4. Schizotypal disorder

Schizotypal disorder is characterized by oddities of appearance, behaviour, and speech, and anomalies of thinking similar to those seen in schizophrenia. Anomalies of thinking may include odd beliefs, magical thinking (for example, thinking that words affect the world—‘speak of the devil and he’ll appear’), suspiciousness, obsessional ruminations, and unusual perceptual experiences. A person with schizotypal disorder often fears social interaction and sees other people as ill-intentioned and potentially harmful. This may lead him or her to develop so-called ‘ideas of reference’, which are fleeting impressions that objects, people, or situations have a special significance for him or her. For example, he or she may have the impression that strangers on the bus are talking about him or her, or that the traffic warden’s signaling is an elaborate means of revealing his or her destiny. Compared to the average person, people who suffer from schizotypal disorder have a relatively high probability of ‘converting’ to schizophrenia at some time in the future; for this reason, schizotypal disorder has historically been referred to as ‘latent 

Schizotypal Personality Disorder Symptoms

By PSYCH CENTRAL STAFF

Schizotypal personality disorder is characterized by someone who has  great difficulty in establishing and maintaining close relationships with others. A person with schizotypal personality disorder may have extreme discomfort with such relationships, and therefore have less of a capacity for them. Someone with this disorder usually has cognitive or perceptual distortions as well as eccentricities in their everyday behavior.

Individuals with Schizotypal Personality Disorder often have ideas of reference (e.g., they have incorrect interpretations of casual incidents and external events as having a particular and unusual meaning specifically for the person). People with this disorder may be unusually superstitious or preoccupied with paranormal phenomena that are outside the norms of their subculture.

Individuals with Schizotypal Personality Disorder often seek treatment for the associated symptoms of anxiety, depression, or other dysphoric affects rather than for the personality disorder features per se.

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Symptoms of Schizotypal Personality Disorder

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

Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.

Schizotypal personality disorder appears in about 3.9 percent of the general population according to NESARC research.

Like most personality disorders, schizotypal personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

How is Schizotypal Personality Disorder Diagnosed?

Personality disorders such as  schizotypal personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or  psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose schizotypal personality disorder.

Many people with schizotypal personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis for schizotypal  personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Causes of Schizotypal Personality Disorder

Researchers today don’t know what causes  schizotypal personality disorder.  There are many theories, however, about the possible causes of  schizotypal personality disorder.  Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of  are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.

Treatment of Schizotypal Personality Disorder

Treatment of  schizotypal personality disorder  typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see schizotypal personality disorder treatment.

Schizotypal Personality Disorder

What Are Personality Disorders?

People with personality disorders have long-standing patterns of thinking and acting that differ from what society considers usual or normal. The inflexibility of their personality can cause great distress, and can interfere with many areas of life, including social and work functioning. People with personality disorders generally also have poor coping skills and difficulty forming healthy relationships.

Unlike people with anxiety disorders, who know they have a problem but are unable to control it, people with personality disorders generally are not aware that they have a problem and do not believe they have anything to control.

What Is Schizotypal Personality Disorder?

Schizotypal personality disorder is one of a group of conditions called eccentric personality disorders. People with these disorders often appear odd or peculiar. They may display unusual thinking patterns, behaviors, or appearances.

People with schizotypal personality disorder may have odd beliefs or superstitions. These individuals are unable to form close relationships and tend to distort reality. In this respect, schizotypal personality disorder can seem like a mild form of schizophrenia -- a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. In rare cases, people with schizotypal personality disorder can eventually develop schizophrenia.

What Are the Symptoms of Schizotypal Personality Disorder?

People with schizotypal personality disorder display a combination of odd behavior, speech patterns, thoughts, and perceptions. Other people often describe these individuals as strange or eccentric. Additional traits of people with this disorder include the following:

• Dressing, speaking, or acting in an odd or peculiar way
• Being suspicious and paranoid
• Being uncomfortable or anxious in social situations due to their distrust of others
• Having few friends and being extremely uncomfortable with intimacy
• Tending to misinterpret reality or to have distorted perceptions (for example, mistaking noises for voices)
• Having odd beliefs or magical thinking (for example, being overly superstitious or thinking of themselves as psychic)
• Being preoccupied with fantasy and daydreaming
• Tending to be stiff and awkward when relating to others
• Coming across as emotionally distant, aloof, or cold

What Causes Schizotypal Personality Disorder?

Genetics may play a role in the development of schizotypal personality disorder. This disorder is more common in relatives of people with schizophrenia and typically develops in early adulthood.

How Is Schizotypal Personality Disorder Diagnosed?

If symptoms are present, a health care professional will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate someone for a personality disorder.

How Is Schizotypal Personality Disorder Treated?

People with schizotypal personality disorder rarely seek treatment for the disorder itself. When they do seek treatment, it most often is due to a related disorder, such as depression or anxiety.

Psychotherapy -- a form of counseling -- is the form of treatment most often used. The goal of therapy is to help a person change his or her habits of thinking and behavior, and to develop more appropriate social skills. Through treatment, people with this disorder can be taught to recognize when they are distorting reality.

People with schizotypal personality disorder who also suffer from another disorder, such as anxiety or depression, might benefit frommedication, such as an antidepressant or anti-anxiety drug. In some instances, especially at times of crises or extreme stress, severe symptoms might develop, requiring a brief period of hospitalization.

Treatment for people with this disorder is most effective when family members are involved and supportive.

What Complications Are Associated With Schizotypal Personality Disorder?

People with this disorder might be at risk for developing anxiety or depression. They also tend to have poor social skills and lack fulfilling relationships. Without treatment, people with this disorder can become even more uncomfortable in social situations, which can lead to greater isolation.

What Is the Outlook for People With Schizotypal Personality Disorder?

The outlook with schizotypal personality disorder varies with its severity. The outlook generally improves for a person who seeks and complies with treatment. With treatment, some people experience significant improvement while others do not.

Can Schizotypal Personality Disorder Be Prevented?

At this time, there is no known way to prevent schizotypal personality disorder. However, assessing the risk for the disorder, such as having a family history of schizophrenia, might allow for early diagnosis and treatment.

Schizotypal Personality Disorder

In-depth look at Schizotypal Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.

Schizotypal personality disorder is characterized by an ongoing pattern in which the affected person distances him- or herself from social and interpersonal relationships. Affected people typically have an acute discomfort when put in circumstances where they must relate to others. These individuals are also prone to cognitive and perceptual distortions and a display a variety of eccentric behaviors that others often find confusing.

People with schizotypal personality disorder are more comfortable turning inward, away from others, than learning to have meaningful interpersonal relationships. This preferred isolation contributes to distorted perceptions about how interpersonal relationships are supposed to happen. These individuals remain on the periphery of life and often drift from one aimless activity to another with few, if any, meaningful relationships.

A person with schizotypal personality disorder has odd behaviors and thoughts that would typically be viewed by others as eccentric, erratic, and bizarre. They are known on occasion to have brief periods of psychotic episodes. Their speech, while coherent, is marked by a focus on trivial detail. Thought processes of schizotypals include magical thinking, suspiciousness, and illusions. These thought patterns are believed to be the schizotypal's unconscious way of coping with social anxiety. To some extent, these behaviors stem from being socially isolated and having a distorted view of appropriate interpersonal relations.

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What are the signs and symptoms of Schizotypal Personality Disorder?

Classic schizotypal personalities are apt to be loners, having few to no intimate relationships. They exhibit extreme anxiety in social situations, often associated more with distrust and an inability to communicate with others than with a negative self-image. They view themselves as alien or forlorn, and this isolation causes pain as they disengage more and more from relationships and the outside world.

People with schizotypal personalities often have odd patterns of speech and ramble endlessly on subjects tangent to a topic of conversation. They may dress in peculiar ways and have very strange ways of viewing the world around them. Often they harbor unusual ideas, such as believing in the powers of ESP or a "sixth sense." At times, they believe they can magically influence people's thoughts, actions and emotions.

In adolescence, signs of a schizotypal personality may begin as a gravitation toward solitary activities or a high level of social anxiety. The child may be an underperformer in school or appear socially out-of-step with peers, and as a result often becomes the subject of bullying or teasing.

Symptoms of schizotypal personality disorder include:

• Incorrect interpretation of events, including feeling that external events have personal meaning
• Peculiar thinking, beliefs or behavior
• Belief in special powers, such as telepathy
• Perceptual alterations, in some cases bodily illusions, including "phantom pains" or other distortions in the sense of touch
• Idiosyncratic speech, such as loose or vague patterns of speaking or tendency to go off on tangents
• Suspicious or paranoid ideas
• Flat emotions or inappropriate emotional responses
• Lack of close friends outside of the immediate family
• Persistent and excessive social anxiety that doesn't abate with time

Schizotypal personality disorder can easily be confused with schizophrenia, which is characterized by intense psychosis, a severe mental state characterized by a loss of contact with reality. While schizotypal personalities may experience brief psychotic episodes with delusions or hallucinations, they are not as pronounced, frequent or intense as in schizophrenia.

Both disorders, along with schizoid personality disorder, belong to what's generally referred to as the "schizophrenic spectrum." Schizotypal personality falls in the middle of the spectrum, with schizoid personality disorder on the milder end and schizophrenia on the more severe end.

DSM IV Criteria for Schizotypal Personality Disorder

A pervasive 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

What causes someone to develop Schizotypal Personality Disorder?

Schizotypal personality disorder is believed to stem from the affected person's original family, or family of origin. Usually the parents of the affected person were emotionally distant, formal, and displayed confusing parental communication. This modeling of remote, unaffectionate relationships is then reenacted in the social relationships encountered in the developing years. The social development of people with schizotypal personality disorder shows that many were also regularly humiliated by their parents, siblings, and peers resulting in significant relational mistrust. Many display low self-esteem, self-criticism and self-deprecating behavior. This further contributes to a sense that they are socially incapable of having meaningful interpersonal relationships.

What are the risk factors linked to Schizotypal Personality Disorder?

Schizotypal personality disorder appears to occur more frequently in individuals who have an immediate family member with schizophrenia. The prevalence of schizotypal personality disorder is approximately 3% of the general population and is believed to occur slightly more often in males.

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Factors that increase the risk of developing the schizotypal personality disorder include:

• Having a relative who has schizophrenia
• Living in a childhood environment of deprivation or neglect
• Experiencing child abuse or mistreatment
• Undergoing a childhood trauma
• Having an emotionally detached parent

How is Schizoid Schizotypal Personality Disorder diagnosed?

The symptoms of schizotypal personality disorder may begin in childhood or adolescence showing as a tendency toward solitary pursuit of activities, poor peer relationships, pronounced social anxiety, and underachievement in school. Other symptoms that may be present during the developmental years are hypersensitivity to criticism or correction, unusual use of language, odd thoughts, or bizarre fantasies. Children with these tendencies appear socially out-of-step with peers and often become the object of malicious teasing by their peers, which increases the feelings of isolation and social ineptness they feel. For a diagnosis of schizotypal personality disorder to be accurately made, there must also be the presence of at least four of the above-mentioned symptoms.

The symptoms of schizotypal personality disorder can sometimes be confused with the symptoms seen in schizophrenia. The bizarre thinking associated with schizotypal personality disorder can be perceived as a psychotic episode and misdiagnosed. While brief psychotic episodes can occur in the patient with schizotypal personality disorder, the psychosis is not as pronounced, frequent, or as intense as in schizophrenia. For an accurate diagnosis of schizotypal personality disorder, the symptoms for schizotypal cannot occur exclusively during the course of schizophrenia or other mood disorder that has psychotic features.

Another common difficulty in diagnosing schizotypal personality disorder is distinguishing it from other the schizoid, avoidant, and paranoid personality disorders. Some researchers believe that schizotypal personality disorder is essentially the same disorder as schizoid, but many feel there are distinguishing characteristics. Schizoids are deficient in their ability to experience emotion, while schizotypals are more pronounced in their inability to understand human motivation and communication. While avoidant personality disorder has many of the same symptoms as schizotypal personality disorder, the distinguishing symptom in schizotypal is the presence of behavior that is noticeably eccentric. The schizotypal differs from the paranoid by tangential thinking and eccentric behavior.

The diagnosis of schizotypal personality disorder is based on a clinical interview to assess symptomatic behavior. Other assessment tools helpful in confirming the diagnosis of schizotypal personality disorder include:

• Minnesota Multiphasic Personality Inventory(MMPI-2)
• Millon Clinical Multiaxial Inventory (MCMI-II)
• Rorschach Psychodiagnostic Test
• Thematic Apperception Test(TAT)

How is Schizotypal Personality Disorder treated?

The patient with schizotypal personality disorder finds it difficult to engage and remain in treatment. For those higher-functioning individuals who seek treatment, the goal will be to help them function more effectively in relationships rather than restructuring their personality.

Psychodynamically oriented therapies
A psychodynamic approach would typically seek to build a therapeutically trusting relationship that attempts to counter the mistrust most people with this disorder intrinsically hold. The hope is that some degree of attachment in a therapeutic relationship could be generalized to other relationships. Offering interpretations about the patient's behavior will not typically be helpful. More highly functioning schizotypals who have some capacity for empathy and emotional warmth tend to have better outcomes in psychodynamic approaches to treatment.

Cognitive-behavioral therapy
Cognitive approaches will most likely focus on attempting to identify and alter the content of the schizotypal's thoughts. Distortions that occur in both perception and thought processes would be addressed. An important foundation for this work would be the establishment of a trusting therapeutic relationship. This would relax some of the social anxiety felt in most interpersonal relationships and allow for some exploration of the thought processes. Constructive ways of accomplishing this might include communication skills training, the use of videotape feedback to help the affected person perceive his or her behavior and appearance objectively, and practical suggestions about personal hygiene, employment, among others.

Interpersonal therapy
Treatment using an interpersonal approach would allow the individual with schizotypal personality disorder to remain relationally distant while he or she "warms up" to the therapist. Gradually the therapist would hope to engage the patient after becoming "safe" through lack of coercion. The goal would be to develop trust in order to help the patient gain insight into the distorted and magical thinking that dominates. New self-talk can be introduced to help orient the individual to reality-based experience. The therapist can mirror this objectivity to the patient.

Group therapy
Group therapy may provide the patient with a socializing experience that exposes them to feedback from others in a safe, controlled environment. It is typically recommended only for schizotypals who do not display severe eccentric or paranoid behavior. Most group members would be uncomfortable with these behavioral displays and it would likely prove destructive to the group dynamic.

Family and marital therapy
It is unlikely that a person with schizoid personality disorder will seek family or marital therapy. Many schizoid types do not marry and end up living with and being dependent upon first-degree family members. If they do marry they often have problems centered on insensitivity to their partner's feelings or behavior. Marital therapy (couples therapy) may focus on helping the couple to become more involved in each other's lives or improve communication patterns.

Medications
There is considerable research on the use of medications for the treatment of schizotypal personality disorder due to its close symptomatic relationship with schizophrenia. Among the most helpful medications are the antipsychotics that have been shown to control symptoms such as illusions and phobic anxiety, among others. Amoxapine (trade name Asendin), is a tricyclic antidepressant with antipsychotic properties, and has been effective in improving schizophrenic-like and depressive symptoms in schizotypal patients. Other antidepressants such as fluoxetine (Prozac) have also been used successfully to reduce symptoms of anxiety, paranoid thinking, and depression.

Prognosis
The prognosis for the individual with schizotypal personality disorder is poor due to the ingrained nature of the coping mechanisms already in place. Schizotypals who depend heavily on family members or others are likely to regress into a state of apathy and further isolation. While some measurable gains can be made with mildly affected individuals, most are not able to alter their ingrained ways of perceiving or interpreting reality. When combined with poor social support structure, most will not enter any type of treatment.

Sources:

• American Psychiatric Association pamphlet on Personality Disorders
• American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC.
• NIMH
• Wikipedia: Schizotypal Personality Disorder