Schizotypal personality disorder is a mental health condition that is characterized by a pervasive pattern of intense discomfort with and reduced capacity for close relationships, by distorted ways of thinking and perceiving, and by eccentric (odd) behavior.
People with schizotypal personality disorder may prefer not to interact with people because they feel like they are different and do not belong.
Doctors diagnose schizotypal personality disorder based on specific symptoms, including intense discomfort with close relationships, distorted ways of thinking and perceiving, and odd behavior.
Treatment includes antipsychotic medications, antidepressants, and cognitive-behavioral therapy.
Personality disorders are mental health conditions that involve long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.
People with schizotypal personality disorder are less in touch with reality, and their thought and speech are more disorganized than occurs in other personality disorders. However, thoughts and behavior are not as unusual and out of touch with reality as in schizophrenia.
Schizotypal personality disorder is estimated to occur in less than 1 to 4% of people in the United States. It may be slightly more common among men. Schizotypal personality disorder is less likely to resolve or lessen as people age than most personality disorders.
Other disorders are often also present. Over half of people with schizotypal personality disorder have had at least one episode of major depressive disorder, and 30 to 50% of them have major depressive disorder when schizotypal personality disorder is diagnosed. These people often also have a substance use disorder.
Causes of Schizotypal Personality Disorder
Genes are thought to have an important role in the development of schizotypal personality disorder. It is more common among first-degree relatives (parents, siblings, and children) of people who have schizophrenia or another psychotic disorder.
Symptoms of Schizotypal Personality Disorder
Effect on relationships
People with schizotypal personality disorder do not have close friends or confidants, except for first-degree relatives. They are very uncomfortable relating to people. They interact with people if they have to but prefer not to because they feel like they are different and do not belong. However, they may say their lack of relationships makes them unhappy. They are very anxious in social situations, especially unfamiliar ones. Spending more time in a situation does not ease their anxiety.
People with this disorder may ignore ordinary social conventions (for example, not make eye contact), and because they do not understand usual social cues, they may interact with others inappropriately or stiffly.
Odd thinking and behavior
People with schizotypal personality disorder have odd ways of thinking, perceiving, and communicating. The following are examples:
Ideas of reference: People with these ideas think that ordinary occurrences have special meaning just for them.
Magical thinking: People think that they have magical control over others. For example, they may think that they cause other people to do ordinary things (such as feed the dog) or that they can perform magical rituals to prevent harm (such as washing their hands 3 times to prevent illness).
Paranoia: People are suspicious and mistrustful and wrongfully think that other people are out to get them or intend to harm them.
Paranormal powers: People think they have paranormal powers, enabling them to sense events before they happen or to read other people's minds.
Speech may be odd. It may be excessively abstract or concrete or contain odd phrases or use phrases or words in odd ways. They often dress oddly or in an unkempt way (for example, wearing ill-fitting or dirty clothes) and have odd mannerisms.
Perception of reality
In people with schizotypal disorder, perceptions (what they see, hear, or sense) may be distorted. For example, they may hear a voice whispering their name.
Diagnosis of Schizotypal Personality Disorder
A doctor's evaluation, based on standard psychiatric diagnostic criteria
Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision, (DSM-5-TR), the standard reference for psychiatric diagnosis from the American Psychiatric Association.
For doctors to diagnose schizotypal personality disorder, people must be intensely uncomfortable with and have very few close relationships and have odd thinking and behavior. They must also have at least 5 of the following:
Ideas of reference
Odd beliefs or magical thinking
Distorted perceptions
Odd thought and speech
Suspicions or paranoid thoughts
Inappropriate or limited expression of emotion
Odd, eccentric, or peculiar behavior and/or appearance
Lack of close friends or confidants, except first-degree relatives
Excessive social anxiety that does not lessen with familiarity and is related mainly to paranoid fears
Also, symptoms must have begun by early adulthood.
Doctors must distinguish schizotypal personality disorder from schizophrenia, which causes similar, but more severe symptoms.
Treatment of Schizotypal Personality Disorder
Antipsychotic medications and antidepressants
Cognitive-behavioral therapy
The general principles for treatment of schizotypal personality disorder are the same as those for all personality disorders.
The main treatment for schizotypal personality disorder is medications. Antipsychotic medications (used to treat schizophrenia) lessen anxiety and other symptoms. Newer (second-generation) antidepressants may also help lessen anxiety in people with schizotypal personality disorder.
Cognitive-behavioral therapy that focuses on acquiring social skills and managing anxiety can help. Such therapy can also make people more aware of how their own behavior may be perceived.
Doctors try to establish an emotional, encouraging, supportive relationship with people who have this personality disorder and thus help them learn to relate to others in more appropriate ways.
