Schizotypal Personality Disorder

A schizotypal personality disorder is characterized by someone who has great difficulty in establishing and maintaining close relationships with others. A person with a 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.

Schizotypal: Eccentric, self-estranged, bizarre, absent. Exhibits peculiar mannerisms and behaviors. Thinks can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blurs the line between reality and fantasy. Magical thinking and strange beliefs.

Individuals with Schizotypal Personality Disorder often seek treatment for the associated symptoms of anxiety, depression, or other dysphoric affects rather than for the personality disorder features.

Schizotypal Personality Disorder
Schizotypal Personality Disorder

Symptoms of Schizotypal Personality Disorder

Schizotypal personality disorder is characterized by a 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:

  • Ideas of reference (excluding delusions of reference)
  • Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitious-ness, 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

As with all personality disorders, the person must be at least 18 years old before they can be diagnosed with it.

Schizotypal personality disorder appears in less than 3 percent of the general population.

Like most personality disorders, schizotypal personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

Schizotypal Personality Disorder
Schizotypal Personality Disorder

How is Schizotypal Personality Disorder Diagnosed

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 a schizotypal personality disorder.

It is classified as a clinical disorder associated with schizophrenia, rather than a personality disorder as in DSM-5.

Many people with the schizotypal personality disorder don’t 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 person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis of 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 whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Schizotypal Personality Disorder
Schizotypal Personality Disorder

At least five of the following symptoms must be present in order to diagnose

  • ideas of reference
  • strange beliefs
  • magical thinking
  • abnormal perceptual experiences
  • strange thinking and speech
  • paranoia
  • inappropriate or constricted affect
  • strange behavior or appearance
  • lack of close friends
  • the 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).

Causes of Schizotypal Personality Disorder

Researchers today don’t 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 of 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 individual’s 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.

Schizotypal Personality Disorder
Schizotypal Personality Disorder

Differential diagnosis of Schizotypal Personality Disorder

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 distinguishes them. Also, STPD is characterized by a lifelong pattern without much change whereas simple schizophrenia represents a deterioration.

How to Treat Schizotypal Personality Disorder

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.

Schizotypal Personality Disorder
Schizotypal Personality Disorder

The social consequences of serious mental disorders those that affect a person’s ability to function in social and occupational settings can be calamitous. Comprehensive treatment is crucial to the alleviation of symptoms and finding a path toward recovery. Consumer self-help programs, family self-help, advocacy, and services for housing and vocational assistance complement and supplement the formal treatment system. Many of these services are operated by people who use mental health services themselves. The logic behind their leadership in the delivery of these services is that those using the system might be especially effective in reaching out to those in need.

  • Schizotypal patients who appear to be almost schizophrenic in their beliefs and behaviors (aberrant perceptions and cognitions) are usually treated with low doses of antipsychotic medications, e.g. thiothixene. However, it must be mentioned that long-term efficacy of neuroleptics is doubtful.
  • For schizotypal patients who are more obsessive-compulsive in their beliefs and behaviors, SSRIs like Sertraline appear to be more effective.

Lamotrigine, an anti-convulsant, appears to be helpful in dealing with social isolation.

Psychotherapy treatment for Schizotypal Personality Disorder

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.


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