What is Schizotypal Personality Disorder: Types, Causes, Symptoms, Treatment, Diagnosis, Epidemiology

Schizotypal personality disorder or STDP is a mental disorder illustrated by severe paranoia, unconventional belief and social anxiety. Individuals who suffer from such disorder usually find it difficult to maintain close relationship with people, majorly due to the reason that they think their peers nurture negative thoughts about them, so they stay away from them. Strange speech mannerisms as well as odd means of dresses are some indications of Schizotypal personality disorder or STDP. People, who have Schizotypal personality disorder or STDP in many cases, may react differently in conversations, talk to themselves or not respond to others.

They more often misinterpret things and situation as being peculiar or have odd connotations for them; superstitious and paranormal beliefs are very common among people who have Schizotypal personality disorder or STDP. These people frequently need medical attention for their depression and anxiety instead of personality disorder. Schizotypal personality disorder or STDP occurs in around 3% of usual population and it is slightly more common in men.

Schizotypal personality disorder or STDP shouldn’t be confused with the schizophrenia as people with this disorder have strange behavior and beliefs. However, unlike individuals suffering from schizophrenia, they aren’t disconnected from the reality as well as generally don’t hallucinate. They don’t have delusions as well. People who have Schizotypal personality disorder or STDP might be quite disturbed and may have unusual fears and preoccupations like fear of being observed by the government agencies.

Most of the times, individuals with Schizotypal personality disorder or STDP behave oddly and possess unusual beliefs like aliens. They adhere to these facts so powerfully that they’ve difficulty keeping and forming close relationships. Schizotypal personality disorder or STDP sufferers might have depressions and anxiety issues and also personality disorders like paranoia is very common.

Here are some common signs of Schizotypal personality disorder or STDP:

• They don’t have close friends
• Inappropriate display of feelings
• Odd appearance or behavior
• Discomfort in various social gatherings
• Odd speech
• Odd fantasies, preoccupations and beliefs

Schizotypal personality disorders or STPD is also characterized by attention impairment in different degrees. According to studies, attention deficits may serve as biological susceptibility maker to schizotypal personality disorder. One of the main reasons behind this is that a person who has problem taking in information, might find it tricky in complex social gatherings where interpersonal signs as well as attentive communications are important for quality interactions. This may eventually cause a person to depart from many social interactions, hence leading to isolation and asocial.

Theodore Millon suggests 2 subtypes of Schizotypal personality disorder or STDP. Any person who has this disorder might exhibit either of the following subtypes; however, he also believes that a person experiencing only one variant is extremely rare, rather most individuals experiences a mixture of one pure variant along with more than one sub variants. The subtypes include:

• Insipid Schizotypal Personality Disorder: This is a structural overstatement of passive-detached pattern and it includes depressive, dependent and schizoid features. The personality traits displayed by people of this subtype are a sense of nonbeing and strangeness, sluggish, inexpressive, overtly drab, barren, indifferent, obscured, insensitive, internally bland, tangential thoughts and vague.
• Timorous Schizotypal Personality Disorder: This is also a structural overstatement of the active detached pattern. It includes negativistic, avoidant passive aggressive features. The personality traits are watchful, warily apprehensive, shrinking, suspicious, guarded, alienated from others and self, deadens excess sensitivities and reverses, blocks and prohibits own thoughts.

Reported occurrence of Schizotypal personality disorder or STDP ranges from 0.6 percent in community studies in Norwegian sample, and lasts to 4.6 percent in American sample. A huge American study found a lifetime occurrence of 3.9 percent with a higher rate of 4.2% among male and 3.7% in female. It was found to be uncommon in clinical population with reported rate of 0 to 1.9 percent.

There are many causes for Schizotypal personality disorder such as:

• Genetic Causes for Schizotypal Personality Disorder: This disorder is hugely understood to be a schizophrenia spectrum disorder. The rate of occurrence of Schizotypal personality disorder is much higher in individuals having relatives with schizophrenia rather than in the individuals with relatives having various other mental illnesses or in persons without mentally sick relatives.
• Environmental and Social Causes of Schizotypal Personality Disorder: There are many evidences available that suggests parenting style, trauma, maltreatment history specifically childhood negligence, early separations etc. can lead to the development of Schizotypal personality disorder or STDP and schizotypal traits. As the time passes, kids learn to respond appropriately and interpret social indications but for reasons unknown, this procedure doesn’t work well with people with such disorder. Neglect, trauma or abuse, family dysfunction during the childhood can enhance the danger of developing schizotypal personality disorder.

People with schizotypal personality disorder often seek the first line of help from their general physician owing to the symptoms of anxiety, depression and the like. The doctor after doing the overall health assessments usually refers to a mental health professional for further diagnosis and treatment. The mental healthcare provider does the diagnosis based on detailed personal, medical and family history and interviewing the symptoms experienced and compares it with the DSM-5 or ICD-10 manual for mental health disorders for the diagnosis.

The characteristics features of a personality disorder are dysfunctional personality (self and interpersonal) functioning and the presence of personality traits that are pathological. DSM-5 states that the following criteria must be met for diagnosing schizotypal personality disorder:

1. Significant impairments in personality functioning manifest by:

   1. Impairments in self functioning:

      1. Identity: Confused boundaries between self and others; distorted self-concept; emotional expression often not congruent with context or internal experience.
      2. Self-direction: Unrealistic or incoherent goals; no clear set of internal standards.

   2. Impairments in interpersonal functioning:

      1. Empathy: Pronounced difficulty understanding impact of own behaviors on others; frequent misinterpretations of others? motivations and behaviors.
      2. Intimacy: Marked impairments in developing close relationships, associated with mistrust and anxiety.

2. Pathological personality traits in the following domains:

   1. Psychoticism, characterized by:

      1. Eccentricity: Odd, unusual, or bizarre behavior or appearance; saying unusual or inappropriate things.
      2. Cognitive and perceptual dysregulation: Odd or unusual thought processes; vague, circumstantial, metaphorical, over-elaborate, or stereotyped thought or speech; odd sensations in various sensory modalities.
      3. Unusual beliefs and experiences: Thought content and views of reality that are viewed by others as bizarre or idiosyncratic; unusual experiences of reality.

   2. Detachment, characterized by:

      1. Restricted affectivity: Little reaction to emotionally arousing situations; constricted emotional experience and expression; indifference or coldness.
      2. Withdrawal: Preference for being alone to being with others; reticence in social situations; avoidance of social contacts and activity; lack of initiation of social contact.

   3. Negative Affectivity, characterized by:

      1. Suspiciousness: Expectations of  and heightened sensitivity to  signs of interpersonal ill-intent or harm; doubts about loyalty and fidelity of others; feelings of persecution.

3. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

4. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

5. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

There is a high rate of co-morbidity with various other personality disorders. According to McGlashan et al. (2000), the high co-morbidity might be because of the overlapping diagnostic criteria with other disorders like avoidant personality disorders, paranoid personality disorder, as well as borderline personality disorders. There also exist a number of similarities among schizoid and schizotypal personalities. However, the main difference between these 2 disorders appear to be those that individuals with schizotypal disorders avoid society and social interactions due to some deep seated fear of people; whereas people with schizoid personality disorder just feel no craving to make relationships, as they find it waste of time to share anything with other people.

Schizotypal personality disorder or STDP generally co-occurs with core depressive disorder, generalized social phobias and dysthymia. Furthermore, a few times, Schizotypal personality disorder may co-occur with obsessive compulsive disorder, as well as its presence seems to affect the outcome of treatment adversely. Many individuals with Schizotypal personality disorder also have schizophrenia, however, a majority of them don’t. Although, symptoms of schizotypal personality disorder have been considered longitudinally in various numbers of studies, the outcomes do not necessarily suggest development of schizophrenia.

The risk factors involved in Schizotypal personality disorder or STDP is poor community skills and lack of all interpersonal relationships.

• Medication: There is no approved medication yet by the Food and Drug Administration for schizotypal personality disorder. However, psychiatrist usually use antipsychotic, antidepressant, anti-anxiety medicines and mood stabilizers to cure the symptoms of Schizotypal personality disorder or STDP. Some of the more frequently prescribed antipsychotic medications generally used to cure patients who have schizophrenia and is also prescribed to people with this disorder are Thiothixene and Haloperidol. Medications are given depending on the type and severity of Schizotypal personality disorder or STDP symptoms experienced by the patient and are as follows:
  • Antipsychotic: Schizotypal patients experiencing more psychotic symptoms similar to schizophrenia are commonly treated with lower dosages of antipsychotics like thiothixene.
  • Anti-convulsants: Lamotrigine, an anti convulsant, seems to be quite helpful in handling with social isolation and communication issues.
  • SSRIs: Schizotypal patients who experience more obsessive compulsive behaviors and beliefs are usually treated with Selective Serotonin Reuptake Inhibitors (SSRIs).
• Psychotherapy: Counseling and psychotherapy goes along with medication which helps the person in coping with the situation and also in developing trust on others by developing a trustful relationship with the therapist. Psychotherapy could include a combination of therapies like:
  • Cognitive Behavioral Therapy for Schizotypal Personality Disorder or STDP: It helps in identifying and changing or modifying distorted thought processes, negative thoughts, change problem behaviors, and learning social skills.
  • Family Therapy: Family therapy helps in building trust on the family members thus improving communication. It also empowers the family by psycho-educating them about the disorder and ways to handle and communicate with patient.
  • Supportive Therapy for Schizotypal Personality Disorder or STDP: Supportive therapy focuses on encouraging the patient and also helping them in learning adaptive skills.

People with schizotypal personality disorder often improve over time when proper support is provided along with positive skill building like self-confidence and social skills. A positive and supportive relationship with family and friends and social achievements also help in improving the symptoms and condition in the patients.

Schizotypal personality disorder is often misdiagnosed as schizoid disorder or schizophrenia. However, it is a completely different personality disorder having symptoms like distorted thought and inappropriate behavior along with paranoia. Nevertheless, a person with this disorder can often overcome the problem with proper treatment of medication and psychotherapy.