Schizotypal Personality Disorder

What is schizotypal personality disorder?

People with schizotypal disorder experience cognitive and perceptual disturbances that cause discomfort in social situations and present barriers to building close relationships. They often have thoughts and beliefs that others consider bizarre and act in unusual ways. 

As with other personality disorders, schizotypal personality disorder is a chronic condition that impacts functioning in multiple contexts of daily life and will often lead to social and relational difficulties, causing problems with meeting personal responsibilities.

People with this disorder may feel they are different or don't belong, which often leads to further social isolation. Additionally, it is strongly associated with disorders such as substance use disorders, anxiety disorders (e.g., generalized anxiety disorder), mood disorders (e.g., major depressive disorder), and other personality disorders (e.g., borderline personality disorder), which can make further increase isolation.

Symptoms of schizotypal personality disorder

People may consider someone with schizotypal personality disorder as being odd or eccentric. They may dress in unconventional ways or appear unkempt. They often display unusual mannerisms during conversations and may avoid eye contact or appear nervous during interactions with others.

Sadly, many with schizotypal personality disorder feel they are different, making them more likely to withdraw from others. Isolation worsens symptoms of anxiety, paranoia, and perceptual disturbances. 

Schizotypal personality disorder symptoms include:

• Interpretations of events as directly relating to them (termed ideas of reference)
• Beliefs outside their cultural norm such as telepathy, paranormal events, or UFOs
• Odd thought patterns such as magical thinking
• Odd speech patterns such as metaphorical, overly elaborate, or stereotyped 
• Circumstantial thinking (talking in circles, providing excessive and unnecessary detail)
• Paranoid ideation, suspiciousness towards others
• Emotional displays that are inappropriate to the situation 
• Restricted emotions or appearing ‘flat’
• Few close friends except for relatives
• Social anxiety and difficulty responding to social cues such as eye contact
• Transient psychotic episodes ^[1]

Social anxiety symptoms for schizotypal personality disorder are associated with paranoid ideation rather than a negative self-judgment of themselves. These anxiety symptoms are usually present regardless of how familiar the social setting is ^[1]. Someone with schizotypal personality disorder may interpret people laughing across the street as laughing at them (ideas of reference) or that their dream of rain last night caused the rain today (magical thinking). These perceptual disturbances do not meet the threshold for delusional thinking and are considered oddly egocentric ways of interpreting events.

 Transient psychotic episodes are more likely to occur during stressful times and typically do not meet the threshold for an additional diagnosis.

Schizotypal personality disorder symptoms in children and teens include:

• Solitariness and poor relationships with peers
• Social anxiety
• Academic underachievement
• Hypersensitivity
• Peculiar thoughts and language
• Bizarre fantasies ^[1]

Parents should contact a healthcare professional for an evaluation if they have concerns about an adolescent's social functioning, as many of the symptoms above overlap with other mental health conditions that begin in adolescence, such as anxiety, depression, autism, and ADHD. If treated early, adolescents are less likely to experience enduring symptoms into adulthood.

Causes of schizotypal personality disorder

There is no known cause of schizotypal personality disorder, and research into risk factors for developing this disorder is lacking. 

Experts believe that personality disorders develop from combined genetic, environmental, and social factors. Research has shown a higher prevalence in people with a first-degree family member diagnosed with schizophrenia, indicating a genetic component to the disorder. The rate of occurrence may be slightly higher in males ^[1]. 

Diagnosing schizotypal personality disorder

Schizotypal personality disorder symptoms must occur most of the time, across multiple settings and have been present by early adulthood to meet criteria for diagnosis. As personality continuously develops throughout childhood, adolescence, and early adulthood, diagnosis usually does not occur until at least 18.

A psychologist or psychiatrist is most likely to diagnose schizotypal personality disorder. A physical exam may be completed to rule out medical causes. The psychological evaluation will include questions about mental health, family history, social support, and the timeframe of symptoms. Psychological testing may also be administered. 

Schizotypal personality disorder shares diagnostic criteria and symptoms with other mental health disorders, including psychotic disorders, neurodevelopmental disorders, substance use disorders, and other personality disorders. Certain medical conditions, particularly those involving the central nervous system and brain, can cause personality changes ^[1]. 

A formal evaluation for diagnosis is important to rule out these other conditions, and to determine the most appropriate treatment. 

Prevention of schizotypal personality disorder

Since there is no known cause of schizotypal personality disorder, there is no known way to prevent it from developing. Early recognition of symptoms and commitment to psychotherapy is key to managing symptoms.

Treatment for schizotypal personality disorder

Those seeking treatment generally do so out of concern for related symptoms of anxiety, depression, or relationship difficulties. Schizotypal personality disorder is usually treated through psychotherapy; however, sufferers may find this challenging due to the interpersonal element of psychotherapy and the need for self-disclosure and attachment. Furthermore, the social isolation that occurs within the disorder can make it even more challenging to seek out support in the first place.

Psychotherapy

Detachment from others plays a significant role in the severity of other symptoms for those with schizotypal personality. Psychotherapy can be highly beneficial if somebody with the disorder works with a therapist with knowledge and experience of the condition and with whom they can build an authentic, trusting relationship.

Cognitive behavioral therapy is a commonly used treatment approach focusing on skills building and learning to recognize and change unhelpful thought patterns. It can also help manage anxiety symptoms commonly experienced by people with schizotypal personality disorder.

Family therapy is also helpful for schizotypal personality disorder treatment and is recommended in conjunction with individual therapy. Family therapy involves family members learning ways of providing support, working together, and establishing healthy attachments ^[3].

Pharmacology

There are no specific medications used to treat schizotypal personality disorder. A medical provider may prescribe medication to treat comorbid symptoms such as antianxiety medication, antidepressant medication, or antipsychotics ^[3]. 

Self-care for schizotypal personality disorder

Schizotypal personality disorder symptoms often worsen during stressful periods. The following self-care practices can help to both prevent and manage stress, and reduce daily symptoms. 

• Try new things. Confidence builds through achievement and the development of new skills. Self-confidence is a protective factor against stress.
• Develop routines. Following a daily routine has been shown to reduce feelings of stress, anxiety, and depression. 
• Get adequate sleep. Sleep is an integral part of managing stress and improving overall well-being. It plays a large role in managing paranoid ideation and transient psychosis.
• Eat healthily. Eating regular meals throughout the day helps regulate blood sugar and stress hormones in the body.
• Get active. Exercise can help burn off anxious, nervous energy while releasing feel-good chemicals in the brain.
• Seek supportive individuals. Supportive individuals can be family members, friends, or helping professionals who can help recognize when symptoms may be worsening. 

Helping someone with schizotypal personality disorder

People with schizotypal personality disorder tend to have the closest relationships with family members. Parents and siblings are often at the forefront of providing support but may not know the best approach.

A family therapist can help facilitate dialogue amongst family members to build a supportive home environment. Family members will learn to work together, openly communicate with one another, and find supportive ways to reduce enabling behaviors.

Ways of providing support to someone with schizotypal personality disorder include:

• Giving positive feedback and reinforcement. Managing daily life responsibilities, especially those requiring contact with other people, is difficult for those with schizotypal personality disorder. Receiving recognition for accomplishing these tasks helps build confidence and esteem.
• Seeking them out to talk. People with schizotypal personality disorder often isolate themselves from others, despite wanting to connect. Purposefully seeking them out encourages them to stay connected. This can also be a good way to model relational skills.
• Providing opportunities to build confidence. Experiencing a sense of achievement has been found to reduce symptoms ^[2]. 
• Practicing self-care. Self-care practices include getting enough sleep, healthy eating, regular exercise, and socializing are important for family members. No one can support anyone without taking care of themselves. 

FAQs about schizotypal personality disorder

How common is schizotypal personality disorder?

Schizotypal personality disorder is estimated to occur between 0.6 - 4.6% of the general population. Men are more likely to be diagnosed with this disorder than women ^[1].

What is the outlook for schizotypal personality disorder?

The outlook for untreated schizotypal personality disorder is poor. Through psychotherapy, people with this disorder can learn effective ways of managing their symptoms and establishing healthy relationships with others. 

Family therapy is recommended in conjunction with individual therapy. Family members can collaboratively work together to create a supportive environment through family therapy. 

Schizotypal personality disorder is a chronic, lifelong condition. However, with the right treatment and support symptoms are manageable. 

Schizotypal vs Schizoid personality disorder – What is the difference?

The perceptual disturbances and socially eccentric behaviors that are the hallmark of schizotypal personality disorder differentiate it from other personality disorders, including schizoid personality disorder ^[1]. Schizoid and schizotypal personality disorders overlap in symptoms of isolation and social withdrawal; however, those with schizotypal personality disorder avoid social interactions because of social deficits and anxiety rather than a lack of desire for relationships.