Schizotypal Personality Disorder

Schizotypal Personality Disorder

Schizotypal Personality Disorder

Schizotypal personality disorder (STPD) is characterized by extreme social anxiety, disorderly thoughts, paranoia, odd or eccentric behaviors, unusual beliefs, and episodes of psychosis — such as hallucinations.

People with schizotypal personality disorder find it hard to form close relationships and they think or believe unusual things and behave in unusual ways. They can misinterpret people’s social cues and behavior, leading to a general mistrust of everyone.

Prevalence

STPD affects approximately 3% of the general population and is slightly more common in males than in females. STPD begins in early adulthood.

Schizotypal Personality Disorder vs Schizophrenia

The difference between schizotypal personality disorder and schizophrenia is that people with STPD know the difference between reality and their delusions whereas those with schizophrenia cannot. Also, those with STPD experience shorter, less intense, fewer episodes of psychosis.

Symptoms of Schizotypal Personality Disorder:

People with SPD:

  • Often are hyper focused on paranormal phenomena (which are accepted in certain cultures as normal, but those with STD have stranger beliefs) and believe they have special powers such as:

    • Mental telepathy and ability to read others’ thoughts
    • The capacity to communicate with spirits via a medium
    • A supernatural ability to perceive events in the future
    • Beyond normal sensory contact, such as clairvoyance
    • The ability to make things happen through magical rituals, such as walking around a bed three times
  • Either avoid developing close relationships with people or experience extreme discomfort maintaining close relationships due to beliefs that others have negative thoughts about them
  • Tend to be withdrawn, cold, aloof, and lead isolated lives
  • Have peculiar, vague, but not incoherent speech mannerisms; react oddly in conversations; dress in strange ways
  • Display “flat” emotions, react inappropriately, or are completely unresponsive
  • Can often be found talking and muttering to themselves
  • Read into everything as if it’s being directed at them or means something unusual
  • Episodes when they hallucinate, “sense” someone’s presence is nearby, or “hears” voices, especially in response to stress
  • Extreme and ongoing social anxiety
  • Suspicious of everyone and constantly having obsessive, paranoid thoughts

Teens beginning to develop STPD will show signs of odd behavior and appear unmotivated, prefer solitary tasks, and have social anxiety. They are often bullied.

Diagnosis of Schizotypal Personality Disorder:

A diagnosis of schizotypal disorder is only given once other medical conditions or illnesses, and other mental health possibilities, are ruled out. Family observation can also help with the diagnosis.

DSM-5 says schizotypal disorder is:

  1. 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 following:
    1. Ideas of reference (excluding delusions of reference).
    2. 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).
    3. Unusual perceptual experiences, including bodily illusions.
    4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
    5. Suspiciousness or paranoid ideation.
    6. Inappropriate or constricted affect.
    7. Behavior or appearance that is odd, eccentric, or peculiar.
    8. Lack of close friends or confidants other than first-degree relatives.
    9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
  2. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.

Thirty to 50% of people with STPD will also have major depressive disorder, and many also have a co-occurring personality disorder.

Causes of Schizotypal Personality Disorder:

The exact cause of STPD remains unknown; however, genetic and environmental factors have both been implicated.

  • Genetics – An individual’s risk of developing STPD may be greater if they have a close relative who has schizophrenia or another psychotic disorder.
  • Environmental – There is evidence to suggest that parenting styles, early separation, and trauma or abuse may increase the risk of developing STPD.

STPD often coexists with other conditions such as major depressive disorder, obsessive compulsive disorder, and generalized social phobia.

Schizotypal Personality Disorder complications:

Complications of STPD include:

  • Depression, suicidal behavior
  • Impaired work, social, academic, and relational functioning
  • May develop schizophrenia; however, most do not
  • Additional personality disorders
  • Substance or alcohol abuse
  • Psychotic episodes
  • A risk of developing permanent psychosis if using meth

Treatment for Schizotypal Personality Disorder:

Treatment for STPD often includes a combination of medication and one or more types of talk therapy that focus on improving confidence and providing trustworthy support. Symptoms can lessen over time with the right help.

People with STPD usually don’t seek help for their STPD symptoms but for the coexisting symptoms of depression or anxiety. STPD is difficult to treat due to the increasing anxiety and discomfort during interpersonal communication, familiarity, and informality.

Psychotherapy

  • Cognitive behavioral therapy – helps examine thought processes that have hindered social skills and teaches healthy behavioral responses to triggers.
  • Supportive/group therapy – can help if it follows a strict structure. Stress coping skills are taught, and understanding and encouragement are received.
  • Family therapy – helps clarify communication and build trust. Family members are educated as to how to help lessen the person’s anxiety and support them.
  • Speech therapy – can help one become less vague in communication

Rehabilitation services – provided by the state can help with practical skills such as job skills, job searches, social skills, and work accommodations for the disability.

Self-care – Personality-based activities can increase one’s sense of achievement. Structure to one’s day can also help ease anxiety and improve overall health — regular, healthy meals; exercise, regular therapy sessions, continuing to take prescribed meds, and enough sleep.

Medications for Schizotypal Personality Disorder:

Some medications can help relieve the symptoms of psychosis and anxiety.


  • Anti-psychotics – to lessen the intensity of hallucinations and paranoid thoughts
  • Mood stabilizers – to relieve anxiety
  • Antidepressants – to relieve depression or anxiety

Symptoms of Schizotypal Personality Disorder:

People with SPD:

  • Often are hyper focused on paranormal phenomena (which are accepted in certain cultures as normal, but those with STD have stranger beliefs) and believe they have special powers such as:

    • Mental telepathy and ability to read others’ thoughts
    • The capacity to communicate with spirits via a medium
    • A supernatural ability to perceive events in the future
    • Beyond normal sensory contact, such as clairvoyance
    • The ability to make things happen through magical rituals, such as walking around a bed three times
  • Either avoid developing close relationships with people or experience extreme discomfort maintaining close relationships due to beliefs that others have negative thoughts about them
  • Tend to be withdrawn, cold, aloof, and lead isolated lives
  • Have peculiar, vague, but not incoherent speech mannerisms; react oddly in conversations; dress in strange ways
  • Display “flat” emotions, react inappropriately, or are completely unresponsive
  • Can often be found talking and muttering to themselves
  • Read into everything as if it’s being directed at them or means something unusual
  • Episodes when they hallucinate, “sense” someone’s presence is nearby, or “hears” voices, especially in response to stress
  • Extreme and ongoing social anxiety
  • Suspicious of everyone and constantly having obsessive, paranoid thoughts

Teens beginning to develop STPD will show signs of odd behavior and appear unmotivated, prefer solitary tasks, and have social anxiety. They are often bullied.

Diagnosis of Schizotypal Personality Disorder:

A diagnosis of schizotypal disorder is only given once other medical conditions or illnesses, and other mental health possibilities, are ruled out. Family observation can also help with the diagnosis.

DSM-5 says schizotypal disorder is:

  1. 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 following:
    1. Ideas of reference (excluding delusions of reference).
    2. 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).
    3. Unusual perceptual experiences, including bodily illusions.
    4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
    5. Suspiciousness or paranoid ideation.
    6. Inappropriate or constricted affect.
    7. Behavior or appearance that is odd, eccentric, or peculiar.
    8. Lack of close friends or confidants other than first-degree relatives.
    9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
  2. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.

Thirty to 50% of people with STPD will also have major depressive disorder, and many also have a co-occurring personality disorder.

Causes of Schizotypal Personality Disorder:

The exact cause of STPD remains unknown; however, genetic and environmental factors have both been implicated.

  • Genetics – An individual’s risk of developing STPD may be greater if they have a close relative who has schizophrenia or another psychotic disorder.
  • Environmental – There is evidence to suggest that parenting styles, early separation, and trauma or abuse may increase the risk of developing STPD.

STPD often coexists with other conditions such as major depressive disorder, obsessive compulsive disorder, and generalized social phobia.

Schizotypal Personality Disorder complications:

Complications of STPD include:

  • Depression, suicidal behavior
  • Impaired work, social, academic, and relational functioning
  • May develop schizophrenia; however, most do not
  • Additional personality disorders
  • Substance or alcohol abuse
  • Psychotic episodes
  • A risk of developing permanent psychosis if using meth

Treatment for Schizotypal Personality Disorder:

Treatment for STPD often includes a combination of medication and one or more types of talk therapy that focus on improving confidence and providing trustworthy support. Symptoms can lessen over time with the right help.

People with STPD usually don’t seek help for their STPD symptoms but for the coexisting symptoms of depression or anxiety. STPD is difficult to treat due to the increasing anxiety and discomfort during interpersonal communication, familiarity, and informality.

Psychotherapy

  • Cognitive behavioral therapy – helps examine thought processes that have hindered social skills and teaches healthy behavioral responses to triggers.
  • Supportive/group therapy – can help if it follows a strict structure. Stress coping skills are taught, and understanding and encouragement are received.
  • Family therapy – helps clarify communication and build trust. Family members are educated as to how to help lessen the person’s anxiety and support them.
  • Speech therapy – can help one become less vague in communication

Rehabilitation services – provided by the state can help with practical skills such as job skills, job searches, social skills, and work accommodations for the disability.

Self-care – Personality-based activities can increase one’s sense of achievement. Structure to one’s day can also help ease anxiety and improve overall health — regular, healthy meals; exercise, regular therapy sessions, continuing to take prescribed meds, and enough sleep.

Medications for Schizotypal Personality Disorder:

Some medications can help relieve the symptoms of psychosis and anxiety.


  • Anti-psychotics – to lessen the intensity of hallucinations and paranoid thoughts
  • Mood stabilizers – to relieve anxiety
  • Antidepressants – to relieve depression or anxiety
Sources MAYO CLINIC – Schizotypal Personality Disorder Symptoms & causes | PSYCHOLOGY TODAY – Schizotypal Personality Disorder Symptoms, Causes & Treatment | PSYCOM – Schizotypal Personality Disorder Symptoms, Causes, Diagnosis & Treatment | NIH – National Epidemiologic Survey on Alcohol and Related Conditions | Deidre M. Anglina, Patricia R. Cohenab, Henian Chena (2008) Duration of early maternal separation and prediction of schizotypal symptoms from early adolescence to midlife, Schizophrenia Research Volume 103, Issue 1, Pages 143–150 (August 2008) | Chen, C. K.; Lin, S. K.; Sham, P. C.; et al. (2005). “Morbid risk for psychiatric disorder among the relatives of methamphetamine users with and without psychosis”. American Journal of Medical Genetics. 136 (1): 87–91.