Schizotypal Personality Disorder

I. Overview of Mental Illness

Schizotypal disorder is characterized by eccentric behaviour and anomalies of
thinking and affect which resemble those seen in schizophrenia, though no definite
and characteristic schizophrenic anomalies occur at any stage. The symptoms may
include a cold or inappropriate affect; anhedonia; odd or eccentric behaviour; a
tendency to social withdrawal; paranoid or bizarre ideas not amounting to true
delusions; obsessive ruminations; thought disorder and perceptual disturbances;
occasional transient quasi-psychotic episodes with intense illusions, auditory or other
hallucinations, and delusion-like ideas, usually occurring without external
provocation. There is no definite onset. The evolution and course are usually those of
a personality disorder. (World Health Organization, 2010)
Individuals with Schizotypal Personality Disorder grow up being socially and
emotionally withdrawn and odd or eccentric. The core features of this disorder are:
(1)detachment (suspiciousness, social withdrawal, intimacy avoidance, inability to
feel pleasure, restricted emotional expression), and (2) irrationality (eccentricity, odd
beliefs, perceptual distortions). This disorder is only diagnosed if: (1) it begins no
later than early adulthood, (2) these behaviors occur at home, work, and in the
community, and (3) these behaviors lead to clinically significant distress or
impairment in social, occupational, or other important areas of functioning. This
disorder should not be diagnosed if its symptoms occur exclusively during the course
of a Psychotic Disorder, Autism Spectrum Disorder, or if it is attributable to Substance
Use Disorder another medical condition. (Long, 2015)
Individuals with Schizotypal Personality Disorder have acute discomfort
with close relationships. Thus these individuals have few close friends and little
desire for sexual intimacy. They have little reaction to emotionally arousing situations,
and restricted emotional expression. Thus they may appear indifferent or cold. They
may have social withdrawal with avoidance of social contacts and activity. Individuals
with this disorder may have undue suspiciousness and feelings of persecution. They
may have excessive social anxiety with these paranoid fears.

Individuals with Schizotypal Personality Disorder do not have psychotic

symptoms (i.e., delusions, hallucinations, disorganized speech, or grossly
disorganized/catatonic behavior). However, they may have ideas of reference and odd
beliefs that are almost delusions. Likewise, they may have unusual perceptual
experiences, including bodily illusions, that are almost hallucinations. They may have
odd speech (e.g., vague, circumstantial, overelaborate, or stereotyped) that is almost
grossly disorganized.
Like all personality disorders, Schizotypal Personality Disorder is a deeply
ingrained and enduring behaviour pattern, manifesting as an inflexible response to a
broad range of personal and social situations. This behavior represents an extreme
or significant deviation from the way in which the average individual in a given
culture

Subtype

Insipid
schizotypal

Timorous
schizotypal

relates

to

others.

This

behaviour

pattern

tends

to

be

stable.

Description

Personality Traits

A structural exaggeration of the passive-detached

pattern. It
includes schizoid, depressive, dependent features.

Sense of strangeness and

nonbeing; overtly drab,
sluggish, inexpressive;
internally bland, barren,
indifferent, and insensitive;
obscured, vague, and
tangential thoughts.

A structural exaggeration of the active-detached

pattern. It includes avoidant, negativistic
(passive-aggressive) features.

Warily apprehensive,
watchful, suspicious, guarded,
shrinking, deadens excess
sensitivity; alienated from self
and others; intentionally
blocks, reverses, or
disqualifies own thoughts.

Causes
1. Genetics: Although listed in the DSM-IV-TR on axis II, schizotypal
personality disorder is widely understood to be a "schizophrenia spectrum"
disorder that is on axis I. 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.
2. Social and Enviromental: 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. 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.
Neglect or abuse, trauma, or family dysfunction during childhood can increase
the risk of developing schizotypal personality disorder.

Course of the Disease

Schizotypal Personality Disorder may first appear in childhood and
adolescence

with

solitariness,

poor

peer

relationships,

social

anxiety,

underachievement in school, hypersensitivity, peculiar thoughts and language, and

bizarre fantasies. These children may appear odd or eccentric and attract teasing. With
some adolescents, these schizotypal features may be caused by transient emotional
turmoil, and these features disappear when the turmoil resolves. For other adolescents,
these schizotypal features persist into adulthood, and almost half of individuals with
this

disorder

go

on

to develop

psychotic

disorder.

Complications
In response to stress, individuals with Schizotypal Personality Disorder may
experience very brief psychotic episodes (lasting minutes to hours). If the psychotic
episode lasts longer, this disorder may actually develop into Brief Psychotic Disorder,
Schizophreniform Disorder, Delusional Disorder or Schizophrenia.

Comorbidity
Personality disorders are an overlooked and underappreciated source of
psychiatric morbidity. Comorbid personality disorders may, in fact, account for much
of the morbidity attributed to axis I disorders in research and clinical practice. "High
percentages of patients with schizotypal (98.8%), borderline (98.3%), avoidant
(96.2%), and obsessive-compulsive (87.6%) personality disorder and major
depressive disorder (92.8%) exhibited moderate (or worse) impairment or poor (or
worse) functioning in at least one area."
Prevalence
Schizotypal personality disorder occurs in 0.6%-4.6% of the general
population.

This

disorder

occurs

slightly

more

commonly

in

males.

Outcome
This disorder is chronic. In a two-year follow-up study 48.3% of patients with
Schizotypal Personality Disorder develop psychosis.
Familial Pattern
Schizotypal personality disorder is more common among first-degree
biological relatives of those with schizophrenia, and visa versa.
Social Skill
Behavior
Beliefs

Schizotypal
Eccentric (odd, unusual, bizarre)
Odd (paranoid, bizarre not amounting to

Perception

delusions)
Perceptual Distortions (depersonalization,
derealization, dissociative, thought-

Intimacy
Sociability
Emotional Expression
Trust
II. Signs and Symptoms

control experiences)
Intimacy Avoidance
Social Withdrawal
Lacking
Suspiciousness

Criteria for the Diagnosis of Schizotypal Personality Disorder, According

to American Psychiatric Association,
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., 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.
Enduring pattern of inner experience and behavior must deviate markedly
from the expectations of the individual's culture. This enduring pattern is
inflexible and pervasive across a broad range of personal and social situations.
This enduring pattern leads to clinically significant distress or impairment in
social, occupational, or other important areas of functioning.

III. Treatment
Psychotherapy

As with most personality disorders, schizotypal personality disorder is best

treated with some form of psychotherapy. Individuals with this disorder usually distort
reality more so than someone with Schizoid Personality Disorder.

As with Delusional Disorder and Paranoid Personality Disorder, the clinician

must exercise care in therapy to not directly challenge delusional or inappropriate
thoughts. A warm, supportive, and client-centered environment should be established
with initial rapport. As with Avoidant Personality Disorder, the individual lacks an
adequate social support system and usually avoids most social interactions because of
extreme social anxiety. The patient often reports feelings of being "different" and not
"fitting in" with others easily, usually because of their magical or delusion thinking.
There is no simple solution to this problem. Social skills training and other behavioral
approaches which emphasize the learning of the basics of social relationships and
social interactions may be beneficial.
While individual therapy is the preferred modality at the onset of therapy, it
may be appropriate to consider group therapy as the client progresses. Such a group
should be for this specific disorder, though, which may be difficult to form or find in
smaller communities.
Medications
Medication can be used for treatment of this disorder's more acute phases of
psychosis. These phases are likely to manifest themselves during times of extreme
stress or life events with which they cannot adequately cope. Psychosis is usually
transitory, though, and should effectively resolve with the prescription of an
appropriate anti-psychotic. (e.g haloperidol and thiothixine)

Self-Help
There are not any self-help support groups or communities that we are aware
of that would be conducive to someone suffering from this disorder. Such approaches

would likely not be very effective because a person with this disorder is likely to be
mistrustful and suspicious of others and their motivations, making group help and
dynamics unlikely and possibly harmful.

References:
1. American Psychiatric Association. (2013). Diagnostic and statistical manual of
mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing.
2. Berger, F. (2014). Schizotypal Personality Disorder. Retrieved February 22,
2016 at https://www.nlm.nih.gov/medlineplus/ency/article/001525.htm
3. Psych Central Stuff. (January 01, 2016). Schizotypal Personality Disorder.
Retrieved February 22, 2016 at http://psychcentral.com/disorders/sx33t.htm