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Schizotypal Personality Disorder:
Mild Schizophrenia?
Schizotypal personality disorder is a mental disorder related to schizophrenia. Symptoms of schizotypal personality disorder are actually so similar to schizophrenia that some researchers speculate the personality disorder is actually a mild variety of schizophrenia. The personality disorder is marked by impaired interpersonal skills, disturbed thought patterns, and unusual behavior or physical appearance.
Defining Schizotypal Personality Disorder
The DSM-IV offers the following definition of 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..."
From an observer's standpoint, this means that individuals with schizotypal personality disorder appear unusually uncomfortable in social situations and possess poor social skills. Social difficulties are compounded by their tendency to behave oddly, to hold unusual or irrational beliefs, and often to dress or speak in a strange manner.
Causes of Schizotypal Personality Disorder and Relationship to Schizophrenia
Like most types of personality disorders, the cause of schizotypal personality disorder is unknown. Researchers have suggested that the personality disorder is closely related to schizophrenia, and schizotypal personality disorder is more common in families with a history of schizophrenia. This connection has suggested a genetic basis for schizotypal personality disorder, but definitive proof of a genetic cause has yet to be found.
Symptoms and Diagnosis of Schizotypal Personality Disorder
Social impairment and isolation are common signs of schizotypal personality disorder. Individuals with the personality disorder do not desire social isolation; isolation results from continuously experiencing intense discomfort in social situations, and enduring the negative reactions to the unusual beliefs and behavior exhibited by so many schizotypal personality disorder sufferers.
Abnormal behavior patterns and beliefs vary in severity among people with schizotypal personality disorder. Severe cases may closely resemble schizophrenic delusions, including bizarre claims and paranoia (believing that dogs are government agents, for instance, or that news reporters are capable of mind control).
In most cases, people with schizotypal personality disorder act eccentrically, and have unusual (but not severely delusional) beliefs. An individual may have a strong belief in the paranormal or government conspiracy theories, for instance. These beliefs are deeply held, and when combined with social discomfort, have a negative impact on the individual's career and relationships.
Ideas of reference" is a common symptom of schizotypal personality disorder. Ideas of reference is a clinical term describing the belief that the individual is the center and cause of all events. For instance, if someone laughs, the schizotypal personality disorder assumes that person laughs at him.
When diagnosing schizotypal personality disorder, certain life habits and signs are looked for. These include:
- inappropriate displays of emotion
- no close friends
- odd beliefs, ideas of reference, or fantasies
- odd or eccentric appearance
- social discomfort
- unusual speech patterns
- unusual, eccentric behavior.
Taken alone, none of these symptoms are proof of schizotypal personality disorder. For a diagnosis to be considered, the patient must display at least five of the criteria for the disorder as described in the DSM-IV:
- has ideas of reference (excluding delusions of reference)
- has 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)
- has unusual perceptual experiences, including bodily illusions
- has odd thinking and speech (e.g. speech that isvague, circumstantial, metaphorical, overelaborate, or stereotyped)"
- exhibits suspiciousness or paranoid ideation
- displays inappropriate or constricted affect
- displays behavior or appearance that is odd, eccentric, or peculiar
- has a lack of close friends or confidants other than first-degree relatives
- experiences excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
From the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, 1994.
Differential Diagnosis of Schizotypal Personality Disorder
Even if an individual meets the DSM-IV requirements for a schizotypal personality disorder diagnosis, other conditions exist that must be ruled out before a firm diagnosis is made. Many people display some degree of schizotypal behavior during adolescence, for instance, which resolves by the time they reach adulthood. It is for this reason that schizotypal personality disorder is only diagnosed in adulthood.
Certain physical medical conditions, drug interactions, and chronic substance abuse can also result in symptoms that mimic schizotypal personality disorder, as can certain language and communication disorders. Certain types of mental disorders and personality disorders can also produce similar symptoms, including:
- Asperger's syndrome
- autism
- avoidant personality disorder
- borderline personality disorder
- delusion disorder
- narcissistic personality disorder
- paranoid personality disorder
- schizoid personality disorder
- schizophrenia.
Schizotypal Personality Disorder Treatments
Treatments for schizotypal personality disorder have not received much study. In part, this is because the disorder's symptoms make it unlikely an individual will seek treatment without outside intervention, and social isolation makes such intervention unlikely. Antipsychotic medication has met with some success with severe cases of schizotypal personality disorder, although if psychoses continue with medication, a different mental or medical condition must be considered.
SSRIs (selective serotonin reuptake inhibitors) are a family of antidepressants that may be used to treat depression arising from social anxiety and isolation. However, when taken with antipsychotics, antidepressants have the potential to cause more severe psychotic symptoms.
Therapy, either individually or in groups, is generally favored over medications for patients with schizotypal personality disorder. Prognosis varies from individual to individual, but generally schizotypal personality disorder is a chronic condition that will follow patients throughout life. Treatment can alleviate symptoms, but not cure the disorder.
Resources
American Psychiatric Association. Diagnostic criteria for 301.22: Schizotypal personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, Washington, DC, 1994.
Long, P. (nd). Schizotypal personality disorder.
National Library of Medicine. (updated 2003). Schizotypal personality disorder.MedlinePlus Medical Encyclopedia.
National Mental Health Association. (nd). Personality disorders.
Psychology Today. (nd). Schizotypal personality disorder.
