Schizotypal personality disorder

Definition

People with schizotypal personality disorder are often described as odd or eccentric, and usually have few, if any, close relationships. They generally don't understand how relationships form, leading to severe anxiety and a tendency to turn inward in social situations.

In schizotypal personality disorder, people also exhibit odd behaviors, respond inappropriately to social cues and hold peculiar beliefs.

Schizotypal personality disorder typically begins in early adulthood and is likely to endure, though symptoms may improve with age. Medications and therapy also may help.

Symptoms

People with classic schizotypal personalities are apt to be loners. They feel extremely anxious in social situations, but they're likely to blame their social failings on others. They view themselves as alien or outcast, and this isolation causes pain as they avoid relationships and the outside world.

People with schizotypal personalities may ramble oddly and endlessly during a conversation. They may dress in peculiar ways and have very strange ways of viewing the world around them. Often they believe in unusual ideas, such as 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 an increased interest in 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.

Schizotypal personality disorder symptoms 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, a severe mental illness in which affected people lose all contact with reality (psychosis). While people with schizotypal personalities may experience brief psychotic episodes with delusions or hallucinations, they are not as frequent or intense as in schizophrenia.

Another key distinction between schizotypal personality disorder and schizophrenia is that people with the personality disorder usually can be made aware of the difference between their distorted ideas and reality. Those with schizophrenia generally can't be swayed from their delusions.

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.

When to see a doctor
Because personality tends to become entrenched as people age, it's best to seek treatment for a personality disorder as early as possible.

People with schizotypal personality are likely to seek help only at the urging of friends or relatives. If you suspect a friend or family member may have the disorder, be on the lookout for certain signs. You might gently suggest that the person seek medical attention, starting with a primary care physician or mental health provider.

Causes

Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of inherited tendencies and environmental factors.

When someone chronically feels or behaves in an inappropriate way, that person has a personality disorder.

In normal development, children learn over time to accurately interpret social cues and respond appropriately. For people with schizotypal personalities, something goes wrong during this process, leading to illogical beliefs, magical thinking and paranoia. What exactly goes wrong isn't known, but it's likely that one or more factors — such as childhood abuse, neglect or stress — cause problems with the way the brain functions.

Risk factors

Factors that appear to increase the risk of schizotypal personality disorder include:

• Having a relative who has schizophrenia or schizotypal personality disorder
• Experiencing neglect or abuse during childhood
• Experiencing trauma during childhood
• Having an emotionally detached parent

Complications

People with schizotypal personality disorder are at an increased risk of:

• Schizophrenia
• Major depression
• Anxiety disorder, characterized by prolonged worry or uneasiness

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you or your family has noticed, and for how long.
• Write down key personal information, including traumatic events in your past and any current, major stressors.
• Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications or supplements you're taking.
• Take a family member or friend along, if possible. Someone who has known you for a long time may be able to ask questions or share information with the doctor that you don't remember to bring up.
• Write down the questions you want to be sure to ask your doctor so that you can make the most of your appointment.

For schizotypal personality disorder, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are possible causes for my symptoms or condition?
• Is my condition likely temporary or chronic?
• What treatments are most likely to be effective for me?
• How much can I expect my symptoms to improve with treatment?
• How often will I need psychotherapy, and for how long?
• Are there medications that can help?
• If you're recommending medications, what are the possible side effects?
• I have these other health conditions. How can I best manage them together?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• What are your symptoms?
• When did you or your family first notice these symptoms?
• How are your symptoms affecting your life?
• Do you feel comfortable in social situations? Why or why not?
• Do you have any close relationships?
• If you're not satisfied with work, school or relationships, what do you think is causing your problems?
• Have you ever thought about harming yourself or others? Have you ever actually done so?
• Have you ever felt that you could influence other people and events through your thoughts or your actions?
• Have your family members or friends expressed concern about your behavior?
• Have any of your close relatives been diagnosed or treated for mental illness?

What you can do in the meantime
While you're waiting for your appointment, it may be helpful to ask friends or family members if they have felt concerned about your behavior. You'll also want to find out about your family's medical history, including any history of mental illness.

If you have fantasies about hurting yourself or someone else, go to an emergency room or call 911 or your local emergency number immediately.

Tests and diagnosis

Doctors diagnose personality disorders based on a thorough interview about your symptoms as well as your personal and medical history. A physical examination will help rule out other conditions, and a mental health provider will likely be consulted for further evaluation.

For a diagnosis of schizotypal personality disorder, at least five of the following criteria must be met, according to criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association:

• Incorrect interpretations of events, including a feeling that something innocuous has a direct personal meaning
• Odd beliefs or magical thinking that's inconsistent with cultural norms
• Unusual perceptions, including illusions
• Odd thinking and speech patterns
• Suspicious or paranoid thoughts, such as the belief that someone's "out to get them"
• Flat emotions, appearing aloof and isolated
• Odd, eccentric or peculiar behavior or appearance
• Lack of close friends or confidants other than relatives
• Excessive social anxiety that doesn't diminish with familiarity

In addition, to be diagnosed with schizotypal personality disorder, a person must never have met the criteria for any other schizophrenic disorder.

To distinguish schizotypal personality disorder from schizophrenia, doctors look for the presence of psychosis and experiences with hallucinations or delusions.

Treatments and drugs

Treatment for schizotypal personality disorder often includes a combination of medication and one or more types of therapy:

• Medications. There's no specific drug treatment for schizotypal personality disorder. However, doctors may prescribe antidepressant or antipsychotic medications to help relieve associated conditions, such as anxiety, depression or other mood disorders. For example, prescription medications such as risperidone (Risperdal) and olanzapine (Zyprexa) may help reduce distorted thinking.
• Psychotherapy. Building a trusting relationship with a therapist may help people with schizotypal personality disorder begin to trust other interpersonal relationships.
• Behavior therapy. People with schizotypal personalities often need to learn specific social skills and behaviors. In behavior therapy, they might be taught to respond to social cues with appropriate words, tone of voice or facial expressions.
• Cognitive therapy. This type of therapy can help people with schizotypal personality disorder identify and change distorted thought patterns. For example, this type of therapy may help a person with schizotypal personality disorder uncover — and change — confused ideas about what goes on in interpersonal exchanges.
• Family therapy. Treatment can be more effective when family members are involved. Seeking professional counseling as a group may help reduce fighting or emotional distance in the home. Family therapy may also offer the affected person a support structure and a boost in morale.

Prevention

Until recently, doctors generally believed that once a personality disorder has developed, it will last throughout life. However, it's thought that symptoms of conditions such as schizotypal personality disorder may improve over time. Factors that appear most likely to reduce the symptoms of this disorder include positive relationships with friends and family as well as a sense of achievement at school, work and in extracurricular activities.

These experiences may create a protective effect by fostering — among other positive traits — self-confidence, a belief in one's ability to overcome difficulty and a sense of social support. In addition, early interventions such as youth programs that foster personal achievement and strong community relationships may help prevent personality disorders in at-risk children. The earlier these kinds of interventions reach a child in any challenging situation, the better are his or her chances of doing well.