Schizotypal Personality Disorder

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 avoid social situations, as the person with schizotypal personality disorder tends to hold peculiar beliefs and may have difficulty with responding appropriately to social cues.

Schizotypal personality disorder typically is diagnosed in early adulthood and is likely to endure across the lifespan, though treatment, such as medications and therapy, can improve symptoms.

Symptoms

Schizotypal personality disorder typically includes five or more of these signs and symptoms:

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

Signs and symptoms of schizotypal personality disorder, such as increased interest in solitary activities or a high level of social anxiety, may be seen in the teen years. The child may be an underperformer in school or appear socially out of step with peers, which may result in teasing or bullying.

Schizotypal personality disorder vs. schizophrenia

Schizotypal personality disorder can easily be confused with schizophrenia, a severe mental illness in which people lose contact with reality (psychosis). While people with schizotypal personality disorder may experience brief psychotic episodes with delusions or hallucinations, the episodes are not as frequent, prolonged or intense as in schizophrenia.

Another key distinction is that people with schizotypal personality disorder usually can be made aware of the difference between their distorted ideas and reality. Those with schizophrenia generally can't be swayed away from their delusions.

Despite the differences, people with schizotypal personality disorder can benefit from treatments similar to those used for schizophrenia. Schizotypal personality disorder is sometimes considered to be on a spectrum with schizophrenia, with schizotypal personality disorder viewed as less severe.

When to see a doctor

People with schizotypal personality disorder are likely to seek help only at the urging of friends or family members. Or people with schizotypal personality disorder may seek help for another problem such as depression. If you suspect that a friend or family member may have the disorder, you might gently suggest that the person seek medical attention, starting with a primary care doctor or mental health professional.

If you need immediate help

If you're concerned that you might harm yourself or someone else, go to an emergency room or call 911 or your local emergency number immediately. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

Causes

Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of inherited tendencies and environmental factors.

In normal development, children learn over time to appropriately interact with others, to interpret social cues, and to respond to social situations appropriately and with flexibility. What exactly goes wrong for a person with schizotypal personality disorder isn't known for certain, but it's likely that changes in the way the brain functions, genetics, environmental influences and learned behaviors may play a role.

Risk factors

Your risk of schizotypal personality disorder may be greater if you have a relative who has schizophrenia or another psychotic disorder.

Complications

People with schizotypal personality disorder are at an increased risk of:

• Depression
• Anxiety
• Other personality disorders
• Schizophrenia
• Temporary psychotic episodes, usually in response to stress
• Problems with alcohol or drugs
• Suicide attempts
• Work, school, relationship and social problems

Diagnosis

People with schizotypal personality disorder may seek help from their primary care doctor because of other symptoms, such as anxiety, depression or problems coping with frustration, or for treatment of substance misuse.

After a physical exam to help rule out other medical conditions, your primary care doctor may refer you to a mental health professional 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 psychotherapy and medication. Many people can be helped by work and social activities that are a fit for their personality styles.

Psychotherapy

Psychotherapy may help people with schizotypal personality disorder begin to trust others and learn coping skills by building a trusting relationship with a therapist.

Psychotherapy may include:

• Cognitive-behavioral therapy — Identifying and challenging negative 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 improve communication, trust and the ability to work together in the home

Medications

There are no medications approved by the Food and Drug Administration specifically for the treatment of schizotypal personality disorder. However, doctors may prescribe an antidepressant to help relieve or reduce certain symptoms, such as depression or anxiety. Some medications may help improve flexibility in thinking.

Coping and support

Though schizotypal personality disorder is lifelong, some symptoms may improve over time through experiences that help foster — among other positive traits — self-confidence, a belief in one's ability to overcome difficulty and a sense of social support.

Factors that appear most likely to help reduce some symptoms of this disorder include:

• Positive relationships with friends and family
• Healthy daily rhythms, including having a schedule, a good sleep routine, exercise and consistency with taking prescribed medications
• A sense of achievement at school, at work and in extracurricular activities

Preparing for your appointment

You're likely to start by seeing your primary care doctor. However, when you call to set up an appointment, you may be referred to a mental health professional such as a psychiatrist or psychologist.

Take a family member or friend along, if possible. With your permission, someone who has known you for a long time may be able to answer questions or share information with the mental health professional that you don't think to bring up.

Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you or your family noticed, and for how long. Ask friends or family members if they've felt concerned about your behavior and what they've noticed.
• Key personal information, including traumatic events in your past and any current, major stressors. Find out about your family's medical history, including any history of mental illness.
• Your medical information, including other physical or mental health conditions with which you've been diagnosed.
• All medications you take, including the names and dosages of any medications, herbs, vitamins or other supplements you're taking.
• Questions you want to ask your doctor to make the most of your appointment.

Some basic questions to ask include:

• What is likely causing my symptoms?
• What are other possible causes for my symptoms?
• What treatments are most likely to be effective for me?
• How much can I expect my symptoms to improve with treatment?
• How often will I need psychotherapy, and for how long?
• Are there medications that can help?
• Is there a generic alternative to the medicine you're prescribing?
• If you're recommending medications, what are the possible side effects?
• I have other health conditions. How can I best manage them together?
• Are there any brochures or other printed material I can take? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• What are your symptoms?
• When did you or your family first notice these symptoms?
• How are your symptoms affecting your life?
• Have your family members or friends expressed concern about your behavior?
• Do you feel comfortable in social situations? Why or why not?
• Do you have any close relationships?
• If you're not satisfied with work, school or relationships, what do you think is causing your problems?
• Have you ever thought about harming yourself or others? Have you ever actually done so?
• Have you ever felt that other people can control your thoughts or that you could influence other people and events through your thoughts?
• Have any of your close relatives been diagnosed with or treated for mental illness?

Your doctor or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.