Schizotypal personality disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 26, 2016
StartDiseasesSchizotypal personality disorder

Schizotypal personality disorder is a mental disorder in which a person exhibits unusual beliefs, paranoia, poor communication and reduced capacity for relationships. It is possibly related to schizophrenia, but it is not as severe in nature.

Contents

Definition & Facts

Schizotypal personality disorder is defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a Cluster A personality disorder. Like other Cluster A disorders, a common symptom is social withdrawal and awkwardness. A person with this disorder experiences severe anxiety or discomfort in social situations, and they have difficulty forming and maintaining close relationships with others.

In addition, they often have a tendency to be more superstitious and paranoid than the general population. They may believe in telepathy, ESP, telekinesis, and so on. Some people with schizotypal personality disorder have reported being able to hear thoughts or have complained of thoughts being stolen from their heads. The occurrence of schizotypal personality disorder in the general population ranges anywhere from 0.6% to 4.6%. It is slightly more common among men than women.

Symptoms & Complaints

The most common symptoms of schizotypal personality disorder are social in nature. A person with this disorder will have acute anxiety in social settings, may have a fear of people, and will lack confidants or close friends other than relatives.

They also will have deficits in emotional and verbal communication. Their speech tends to be odd and rambling, over-elaborate, and difficult to understand. They will exhibit inappropriate emotional displays or lack of emotion. People with schizotypal personality disorder typically are overly superstitious or suspicious, and will have excessive anxiety due to paranoia as opposed to self-consciousness.

Another symptom is thought patterns that deviate from reality. This can include holding unusual beliefs that are not consistent with cultural norms, such as a belief in the supernatural or in mental powers such as telepathy. Ideas of reference, or incorrectly interpreting casual, external events to have significant and unusual meaning, are also common.

They may have mild visual hallucinations, possibly seeing momentarily seeing flashes of light or shadows. They may also experience brief psychotic episodes in response to psychological stress. These symptoms typically begin in early adulthood and present in a variety of contexts.

Causes

A genetic link with schizophrenia has been suggested, as schizotypal personality disorder is more common among relatives of people with schizophrenia. Some practitioners consider the disorder to be on the "schizophrenia spectrum." However, there is little evidence that people with schizotypal personality disorder will go on to develop schizophrenia.

It is also suggested that there is a link to attentional deficit disorders, the reasoning being that people who have difficulty processing information can have extra trouble in social situations, where it's necessary to pay attention to a wide variety of spoken and unspoken cues. Such people may withdraw from socializing, causing or exacerbating many of the social-related symptoms of schizotypal personality disorder.

There is evidence that social and environmental factors can cause the development of schizotypal personality disorder. Family dysfunction, psychological trauma, neglect or abuse increases the risk of developing schizotypal traits. It's theorized that this is due to the abuse interrupting the process by which children learn to respond appropriately to social cues.

Diagnosis & Tests

A mental health professional can diagnose schizotypal personality disorder by comparing the patient's symptoms and personal history to a list of symptoms found in an authoritative resource such as the DSM-5 or the ICD-10. For the former, the patient must present with at least five of the following symptoms:

  • Severe social anxiety
  • Lack of close relationships
  • Inappropriate affect
  • Paranoia
  • Strange speech
  • Strange behavior or appearance
  • Magical thinking
  • Abnormal perceptual experiences

The traits must occur in adult subjects for it to be considered a personality disorder. Generally, they must be observed occurring in multiple contexts for at least a year. The traits should cause impairment or distress in the subject's day to day life. It is more likely in adults age 20 to 40, with the traits becoming less noticeable as the patient grows older.

Schizotypal personality disorder has a high rate of comorbidity with borderline personality disorder, paranoid personality disorder, avoidant personality disorder, and other personality disorders. Presence of these may influence a diagnosis.

Treatment & Therapy

Medication is sometimes prescribed when schizotypal personality disorder is comorbid with other disorders. When the patient's behavior appears more schizophrenic in nature, they may be prescribed antipsychotic drugs such as haloperidol and thiothixene. When the patient appears more obsessive-compulsive disorder, then SSRIs like sertraline may be more beneficial. The anticonvulsant lamotrigine is used to help stabilize moods.

Schizotypal personality disorder can be difficult to treat using therapy. Patients typically are not aware of the effect of their disorder on others and may simply see themselves as eccentric and nonconformist. Cognitive behavioral therapy (CBT) is a form of psychotherapy used to help the patient identify distorted thought patterns and learn how to alter them. It may also be used to teach better social skills and how to avoid problematic behavior.

Family therapy can be used to improve the patient's personal relationships, reduce in-home fighting and increase familial support. One-on-one support is most effective. Group therapy is not typically recommended due to the socially anxious nature of most patients.

Prevention & Prophylaxis

Prevention of a personality disorder such as schizotypal personality disorder is not currently possible. However, the effects of the disorder can be mitigated through early identification and treatment.

While a formal diagnosis cannot be given until the patient is an adult, there are childhood behavior precursors that can be useful in early identification.

As children, individuals with schizotypal personality disorder are typically solitary and have poor relationships with peers, often being the victims of teasing and bullying. They may underperform in school, be hypersensitive to external stimuli, and engage in vivid, sometimes bizarre fantasies.