Schizotypal personality disorder, like other personality disorders, is a long-standing pattern of behaviour and experience. As part of that pattern, an individual either has difficulty functioning or experiences a great deal of distress. People with schizotypal personality disorder are loners who prefer to keep their distance from others and are uncomfortable being in relationships. They sometimes exhibit odd speech or behaviour, and they have a limited or flat range of emotions. This pattern begins early in adulthood and continues throughout life. Those with this disorder also tend to have markedly illogical thinking, with unusual ideas or odd beliefs that are not consistent with prevailing ideas, for example, a strong belief in extrasensory perception (ESP). They may report unusual perceptions or strange body experiences.
A schizotypal personality disorder is in the middle of a spectrum of related disorders, with schizoid personality disorder on the milder end and schizophrenia on the more severe end. These disorders are probably biologically related. Many experts believe that people with these disorders have similar genetic vulnerabilities, but it is not clear why a person would develop a more or less severe form of the illness. Many people with schizotypal personality disorder have subtle difficulties with memory, learning and attention. They usually do not have the more severe and disabling psychotic symptoms, such as delusions and hallucinations that appear in schizophrenia. However, people with a schizotypal personality disorder do sometimes develop schizophrenia. Schizotypal personality disorder appears more often in men than in women. Symptoms of depression and anxiety are quite common. About half of people with this disorder have an episode of major depression at some point during life. Stress may cause the disorder to get worse.
The core symptoms of schizotypal personality disorder are:
- Feelings that external events have an unusual personal meaning
- Unusual thinking, beliefs, perceptions or behaviour
- Odd speech
- Suspicious or paranoid ideas
- Bland or strange emotional responses
- Lack of close friends outside the family
- Excessive, persistent social anxiety
A schizotypal personality disorder is diagnosed by a person’s symptoms and history, usually by a mental health professional. There are no laboratory tests to determine if a person has this disorder. To differentiate schizotypal personality disorder from other mental disorders, the professional will look for signs of a mood or anxiety disorder or the presence of psychotic thinking.
All personality disorders are long-lasting (chronic), often lifelong. In contrast to an illness like depression, the symptoms tend to be consistently present rather than occurring in episodes.
There is no known way to prevent this disorder, but early intervention may reduce symptoms and improve functioning over the long term.
Schizotypal personality disorder often is treated with a combination of medication and psychotherapy. Medications can be prescribed if there are obvious symptoms. Illogical thinking can be treated with antipsychotic medications, usually in low doses. If there are symptoms of depression or anxiety, the doctor can prescribe antidepressant or antianxiety medications.
People with schizotypal personality disorders may find psychotherapy difficult because, as part of the disorder, they tend to be uncomfortable in relationships. A therapist can, however, foster a trusting relationship by accepting the person’s need for more distance. Since people with this disorder have difficulty picking up on social cues, it is often necessary to teach specific social skills, for example, explaining that certain behaviours may be seen by others as rude or off-putting. Similarly, a therapist can help a person with schizotypal personality disorder learn how his or her thoughts and perceptions are distorted and how best to respond to them. Difficulties in social interactions can lead to personal disappointment and poor self-image throughout life. These kinds of problems may become an important focus in psychotherapy.
If a person’s symptoms are mild to moderate, he or she may be able to adjust with relatively little support. If the problems are more severe, however, a person with a schizotypal personality disorder may have more than average difficulty maintaining a job or living independently. For example, routine interactions at work may be very awkward or may provoke anxiety. The person may not be able to accomplish daily tasks like shopping for food or other necessities. People with this disorder may, therefore, need more support from family members or require the framework of a residential treatment setting. He or she also may be more capable of doing a job that includes a good deal of structure and requires little, if any, social interaction. And it is helpful if a job supervisor can understand and accommodate the person’s eccentricities.
When To Call a Professional
Since personality styles tend to become more entrenched as people get older, it is best when help can be provided as soon as significant distress or poor functioning is noticed.
The outlook for schizotypal personality disorder varies and depends on many factors, including the severity of the symptoms, the availability of support, how much the person’s ability to function is impaired, and whether the person has depression or anxiety. If a person is willing and able to participate in treatment, the prognosis improves. It may not be realistic to expect a person with a schizotypal personality disorder to become very comfortable socially. However, some with this disorder do respond very well to treatment with medication. In the best case, people with a schizotypal personality disorder can lead satisfying lives by finding suitable work and enjoying relationships and leisure activities that are a good fit for their personality style.
Credit: Harvard Health Publishing, Harvard Medical School, March 2013.