pharmaceuticals, more often they are prescribed the same medications that are used to treat patients with schizophrenia.

Including traditional neuroleptics such as haloperidol and thiothixene. In deciding what type of medicine to use, Paul Markovitz distinguishes two basic groups of schizotypal patients:

Schizotypal patients who appear to be almost schizophrenic in their beliefs and behaviors (aberrant perceptions and cognitions) are generally treated with low doses of antipsychotic medications, for example. thiothixene.

However, it should be mentioned that the long-term efficacy of neuroleptics is doubtful.

For schizotypal patients who are more obsessive-compulsive in their beliefs and behaviors, selective serotonin reuptake inhibitors (SSRIs) such as Sertraline appear to be more effective.

Lamotrigine, an anticonvulsant, appears to be helpful in treating social isolation.

Therapy

Several types of therapy can help treat schizotypal personality disorder. People with schizotypal personality disorder generally consider themselves simply eccentric, productive, or nonconforming.

As a rule, they underestimate the maladjustment of their social isolation and perceptual distortions.

It is not so easy to relate to people suffering from schizotypal personality disorder due to the fact that increased familiarity and intimacy generally increase their level of anxiety and discomfort. In most cases, they do not respond to informality and humor.

Psychotherapy or talk therapy can help you learn to build relationships. You can get this type of therapy along with social skills training to help you feel more comfortable in social situations.

Group therapy is recommended for people with schizotypal personality disorder only if the group is well structured and supportive. Otherwise it could lead to loose and tangential ideation.

Support is especially important for schizotypal patients with predominant paranoid symptoms, as they will have a lot of difficulty even in highly structured groups.

Family therapy can be helpful, especially if you live with other people. It can help you strengthen your relationships with your family members. It can also help you feel more supported by your family.

Cognitive behavioral therapy can help you address some of the behaviors associated with your condition. Your therapist can help you learn how to act in social situations and respond to social cues.

They can also help you learn to recognize unusual or harmful thoughts and change them.

Coping and support

Symptoms of conditions such as Schizotypal Personality Disorder can improve over time through experiences that help foster, among other positive traits, self-confidence, a belief in one’s ability to overcome difficulties, and a sense of of social support.

The factors that seem to be more likely to reduce the symptoms of this disorder include:

Positive relationships with friends and family. A sense of accomplishment in school, work, and in extracurricular activities.

epidemiology

The reported prevalence of schizotypal personality disorder in community studies ranges from 0.6% in a Norwegian sample to 4.6% in an American sample.

A large American study found a lifetime prevalence of 3.9%, with somewhat higher rates among men (4.2%) than among women (3.7%). It may be uncommon in clinical populations, with reported rates of 0% to 1.9%.

Along with other group A personality disorders, it is also very common among the homeless.

A University of Colorado Colorado Springs study comparing personality disorders and Myers-Briggs Type Indicator types found that the disorder had a significant correlation with Introverted (I), Intuitive (I), Thoughtful (P) preferences. and Perceptual (P).

What is the long-term outlook?

It usually requires lifelong treatment. Your specific outlook will depend on the severity of your symptoms. If you can get treatment early, you can be more successful.

Talk to your doctor if you suspect that you are experiencing depression or other mental disorders.