Schizotypal Personality Disorder

What Is It?

Schizotypal personality disorder, like other personality disorders, is a long-standing pattern of behavior and experience. As part of that pattern, the individual either has difficulty functioning or experiences a great deal of distress.

People with schizotypal personality disorder are loners who prefer to keep their distance from others, and are uncomfortable being in relationships. They sometimes exhibit odd speech or behavior and have a limited or flat range of emotions.

These people also tend to have distorted thinking, with unusual ideas that are not consistent with prevailing cultural beliefs, for example, a strong belief in extra sensory perception (ESP). They may report unusual perceptions or strange body experiences.

Schizotypal personality disorder is in the middle of a spectrum of related disorders, with schizoid personality disorder on the milder end and schizophrenia on the more severe end. These disorders are probably biologically related. Many experts believe that people with these disorders have similar genetic vulnerabilities, but it is not clear why a person would develop a more or less severe form of the illness.

The word schizoid (at the root of all three words) means a tendency to be socially withdrawn or have a restricted range of emotional expression. The prefix "schizo-" comes from Greek, and means split, but these illnesses do not involve a split personality.

Many people with schizotypal personality disorder have subtle difficulties with memory, learning and attention. They usually do not have the more severe and disabling psychotic symptoms, such as delusions and hallucinations, that appear in schizophrenia. However, people with schizotypal personality disorder sometimes develop schizophrenia.

The pattern begins early in adulthood and continues throughout life. It appears more often in men than in women. Symptoms of depression and anxiety are quite common, with about half of people with this disorder having an episode of major depression at some point during life. Thinking may become more distorted in stressful circumstances.

Symptoms

The core symptoms of schizotypal personality disorder are:

• Feelings that external events have an unusual personal meaning
• Unusual thinking, beliefs, perceptions or behavior
• Odd speech
• Suspicious or paranoid ideas
• Bland or strange emotional responses
• Lack of close friends outside the family
• Excessive, persistent social anxiety

Diagnosis

Schizotypal personality disorder is diagnosed on the basis of a person's symptoms and history, usually by a mental health professional. There are no laboratory tests to determine if a person has this disorder. In order to differentiate schizotypal personality disorder from other mental disorder, the professional will look for signs of a mood or anxiety disorder, or the presence of psychotic thinking.

Expected Duration

All personality disorders are long-lasting (chronic). This disorder is a lifelong pattern. In contrast to an illness like depression, the pattern does not come and go.

Prevention

There is no way to prevent this disorder, but early intervention may reduce symptoms and improve functioning over the long term.

Treatment

Schizotypal personality disorder often is treated with a combination of medication and psychotherapy.

Medications are available to treat prominent symptoms. Distorted thinking is improved by antipsychotic medications, such as risperidone (Risperdal) and olanzapine (Zyprexa). Even low doses sometimes can help significantly. Depression and anxiety can be treated with antidepressant and antianxiety medications. Selective serotonin reuptake inhibitors (SSRIs) for example, fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) may be particularly helpful if depression and anxiety are present.

People with schizotypal personality disorders may find psychotherapy difficult because of their discomfort with relationships. However, a person with this disorder may be able to develop a trusting relationship with a therapist who appreciates his or her need for distance and who understands the nature of the discomfort.

Since people with this disorder have difficulty picking up on social cues, it is often necessary to teach specific social skills, for example, explaining that certain behaviors may be seen by others as rude or off-putting. Similarly, it is useful to teach the person how his or her thoughts and perceptions are distorted. The difficulties in social interactions can lead to personal disappointment and poor self-image throughout life. This may be an important focus of supportive psychotherapy.

If a person's symptoms are mild to moderate, he or she may be able to adjust with relatively little support. If the problems are more severe, the person may have more difficulty maintaining a job or living independently. For example, routine interactions at work may be very awkward or may provoke anxiety. The person may not be able to accomplish daily tasks like shopping for food or other necessities. A person with schizotypal personality disorder may need more support from family members or the structure of a residential treatment setting. He or she also may need a job that requires little, if any, social interaction. It is also good if a supervisor is willing to accommodate the person's eccentricities.

When To Call A Professional

Since personality styles tend to become more entrenched as people get older, it is best to seek treatment as soon as significant distress or poor functioning is noticed.

Prognosis

The outlook for schizotypal personality disorder is variable and depends on many factors, including the severity of the symptoms, the availability of support, how much the person's ability to function is impaired, the presence of depression or anxiety, and the person's ability to participate in treatment.

It is probably not realistic to expect a person with schizotypal personality disorder to become very comfortable socially. However, some respond very well to treatment with medication, and learn to find work, relationships and leisure activities that are a good fit for their personality style.

Additional Info

American Psychiatric Association

1400 K St., NW

Washington, DC 20005

Toll-Free: (888) 357-7924

Fax: (202) 682-6850

E-Mail: apa@psych.org

http://www.psych.org/

American Psychological Association

750 First St., NE

Washington, DC 20002-4242

Phone: (202) 336-5510

Toll-Free: (800) 374-2721

TTY: (202) 336-6123

Fax: (202) 336-5500

http://www.apa.org/

National Alliance for the Mentally Ill

Colonial Place Three

2107 Wilson Blvd.

Suite 300

Arlington, VA 22201-3042

Phone: (703) 524-7600

Toll-Free: (800) 950-6264

http://www.nami.org/

National Mental Health Association

2001 N. Beauregard St., 12th Floor

Alexandria, VA 22311

Phone: (703) 684-7722

Fax: (703) 684-5968

Toll-Free: (800) 969-6642

TTY: (800) 433-5959

http://www.nmha.org/

National Institute of Mental Health

6001 Executive Blvd.

Room 8184, MSC 9663

Bethesda, MD 20892-9663

Phone: (301) 443-4513

E-Mail: nimhinfo@nih.gov

http://www.nimh.nih.gov/