Schizotypal Personality Disorder

MAYOCLINIC
Overview
People with schizotypal personality disorder are often described as odd or eccentric
and usually have few, if any, close relationships. They generally don't understand
how relationships form or the impact of their behavior on others. They may also
misinterpret others' motivations and behaviors and develop significant distrust of
others. These problems may lead to severe anxiety and a tendency to turn inward in
social situations, as the person with schizotypal personality disorder responds
inappropriately to social cues and holds peculiar beliefs. Schizotypal personality
disorder typically is diagnosed in early adulthood and is likely to endure, though
treatment, such as medications and therapy, can improve symptoms.

Symptoms
Being a loner and lacking close friends outside of the immediate family
Incorrect interpretation of events, such as a feeling that something which is
actually harmless or inoffensive has a direct personal meaning
Peculiar, eccentric or unusual thinking, beliefs or mannerisms
Dressing in peculiar ways, such as appearing unkempt or wearing oddly matched
clothes
Belief in special powers, such as mental telepathy or superstitions
Unusual perceptions, such as sensing an absent person's presence or having
illusions
Persistent and excessive social anxiety
Peculiar style of speech, such as vague or unusual patterns of speaking, or
rambling oddly during conversations
Suspicious or paranoid thoughts and constant doubts about the loyalty of others
Flat emotions or limited or inappropriate emotional responses

Diagnosis
People with schizotypal personality disorder may seek help from their primary care
provider because of other symptoms such as anxiety, depression or angry outbursts
or for treatment of substance abuse. 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.
Diagnosis of schizotypal personality disorder typically is based on:
Thorough interview about your symptoms
Your personal and medical history
Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5), published by the American Psychiatric Association

Treatment
Treatment for schizotypal personality disorder often includes a combination of
medication and one or more types of psychotherapy. Many people can be helped by
work and social activities that are a fit for their personality style. Psychotherapy,
also called talk therapy, may help people with schizotypal personality disorder
begin to trust others by building a trusting relationship with a therapist.

Psychotherapy may include:

Cognitive-behavioral therapy identifying and changing distorted thought
patterns, learning specific social skills, and modifying problem behaviors
Supportive therapy offering encouragement and fostering adaptive skills
Family therapy involving family members, which may help reduce fighting or
emotional distance and improve trust in the home

PSYCHOLOGY TODAY
Schizotypal personality disorder is a psychiatric condition marked by disturbed
thoughts and behavior, unusual beliefs and fears, and difficulty with forming and
maintaining relationships.

Definition
The word personality describes deeply ingrained patterns of behavior and the
manner in which individuals think about themselves and their world. Personality
traits are conspicuous features of behavior and are not necessarily pathological,
although certain ones may encourage social problems. Personality disorders are
enduring, persistent behavior patterns severe enough to cause significant
impairment in functioning as well as internal distress.

Schizotypal personality disorder is a pattern of social and interpersonal difficulties

that includes a sense of discomfort with close relationships, eccentric behavior, and
unusual thoughts and perceptions of reality. Speech may include digressions, odd
use of words or display "magical thinking," such as a belief in clairvoyance and
bizarre fantasies. Patients usually experience distorted thinking, behave strangely,
and avoid intimacy. They typically have few, if any, close friends, and feel nervous
around strangers although they may marry and maintain jobs. The disorder, which
may appear more frequently in males, surfaces by early adulthood and can
exacerbate anxiety and depression.

Symptoms
People with this disorder may be severely disturbed and might appear
schizophrenic. More commonly, however, patient beliefs (aliens, witchcraft,
possessing a "sixth sense") are stranger than their behavior, and may often keep
them isolated from normal relationships. Hallucinations, however, are not a
common symptom. Other symptoms include:

Discomfort in social situations

Odd beliefs, fantasies or preoccupations
Odd behavior or appearance
Odd speech
Difficulty making/keeping friendships
Inappropriate display of feelings
Suspiciousness or paranoia

Treatments
Schizotypal patients rarely initiate treatment for their disorder, tending to seek
relief from depressive problems instead. Some people may be helped by
antipsychotic medications, but therapy is preferable in many situations. Patients
severely afflicted with the disorder may require hospitalization to provide therapy
and improve socialization. Schizotypal personality disorder patients do not often
demonstrate significant progress. Treatment should therefore help patients
establish a satisfying solitary existence.

Psychotherapy
Behavioral modification, a cognitive-behavioral treatment approach, can allow
schizotypal personality disorder patients to remedy some of their bizarre thoughts
and behaviors. Recognizing abnormalities by watching videotapes and meeting with
a therapist to improve speech habits are two effective methods of treatment.
WIKIPEDIA
Schizotypal personality disorder (STPD) or schizotypal disorder is a mental
disorder characterized by severe social anxiety, thought disorder,
paranoia, hallucination, derealization, transient psychosis and often unconventional
beliefs. People with this disorder feel extreme discomfort with maintaining close
relationships with people, mainly because they think that their peers harbor
negative thoughts towards them, so they avoid forming them. Peculiar speech
mannerisms and odd modes of dress are also symptoms of this disorder. Those with
STPD may react oddly in conversations, not respond or talk to themselves.
They frequently interpret situations as being strange or having unusual meaning for
them; paranormal and superstitious beliefs are common. Such people frequently
seek medical attention for anxiety or depression instead of their personality
disorder. Schizotypal personality disorder occurs in approximately 3% of the
general population and is more common in males. The term "schizotype" was first
coined by Sandor Rado in 1956 as an abbreviation of "schizophrenic phenotype".
STPD is classified as a cluster A personality disorder ("odd or eccentric disorders")
and is considered to be the most impairing disorder in this cluster.

Genetic Causes
Schizotypal personality disorder is widely understood to be a "schizophrenia
spectrum" disorder. Rates of schizotypal personality disorder are much higher in
relatives of individuals with schizophrenia than in the relatives of people with other
mental illnesses or in people without mentally ill relatives. Technically speaking,
schizotypal personality disorder may also be considered an "extended phenotype"
that helps geneticists track the familial or genetic transmission of the genes that are
implicated in schizophrenia. But there is also a genetic connection of STPD to mood
disorders and depression in particular.

Social and Environmental Causes

There is now evidence to suggest that parenting styles, early separation,
trauma/maltreatment history (especially early childhood neglect) can lead to the
development of schizotypal traits. Neglect or abuse, trauma, or family dysfunction
during childhood may increase the risk of developing schizotypal personality
disorder. Over time, children learn to interpret social cues and respond
appropriately but for unknown reasons this process does not work well for people
with this disorder.
Schizotypal personality disorders are characterized by a common attentional
impairment in various degrees that could serve as a marker of biological
susceptibility to STPD.[10] The reason is that an individual who has difficulties taking
in information may find it difficult in complicated social situations where
interpersonal cues and attentive communications are essential for quality
interaction. This might eventually cause the individual to withdraw from most social
interactions, thus leading to asociality.

Comorbidity
Schizotypal personality disorder usually co-occurs with major depressive
disorder, dysthymia, and generalized social phobia. Furthermore, sometimes
schizotypal personality disorder can co-occur with obsessive-compulsive disorder,
and its presence appears to affect treatment outcome adversely. The personality
disorders that co-occur most often with schizotypal personality disorder
are schizoid, paranoid, avoidant, and borderline.

Some persons with schizotypal personality disorders go on to

develop schizophrenia, but most of them do not. Although STPD symptomatology
has been studied longitudinally in a number of community samples, the results
received do not suggest any significant likelihood of the development of
schizophrenia. There are dozens of studies showing that individuals with
schizotypal personality disorder score similar to individuals with schizophrenia on
a very wide range of neuropsychological tests. Cognitive deficits in patients with
schizotypal personality disorder are very similar to, but quantitatively milder than,
those for patients with schizophrenia. A 2004 study, however, reported neurological
evidence that did "not entirely support the model that SPD is simply an attenuated
form of schizophrenia.

Diagnosis
-DSM-5
In the American Psychiatric Association's DSM-5, schizotypal personality disorder is
defined as a "pervasive pattern of social and interpersonal deficits marked by acute
discomfort with, and reduced capacity for, close relationships as well as by cognitive
or perceptual distortions and eccentricities of behavior, beginning by early
adulthood and present in a variety of contexts."

At least five of the following symptoms must be present: ideas of reference, strange
beliefs or magical thinking, abnormal perceptual experiences, strange thinking and
speech, paranoia, inappropriate or constricted affect, strange behavior or
appearance, lack of close friends, and excessive social anxiety that does not abate
and stems from paranoia rather than negative judgments about self. These
symptoms must not occur only during the course of a disorder with similar
symptoms (such as schizophrenia or autism spectrum disorder).

-ICD-10
The World Health Organization's ICD-10 uses the name schizotypal disorder. It is
classified as a clinical disorder associated with schizophrenia, rather than
a personality disorder as in DSM-5.

The ICD definition is: A disorder characterized by eccentric behavior and anomalies
of thinking and affect which resemble those seen in schizophrenia, though no
definite and characteristic schizophrenic anomalies have occurred at any stage.
There is no dominant or typical disturbance, but any of the following may be
present:

Inappropriate or constricted affect (the individual appears cold and aloof);

Behavior or appearance that is odd, eccentric or peculiar;
Poor rapport with others and a tendency to withdraw socially;
Odd beliefs or magical thinking, influencing behavior and inconsistent
with subcultural norms;
Suspiciousness or paranoid ideas;
Obsessive ruminations without inner resistance;
Unusual perceptual experiences including somatosensory (bodily) or other
illusions, depersonalization or derealization;
Vague, circumstantial, metaphorical, over-elaborate or stereotyped thinking,
manifested by odd speech or in other ways, without gross incoherence;
Occasional transient quasi-psychotic episodes with intense illusions, auditory or
other hallucinations and delusion-like ideas, usually occurring without external
provocation.

Subtypes
Theodore Millon proposes two subtypes of schizotypal. Any individual with
schizotypal personality disorder may exhibit either one of the following somewhat
different subtypes (Note that Millon believes it is rare for a personality with one
pure variant, but rather a mixture of one major variant with one or more secondary
variants):
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.
Subtype Description Personality traits
Sense of strangeness
and nonbeing; overtly
drab, sluggish,
A structural exaggeration of the passive-detached inexpressive;
Insipid
pattern. It internally bland,
schizotypal
includes schizoid, depressive, dependent features. barren, indifferent,
and insensitive;
obscured, vague, and
tangential thoughts.
Warily apprehensive,
watchful, suspicious,
guarded, shrinking,
deadens excess
Timorous A structural exaggeration of the active-detached sensitivity; alienated
schizotypal pattern. It includes avoidant, negativistic features. from self and others;
intentionally blocks,
reverses, or
disqualifies own
thoughts.

There are many similarities between the schizotypal and schizoid personalities.
Most notable of the similarities is the inability to initiate or maintain relationships
(both friendly and romantic). The difference between the two seems to be that those
labeled as schizotypal avoid social interaction because of a deep-seated fear of
people. The schizoid individuals simply feel no desire to form relationships, because
they see no point in sharing their time with others.
Both simple schizophrenia and STPD may share negative symptoms like avolition,
impoverished thinking and flat affect. Although they can look very similar, the
severity usually dinstinguishes them. Also, STPD is characterized by a lifelong
pattern without much change whereas simple schizophrenia represents a
deterioration.
Treatment
According to Theodore Millon, the schizotypal is one of the easiest personality
disorders to identify but one of the most difficult to treat with psychotherapy.
Persons with STPD usually consider themselves to be simply eccentric, productive,
or nonconformist. As a rule, they underestimate maladaptiveness of their social
isolation and perceptual distortions. It is not so easy to gain rapport with people
who suffer from STPD due to the fact that increasing familiarity and intimacy
usually increase their level of anxiety and discomfort. In most cases they do not
respond to informality and humor.

Group therapy is recommended for persons with STPD 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, because they will have a lot of difficulties even in
highly structured groups.

PYSCH CENTRAL
Schizotypal personality disorder is characterized by someone who has great
difficulty in establishing and maintaining close relationships with others. A person
with schizotypal personality disorder may have extreme discomfort with such
relationships, and therefore have less of a capacity for them. Someone with this
disorder usually has cognitive or perceptual distortions as well as eccentricities in
their everyday behavior.

Individuals with schizotypal personality disorder often have ideas of reference (e.g.,
they have incorrect interpretations of casual incidents and external events as having
a particular and unusual meaning specifically for the person). People with this
disorder may be unusually superstitious or preoccupied with paranormal
phenomena that are outside the norms of their subculture.

Individuals with schizotypal personality disorder often seek treatment for the
associated symptoms of anxiety, depression, or other dysphoric effects rather than
for the personality disorder features per se. A personality disorder is an enduring
pattern of inner experience and behavior that deviates from the norm of the
individuals culture. The pattern is seen in two or more of the following areas:
cognition; affect; interpersonal functioning; or impulse control. The enduring
pattern is inflexible and pervasive across a broad range of personal and social
situations. It typically leads to significant distress or impairment in social, work, or
other areas of functioning. The pattern is stable and of long duration, and its onset
can be traced back to early adulthood or adolescence.

Symptoms
Schizotypal personality disorder is characterized by a pattern of social and
interpersonal deficits marked by acute discomfort with, and reduced capacity for,
close relationships. The disorder is also characterized by cognitive or perceptual
distortions and eccentricities of behavior. These begin by early adulthood and
present in a variety of contexts, as indicated by five (or more) of the following:

Ideas of reference (excluding delusions of reference)

Odd beliefs or magical thinking that influences behavior and is inconsistent with
subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or
sixth sense; in children and adolescents, bizarre fantasies or preoccupations)
Unusual perceptual experiences, including bodily illusions
Odd thinking and speech (e.g., vague, circumstantial,
metaphorical, overelaborate, or stereotyped)
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behavior or appearance that is odd, eccentric, or peculiar
Lack of close friends or confidants other than first-degree relatives
Excessive social anxiety that does not diminish with familiarity and tends to be
associated with paranoid fears rather than negative judgments about self

Because personality disorders describe long-standing and enduring patterns of

behavior, they are most often diagnosed in adulthood. It is uncommon for them to
be diagnosed in childhood or adolescence, because a child or teen is under constant
development, personality changes, and maturation. However, if it is diagnosed in a
child or teen, the features must have been present for at least 1 year.

Diagnosis
Personality disorders such as schizotypal personality disorder are typically
diagnosed by a trained mental health professional, such as a psychologist or
psychiatrist. Family physicians and general practitioners are generally not trained
or well-equipped to make this type of psychological diagnosis. So while you can
initially consult a family physician about this problem, they should refer you to a
mental health professional for diagnosis and treatment. There are no laboratory,
blood, or genetic tests that are used to diagnose schizotypal personality disorder.
Many people with schizotypal personality disorder dont seek out treatment. People
with personality disorders, in general, do not often seek out treatment until the
disorder starts to significantly interfere or otherwise impact a persons life. This
most often happens when a persons coping resources are stretched too thin to deal
with stress or other life events.

A diagnosis for schizotypal personality disorder is made by a mental health

professional comparing your symptoms and life history with those listed here. They
will make a determination as to whether your symptoms meet the criteria necessary
for a personality disorder diagnosis.

Causes
Researchers today dont know what causes schizotypal personality disorder. There
are many theories, however, about the possible causes of schizotypal personality
disorder. Most professionals subscribe to a biopsychosocial model of causation
that is, the causes are likely due to biological and genetic factors, social factors (such
as how a person interacts in their early development with their family and friends
and other children), and psychological factors (the individuals personality and
temperament, shaped by their environment and learned coping skills to deal with
stress). This suggests that no single factor is responsible rather, it is the complex
and likely intertwined nature of all three factors that are important. If a person has
this personality disorder, research suggests that there is a slightly increased risk for
this disorder to be passed down to their children.

MEDICINE.NET

Schizotypal personality disorder is a personality disorder as well as

a schizophrenia spectrum disorder that is characterized by a pattern of odd,
eccentric feelings, behaviors, perceptions, and relating to others that markedly
interferes with the person's ability to function.
 Like most other mental disorders, schizotypal personality disorder is understood
to be the result of a combination of biological predispositions, thought processes,
and social problems.
There is no specific test, like an X-ray, that can correctly determine that someone
has schizotypal personality disorder. To assess the presence of schizotypal
personality disorder, health-care providers perform a mental-health evaluation
that looks for the history and presence of the symptoms, also called diagnostic
criteria. The presence of any medical problem that could be part of the symptoms
will be explored.
Both psychodynamic and cognitive behavioral forms of psychotherapy have been
found to be helpful for the sufferer in managing some of the symptoms of
schizotypal personality disorder.
Medications may be appropriate to alleviate some of the mental-health
symptoms that can accompany this illness.
Without treatment, individuals with schizotypal personality disorder are at risk
for having trouble with work and relationships.
Societal interventions like preventing child abuse and substance abuse in
families can help decrease the occurrence of a number of very different mental-
health problems, including schizotypal personality disorder.

Overview
Schizotypal personality disorder is a mental disorder that belongs to the group of
mental illnesses called personality disorders. Therefore, like other personality
disorders, it is characterized by a consistent pattern of thinking, feeling, and
interacting with others and with the world that tends to cause significant problems
for the sufferer. Specifically, schizotypal personality disorder tends to be associated
with a pattern of odd, eccentric feelings, perceptions, behaviors, and relating to
other people that interferes with the individual's ability to function.

Individuals with this illness have a tendency to be loners and suffer from discomfort
in social situations. They may also be paranoid, although their level of
suspiciousness might not rise to the level of being completely out of touch with
reality (delusional). As with other personality disorders, the person with schizotypal
personality disorder is usually an adolescent or adult before they can be assessed as
meeting the full symptom criteria for the diagnosis of this illness.

Schizotypal personality disorder tends to occur in about 3% of adults, more often in

males than in females. It is thought to be part of a continuum of illnesses related
to schizophrenia, so it is dually grouped with other personality disorders and
with schizophrenia spectrum and other psychotic disorders.

Causes and Risk Factors

Although there is no specific cause for schizotypal personality disorder, like most
other mental disorders, it is understood to be the result of a combination of
biological vulnerabilities, ways of thinking, and social stressors (biopsychosocial
model). Biologically, individuals with schizotypal personality disorder are thought
to have less brain matter in certain areas and abnormalities of the
neurotransmitter dopamine in the brain, with some similarities to the brain
abnormalities found in individuals with schizophrenia.

Having a family history of mental illness is a risk factor for developing schizotypal
personality disorder. People who have a close relative with schizotypal symptoms
(schizotypy) can be as much as 50% more likely to develop schizotypy compared to
people without that family history. If a person has a close relative with
schizophrenia, they are also more likely to develop schizotypal personality disorder
and to have symptoms of similar severity to their schizophrenic relative.
People who were born to a mother who smoked during pregnancy, had a lower
birth weight, and had a smaller head circumference at the age of 12 months seem to
develop symptoms of schizotypal personality disorder at higher rates than people of
normal birth weight and head circumference at 1 year of age. Medical conditions
like epilepsy can be a predisposing factor to developing schizotypy as an adult.

Social risk factors for developing the suspiciousness and unusual perceptive
symptoms of schizotypal personality disorder include birth during the winter or
summer, higher birth order, being the victim of childhood physical or sexual abuse,
or having a lower family socioeconomic status during childhood. Having parents
who have difficult communication or a parent who tends to engage in magical
thinking, like purporting to know what their children are thinking or doing, are
other risk factors for children growing up to develop schizotypal personality
disorder. Children who use marijuana for the first time before 14 years of age or
have been prematurely placed in the role of an adult can be predisposed to
developing this illness as well.

Symptoms
Signs and symptoms associated with schizotypal personality disorder can include
the following:
 Ideas of reference (like feeling strangers are noticing or somehow
communicating with oneself)
Odd beliefs or magical thinking that influences behavior and is inconsistent with
cultural norms (like superstitiousness, belief in clairvoyance, telepathy, or "sixth
sense"; in children and adolescents it may involve bizarre fantasies or
preoccupations)
Unusual perceptions
Odd thinking and speech (like vague speech, or that which contains excessive
detail, is in metaphors, is overly elaborate, or stereotyped)
Suspiciousness or paranoid thoughts
Inappropriate or constricted ways of expressing emotion (affect)
Behavior or appearance that is odd, eccentric, or strange
Lack of close friends or confidants other than close relatives
Excessive social anxiety that does not decrease with familiarity and tends to be
associated with paranoid fears rather than negative thoughts about oneself

Diagnosis
There is no specific definitive test, like a blood test, that can accurately assess that a
person has schizotypal personality disorder. People who are concerned that they
may suffer from this diagnosis might explore the possibility by taking a self-test,
either an online or printable test, like the Schizotypal Personality Questionnaire, the
Structured Interview for Schizotypy, the Oxford-Liverpool Inventory of Feelings and
Experiences (O-LIFE), the Rust Inventory of Schizotypal Cognitions, the Community
Assessment of Psychic Experiences, or the Schizotypal Personality Scale.

To determine the presence of schizotypal personality disorder, health-care

professionals conduct a mental-health interview that looks for the history and
presence of the symptoms, also called diagnostic criteria, previously described. As
with any mental-health assessment, the health-care professional will usually work
toward ruling out other mental disorders, including screening for mood problems
like depression and anxietydisorders, including anxiety attacks or generalized
anxiety, types of other personality disorders like narcissistic personality
disorder, antisocial personality disorder, schizoid personality disorder or histrionic
personality disorder, drug-abuse problems as well as problems of being out of touch
with reality, like schizophrenia or delusional disorder. Besides determining if the
person suffers from schizotypal personality disorder, the mental-health professional
may determine that while some symptoms (traits) of the disorder are present, the
person does not fully qualify for the diagnosis. Since schizotypal personality
disorder has most often been found to co-occur (termed being co-morbid)
with borderline personality disorder, avoidant personality disorder, and paranoid
personality disorder, the presence of those disorders will most likely be specifically
explored as well.

The health-care professional will also likely try to ensure that the individual is not
suffering from a medical problem that may cause emotional symptoms that mimic
those of schizotypal personality disorder. The health-care professional will
therefore often inquire about when the person has most recently had a physical
examination, comprehensive blood testing, and any other tests that a medical
professional deems necessary to ensure that the individual is not suffering from a
medical condition instead of or in addition to their emotional symptoms. Due to the
use of a mental-health interview in making the diagnosis and the fact that this
condition, like any personality disorder, can be quite resistant to treatment, it is of
great importance that the health-care professional knows to conduct a thorough
assessment. This is to assure that the person is not incorrectly assessed as having
schizotypal personality disorder when he or she does not.

In determining the presence of schizotypal personality disorder, the evaluator will

likely explore whether the person's symptoms indicate the presence of a pervasive
pattern of social and interpersonal deficits marked by acute discomfort with, and
reduced capacity for, close relationships as well as by cognitive or perceptual
distortions and eccentricities of behavior, beginning by early adulthood and present
in a variety of contexts as indicated by five or more of the aforementioned
symptoms and signs (diagnostic criteria). The diagnosis is not to be assigned if it
only occurs during the course of having schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, another psychotic disorder, or
an autism spectrum disorder.

Treatment
Given the difficulties associated with schizotypal personality disorder, home
remedies are not generally entertained as viable options for treating schizotypal
personality disorder. Both psychodynamic and cognitive behavioral forms of talk
therapy (psychotherapy) have been found to be useful in helping the sufferer
manage some of the symptoms of schizotypal personality disorder. Cognitive
behavioral therapy, or CBT, is a form of psychotherapy that focuses on helping the
person understand how their thoughts and behaviors affect each other.
Psychodynamic psychotherapy, which is also called psychoanalytic therapy, seeks to
help the individual understand and better manage his or her ways of defending
against negative emotions.
CHECKLIST