What is Schizotypal Personality Disorder?
Schizotypal Personality Disorder: What Does It Mean?
Schizotypal personality disorder is a disorder characterized by difficulties in making and maintaining relationships due to extreme discomfort. Someone with the disorder will also usually display odd or eccentric personality traits and may have difficulty in displaying emotions.
Psychology Today defines the disorder as follows:
“Schizotypal personality disorder is a pattern of social and interpersonal difficulties that includes a sense of discomfort with close relationships, eccentric behavior, and unusual thoughts and perceptions of reality. Speech may include digressions, odd use of words or display “magical thinking,” such as a belief in clairvoyance and bizarre fantasies. Patients usually experience distorted thinking, behave strangely, and avoid intimacy. They typically have few, if any, close friends, and feel nervous around strangers although they may marry and maintain jobs. The disorder, which may appear more frequently in males, surfaces by early adulthood and can exacerbate anxiety and depression.”
Stats: How Many Suffer from this Disorder?
Studies into schizotypal personality disorder have found that around 3.9% of the population will suffer from the disorder during their lifetime. It is slightly more common in men, with 4.2% diagnosed with the disorder compared to 3.7% of women.
Research indicates that the odds of developing the disorder are significantly higher among black women. Asian men are much less likely to have the disorder than any other grouping. People with lower incomes are also more likely to develop the disorder, as well as those who are widowed, divorced or separated.
A recent study has found that people diagnosed with the disorder are less likely to live independently or to have obtained a bachelor’s degree. They are much more likely to work in an isolated job and earn below the national average. The study also indicates that none of these things seem to be as a result of cognitive impairment or intellectual inability.
What Causes Schizotypal Personality Disorder?
There is not one known cause of schizotypal personality disorder currently. However, it is believed to be developed as a result of a combination of causes.
Genetic vulnerability to the disorder is a significant factor. People who have a direct family member who displays schizotypal symptoms are 50% more likely to display schizotypal symptoms themselves, which may result in being diagnosed with this disorder.
Research is on-going, but some scientists believe that people with this disorder have a significantly different makeup in their brains than those without. Specifically, it is believed that certain areas of the brain have less brain matter and that there are abnormalities of the neurotransmitter dopamine.
There is a possible link to childhood experiences although no research has so far proven this. Other childhood-related factors that increase the likelihood of developing the disorder include a lower birth weight, a small head circumference at 12 months old and a mother smoking whilst pregnant with the child in question.
Signs and Symptoms of Schizotypal Personality Disorder
What are the Common Behaviors/Characteristics?
One of the most common characteristics of people with this disorder is extreme discomfort around other people and in social situations. Developing relationships and maintaining relationships is often extremely difficult. This can often result in the person only having a relationship with direct family members and can cause unhappiness due to lack of friendship. Even interacting in seemingly insignificant social situations, such as a store or workplace, can cause anxiety for someone with this disorder.
People with this disorder often have odd or unusual beliefs or fantasies. They may be very superstitious about particular actions or believe they possess magical powers. A person with this disorder may believe there is significant meaning in a normal occurrence or that they are being sent a sign through an innocuous gesture. They may also be very suspicious of other people and/or have paranoid tendencies.
Another common behavior is having different or odd speech. Someone with schizotypal personality disorder will often use strange phrasing or use words out of context. Their appearance is often unusual also, they may wear dirty or ill-fitting clothing.
Testing: What are the Diagnostic Criteria Per the DSM 5?
The DSM 5 criteria for schizotypal personality disorder is:
“A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as 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:
(1) ideas of reference (excluding delusions of reference)
(2) 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)
(3) unusual perceptual experiences, including bodily illusions
(4) odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
(5) suspiciousness or paranoid ideation
(6) inappropriate or constricted affect
(7) behavior or appearance that is odd, eccentric, or peculiar
(8) lack of close friends or confidants other than first-degree relatives
(9) excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
- Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.”
Schizotypal Personality Disorder and Other Conditions
Schizotypal Personality Disorder vs Schizophrenia
Schizophrenia and schizotypal personality disorder are frequently mixed up but there are many significant differences. The differences mainly center around the ways people with these disorders experience delusions and psychotic episodes.
Although people with schizotypal personality disorder do suffer from psychotic episodes, they are far less frequent and long-lasting than the psychotic episodes someone with schizophrenia will experience. Equally, those with schizophrenia will experience much more severe delusions and usually can’t differentiate between a delusion and reality, whereas someone with schizotypal personality disorder usually can.
The two disorders are often treated the same way and can sometimes be referred to as on the same spectrum.
Schizotypal Personality Disorder vs Schizoaffective Disorder
Schizotypal personality disorder and schizoaffective disorder are both similar in name and in symptoms. They are both classified as personality disorder and can both cause the sufferer to display similar behaviors. However, the main difference is the thought process behind the behavior.
Someone with schizotypal disorder will avoid interaction with others and forming relationships because it causes them great stress and anxiety. A person will schizoaffective disorder will also avoid developing long-lasting relationships with others but because -put simply- they see no benefit to such interactions or to social relationships.
As the two conditions share such similar behaviors to an onlooker, it is essential that a doctor or mental health professional take time to get to know the patient and the reasoning behind their behaviors, in order to make a correct diagnosis.
People diagnosed with this disorder are also very likely to be diagnosed with additional disorders. It is estimated that between 30 and 50% of people with schizotypal personality disorder will also be diagnosed with a major depressive disorder. A second personality disorder is also likely, such as paranoid personality disorder. The risk of developing schizophrenia is also much higher for people with this disorder.
Schizotypal Personality Disorder In Adults/Children
The signs and symptoms of schizotypal personality disorder normally begin in childhood or adolescence, with the most obvious signs being avoidance of social situations and a tendency to seek alone-time. For people who are not diagnosed until they are adults, it is likely that these behaviors were being displayed in their childhood and the diagnosing party will usually ask the patient about their childhood and adolescence.
Example Case of Schizotypal Personality Disorder
Bex Gibbons wrote about her experience suffering from schizotypal personality disorder for the online publication The Mighty. After being diagnosed with the disorder in 2017, they said:
“When it comes to talking to people I’m unfamiliar with or even ordering a coffee in a cafe — I struggle to find the words and string a sentence together due to my social anxiety and shyness, but then i’ll quite comfortably sit on my own, muttering and whispering to myself, having a conversation and quietly smiling and laughing at myself. When I do venture out it’s a real challenge because the constant fear I’m being watched, observed and followed is a reoccurring thought in my mind. There have been a few occasions I’ve ran down the street running away from those following me, when realistically no one is following. I guess my mind plays treacherous tricks on me, but what do I believe when I feel suspicious of those people unknown to me — feeling “paranoid” — although I dislike the use of that word and I don’t use it lightly.
I don’t have many friends, in fa,ct I probably have two or three people I would call “friends.” I have more feline friends than human and I don’t mind at all — I love cats, who doesn’t. There have been moments of unusual thinking, believing the male pharmacists at my pharmacy have tampered with my medication, only trusting females and only collecting my medications from the female staff; fortunately, I have a pharmacy team who are very understanding, sympathetic, friendly and always asking how I am. Feeling uncomfortable around males I’m unfamiliar with and avoiding eye contact is a real struggle, which I am working on.”
You can read Bex’s full story here: https://themighty.com/2018/03/schizotypal-personality-disorder-diagnosis/
How to Deal/Coping With Schizotypal Personality Disorder
Look out for These Complications/Risk Factors
People with this disorder are at risk of developing other mental health disorders, such as depression and schizophrenia. The increased risk of depression is a particular risk due to both the higher likelihood of developing it as well as the increased risk of suicidal tendencies.
Some research indicates that people with this disorder may be more likely to develop issues with alcohol and drug abuse.
The issues with socializing and developing relationships can cause substantial complications. For example, a person with this disorder is at high risk of becoming isolated from society and avoiding necessary health care treatment.
Schizotypal Personality Disorder Treatment
Treatment for this disorder is usually a combination of medication and therapy. Of course, due to the one of the main symptoms of the disorder being extreme social interaction anxiety, it can be very difficult for a person with the disorder to engage in therapy. Those with severe symptoms may require hospitalization in order to undergo treatment.
Psychotherapy, such as cognitive behavior therapy (CBT), is the most common type of therapy offered for someone with this disorder. The therapy will often focus on teaching the patient about social interaction, helping with speech and teach methods to copy with anxiety.
Possible Medications for Schizotypal Personality Disorder
Due to it’s similarity to schizophrenia, people with schizotypal personality disorder are often prescribed the same or similar medications. Antipsychotic medications have proven to be a successful treatment, such as amoxapine, as they will help with symptoms such as illusions and severe anxiety. SSRIs such as fluoxetine are also sometimes prescribed and will work on symptoms such as depression and anxiety.
Home Remedies to help Schizotypal Personality Disorder
There isn’t one particular home remedy recommended for someone with this disorder. In fact, in order to avoid causing more harm or reinforcing negative aspects of the disorder, it is vital that someone with the disorder work closely with their doctor or mental health professional before they attempt any home remedy.
A therapist or doctor can work with a patient on tasks or activities to carry out outside the appointment, if they feel it’s in the patient’s best interests.
Living with Schizotypal Personality Disorder
Due to the risks of social isolation or ostracization, this disorder can be very difficult to live with. That’s why it’s essential to seek treatment as soon as possible. Although someone may never be cured of this disorder, they can learn ways to manage it that will alleviate some of the associated anxieties and stress.
It is also worth noting that living with someone with this disorder can be extremely difficult, too. It’s important to seek support when you need it and there are resources below that can help.
Insurance Coverage for Schizotypal Personality Disorder
Every insurance company will have a different insurance policy so it’s important to contact the relevant provider and ask about their insurance coverage for the specific disorder or for personality disorders. Ask for all the policy details, including outpatient and inpatient treatment, along with the cost for medications etc.
How to Find a Therapist
What Should I be Looking for in an LMHP?
For someone with schizotypal personality disorder, finding a mental health professional can be extremely difficult due to the anxiety over social interactions. Therefore, it may be easier to seek recommendations from a trusted doctor or to research online.
Look for a therapist that has experience in this particular condition, with similar personality disorders and with schizophrenia. It’s important that a therapist will understand the worries and anxieties that someone with this disorder will have, especially those behaviors that will make attending appointments very challenging.
Questions to Ask a Potential Therapist
Ask a potential therapist about their experiences with this disorder and similar and what kind of treatment they usually provide for this condition. You may wish to ask about their insurance policies, particularly about cancelation costs.
You may consider asking a therapist whether they do home visits or can provide therapy a third location that both parties would be comfortable attending.
Schizotypal Personality Disorder Resources and Support Helpline
- National Suicide Prevention Lifeline 1-800-273-TALK (1-800-273-8255)
- Mental Health Helpline (855) 653-8178
- National Hopeline Network 800-784-2433
- NAMI (National Alliance for the Mentally Ill) 1-800-950-NAMI (800-950-6264)