Schizotypal Personality Disorder is a complex mental condition which can produce eccentric behavior and affect the daily life of sufferers in multiple ways. However, with treatment, many people can have productive and satisfactory lives.
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Schizotypal Personality Disorder: What Does It Mean?
Schizotypal Personality Disorder is a serious mental illness manifested over a long period in the form of acute social discomfort and anxiety accompanied by periods of suspiciousness and paranoia. Sufferers tend to lack close friends, experience social isolation, and be rather odd in their way of speaking, dressing, and ideas. Symptoms normally develop in early adulthood.
Stats: How Many Suffer from this Disorder?
It is estimated that Schizotypal Personality Disorder occurs in between one and two percent of the population. Personality disorders, in general, may be present in as much as 15-percent of the U.S. population.
What Causes Schizotypal Personality Disorder?
The exact cause of Schizotypal Personality Disorder is unclear, but it seems to be genetically inherited. Parents, children, and siblings of someone suffering from a psychotic disorder, such as schizophrenia, are more likely to develop Schizotypal Personality Disorder. It shares many of the brain-based abnormalities associated with schizophrenia. There are also theories that environmental and social factors can influence the development of Schizotypal Personality Disorder.
Signs and Symptoms of Schizotypal Personality Disorder
What are the Common Behaviors/Characteristics?
Most people with this condition only maintain relationships with very close family members. They do not have friends and they do not include themselves in activities or meetings. If forced into a social event, they are acutely uncomfortable and unable to relate to others in an acceptable manner. They suffer anxiety when in a social situation, and this does not ease the longer they remain in the situation.
People with Schizotypal Personality Disorder consider themselves to be different from other people and feel alienated. They are uncomfortable making eye contact, shaking hands, and performing other social niceties. Frequently they misinterpret social cues and come across as distant and detached, and they exhibit few emotions. They generally avoid as much social interaction as possible and keep all contact to a minimum. However, they do this due to their fear of interaction rather than a lack of need for it, as many sufferers express the desire to make friends and have better interpersonal relationships but are unable to do so.
Very often sufferers of Schizotypal Personality Disorder dress in a peculiar fashion and they are frequently unkempt and dirty. When they do speak it is usually a one-sided rhetoric, often with a very exaggerated language and with strange phrasing and misusage of common words and expressions. They tend to ramble on in a disconnected way, oblivious to the listener.
Due to their difficulty in relating to people, others may not notice the strange and eccentric behavior seen in this disorder. However, close family members will discover that the sufferer thinks, communicates and perceives circumstances in a distorted way.
Frequently people with Schizotypal Personality Disorder experience periods of distrust and paranoia. They think that people are planning, plotting or talking about them, and they believe that they are being persecuted, followed, or are the subject of conspiracies. Sometimes these delusions can be quite specifically related to a certain group of people or situation.
Many believe that they have magical powers and that they can influence the outcome of unrelated actions or events, also known as magical thinking. Some exhibit an exaggerated interest and conviction in paranormal activities and the supernatural, believing themselves to be a channel or a catalyst for this type of energy. Some perform rituals which they believe can prevent bad things happening to them or to others, and they are often very superstitious. Frequently they feel that unrelated occurrences are directly related to them, and they can misinterpret a situation as having a special relevance just for them.
People with this condition often experience perceptual distortions. They may see and hear things not as they really are. These are not the full-blown hallucinations encountered in other psychotic illnesses, such as schizophrenia, but more a misinterpretation of a perception. Some may suffer from voices which whisper in their ear, but these murmurings are generally limited to relatively inoffensive interventions, unlike in some illnesses where they can incite violent or destructive actions.
Frequently people with Schizotypal Personality Disorder engage in conversations with themselves. This differs from the frequently encountered, talking to oneself, which most people do at some time, in that it is an ongoing interactive conversation where the person contributes both sides of the conversation.
Testing: What are the Diagnostic Criteria Per the DSM 5?
According to the American Psychiatric Association, Schizotypal Personality Disorder is defined as: “An all-inclusive pattern of interpersonal and social deficits, which manifest as an acute discomfort with, or a decreased capacity for, close personal relationships. It also involves perceptual or cognitive behavioral eccentricities that begin in the late teens and present themselves in many different contexts”
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) defines Schizotypal Personality Disorder as follows:
- Significant impairments in personality functioning manifest by:
- Impairments in self-functioning
- Identity: Confused boundaries between self and others; distorted self-concept; emotional expression often not congruent with context or internal experience.
- Self-direction: Unrealistic or incoherent goals; no clear set of internal standards.
- Impairments in interpersonal functioning:
- Empathy: Pronounced difficulty understanding impact of own behaviors on others; frequent misinterpretations of others‟ motivations and behaviors.
- Intimacy: Marked impairments in developing close relationships, associated with mistrust and anxiety.
- Pathological personality traits in the following domains:
- Psychoticism, characterized by
- Eccentricity: Odd, unusual, or bizarre behavior or appearance; saying unusual or inappropriate things.
- Cognitive and perceptual dysregulation: Odd or unusual thought processes; vague, circumstantial, metaphorical, overelaborate, or stereotyped thought or speech; odd sensations in various sensory modalities.
- Unusual beliefs and experiences: Thought content and views of reality that are viewed by others as bizarre or idiosyncratic; unusual experiences of reality.
- Detachment, characterized by:
- Restricted affectivity: Little reaction to emotionally arousing situations; constricted emotional experience and expression; indifference or coldness.
- Withdrawal: Preference for being alone to being with others; reticence in social situations; avoidance of social contacts and activity; lack of initiation of social contact.
- Negative Affectivity, characterized by:
- Suspiciousness: Expectations of – and heightened sensitivity to – signs of interpersonal ill-intent or harm; doubts about loyalty and fidelity of others; feelings of persecution.
- The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
- The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.
- The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
More than 50-percent of people who suffer from Schizotypal Personality Disorder suffer from depression and have experienced at least one major depressive episode. People with this condition are also more likely to have a substance abuse disorder.
There are no approved laboratory tests for diagnosis of Schizotypal Personality Disorder.
Schizotypal Personality Disorder and Other Conditions
Schizotypal Personality Disorder vs Schizophrenia
Schizophrenics display many of the same symptoms as those manifested in Schizotypal Personality Disorder, but the level of conviction is far greater in schizophrenia. Auditory and visual hallucinations are much more intense and perceived as real in schizophrenia, whereas in Schizotypal Personality Disorder the sufferer is aware, at least to some degree, that his distorted perception is not reality. In schizophrenia, the voices heard frequently incite the sufferer to perform harm to themselves or to others, and the paranoia and delusions are also experienced more intensely.
Schizotypal Personality Disorder vs Schizoaffective Disorder
Sufferers of Schizotypal Personality Disorder experience more symptoms in their personality and level of social functioning, whereas those with Schizoaffective Disorder display greater delusional patterns and hallucinations, along with more severe problems with depression or anxiety.
Schizotypal Personality Disorder falls into a group of diagnoses called “Cluster A Personality Disorders,” along with schizoid personality disorder and paranoid personality disorder. These disorders are known for causing perceptual distortions and problems with developing interpersonal relationships.
Schizotypal Personality Disorder in Adults/Children
Personality disorders are more pervasive and deeply rooted than most other types of mental disorders and take time to develop. Typically, Schizotypal Personality Disorder will not be diagnosed in individuals under the age of 18, since the brain, as well as the personality, continue to develop and change throughout childhood.
Case History of a Person with Schizotypal Personality Disorder
As a child, “Roger” liked to keep to himself. He rarely joined in group games with his peers or siblings and preferred his own company. His mother thought he was simply a “loner” like his father had been.
During his schooling, “Roger” maintained an average passing rate. His teachers described him as introverted and solitary. Although he was of an academic level to pursue higher education, he refused the opportunity.
Instead, at eighteen he started working in an alternative bookstore. His dress habits became exaggerated and extreme, to the extent that his boss had to ask him to smarten up. His coworkers said he spent most of his time reading esoteric literature, and that as time went on, his conversations and thought patterns became less coherent and more bizarre. They suspected he may have been consuming mind-altering drugs, but “Roger” has denied this.
A heated conversation with a client in the bookstore led to the arrival of the police and “Roger” was arrested and charged with abusive and threatening verbal behavior. While in custody he was seen by a psychiatrist who recommended further testing, which led to the diagnosis of Schizotypal Personality Disorder.
He was started on a course of medication and was required to attend therapy on a weekly basis as part of his bail conditions. Thanks to his brush with the law, “Roger” is now receiving the treatment he needs to help him to live with his diagnosis. His boss agreed to keep him on, and Roger is currently taking his prescribed medication and attending therapy. He says that he feels better since beginning treatment and that he was surprised to discover that he had a mental illness.
How to Deal/Coping with Schizotypal Personality Disorder
For many sufferers of this condition, diagnosis may not occur until there is a personal crisis or until another condition, such as a severe depression, brings the person into contact with the medical community. The diagnosis may come as a surprise to both the patient and the family who usually consider the person to be odd, but not as being mentally ill.
Look out for These Complications/Risk Factors
If there is a history of psychotic disorders in the family, any strange behaviors should be investigated as soon as they are noted. Patients with a diagnosis of Schizotypal Personality Disorder frequently suffer from other mental illnesses, especially depression, and in 30-50-percent of patients, the diagnosis is reached during a major depressive incident. People with this condition are also prone to experimenting with illegal drugs.
Schizotypal Personality Disorder Treatment
Due to the nature of this condition, treatment is aimed at lessening the detrimental effect of the symptoms experienced rather than in achieving a “cure”. Drugs are the primary treatment, supported by cognitive-behavioral therapy. This can help sufferers to appreciate how others see their behavior, teach them how to manage their anxiety in social situations, and aid them to acquire basic social skills. Supportive psychotherapy is also employed to assist the sufferer to build up their trust, establish relationships, and express their emotions.
Possible Medications for Schizotypal Personality Disorder
This condition may be treated with atypical antipsychotic drugs or antidepressants. Second generation antipsychotics such as Clozapine, Olanzapine, Risperidone, Quetiapine, and Ziprasidone are commonly used to reduce psychotic-like symptoms and anxiety. Antidepressants which are commonly used to treat the depression associated with Schizotypal Personality Disorder include Bupropion, Desvenlafaxine, Duloxetine, and Venlafaxine.
Home Remedies to help Schizotypal Personality Disorder
Vitamins and minerals which may be of benefit to sufferers of Schizotypal Personality Disorder include B-vitamins, D-Alanine, D-Serine, Melatonin, N- Acetylcysteine (NAC) and Sarcosine. Additionally, encouraging the sufferer to eat a balanced and varied diet, to avoid alcohol and recreational drugs, and to maintain an acceptable level of personal hygiene can help to reduce symptoms.
Living with Schizotypal Personality Disorder
Many people with a mild level of Schizotypal Personality Disorder may never be diagnosed and can live a relatively normal life without treatment. Those who do receive this diagnosis will respond differently to treatment depending on the level of their condition and their desire and capacity to improve. Although most will retain some level of eccentricity, the negative symptoms can be greatly reduced allowing the sufferer to enjoy a better quality of life. With the correct support and therapies, sufferers can learn to build relationships and reduce their anxiety in social situations so that they can participate in more events.
Insurance Coverage for Schizotypal Personality Disorder
Personality disorders are not covered by health insurance as the condition is long-term and does not present acute symptoms. However, many of the symptoms and effects can be covered by health insurance even though the disorder itself is not. You may be able to claim for treatments, so check with your insurance provider.
How to Find a Therapist
Ask your healthcare team to provide you with a list of therapists who offer appropriate therapies.
What Should I be Looking for in an LMHP?
Check that the therapist holds a relevant and current qualification and works with patients with a diagnosis of Schizotypal Personality Disorder. It is important the sufferer feels safe and comfortable with the therapist as establishing a relationship of trust is vital for therapy to be effective.
Questions to Ask a Potential Therapist
- How does Cognitive-behavioral therapy work?
- For how long would therapy be necessary?
- Would psychotherapy help the condition?
- How long would it take before results are noticed?
Many people with a mild case of Schizotypal Personality Disorder can go undiagnosed. They may be considered eccentric or rather odd, but they can live a relatively “normal” life without medication or therapy. Receiving a diagnosis may help sufferers to feel better about themselves and so to experience an improvement in their condition. Instead of simply feeling different and ostracized, they now have an explanation which can help them to understand their situation. Depending on the severity of the condition, most sufferers can experience an improvement in the debilitating symptoms through the use of prescribed drugs and therapies.
Schizotypal Personality Disorder Resources and Support Helpline
-National Institute of Mental Health: https://www.nimh.nih.gov/index.shtml
-National Rehabilitation Information Center: https://www.naric.com/?q=en/content/resources-specific-disabilities
-National Suicide Prevention Lifeline: 1-800-273-8255 available 24 hrs a day or online at https://suicidepreventionlifeline.org/
-Crisis Text Line: Text “home” to 741741
-Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 1-800-662-HELP (4357) or online at https://findtreatment.samhsa.gov/