Schizotypal Personality Disorder In Adults: Symptoms, Support, And Treatment Options
Personality disorders usually involve persistent, distressing behavioral challenges that can impact relationships, mood, and quality of life. There are three classes of personality disorders, including clusters A, B, and C. Within the cluster A diagnostic category is a condition called schizotypal personality disorder (SPD), which can involve severe social deficits and cognitive distortions. Understanding schizotypal personality disorder in adults can be a step toward finding treatment if you or a loved one is impacted.
What is schizotypal personality disorder?
Schizotypal personality disorder is a cluster A personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The condition is typically characterized by social avoidance, eccentric behavior, and difficulty forming close relationships. People with this condition may isolate themselves and struggle to speak to others. Due to eccentric or “non-traditional” behavior, they may struggle to make friends and form romantic relationships.
- Ideas of reference (believing that random events or coincidences have strong personal significance)
- Magical thinking or strange beliefs that influence their behavior and don’t match cultural norms
- Strange perceptual experiences
- Odd thought and speech patterns
- Paranoia or suspiciousness
- Constricted or inappropriate affect
- Appearance or behavior that is perceived as peculiar, eccentric, or odd
- Lack of close relationships aside from those with first-degree relatives
- Excessive social anxiety that stems from paranoid fears and does not resolve with familiarity
In addition, schizotypal personality disorder cannot be diagnosed if symptoms only arise during active schizophrenia, bipolar disorder with psychotic features, depression with psychotic features, or another psychotic disorder. They also cannot be the result of autism spectrum disorder.
Adolescents vs. adults with schizotypal personality disorder
Children are not typically diagnosed with any personality disorder because their behavior tends to change as they age. However, adolescents may show signs of schizotypal personality disorder, such as complete social avoidance.
Adolescents may exhibit more symptoms of social difficulty in school settings, as schools typically provide many social opportunities. These teens may sit alone at lunch, avoid making new friends, and become quiet and withdrawn in class. They may display “odd” or “eccentric” behavior and could be at risk of being bullied.
Schizotypal personality disorder generally arises in early adulthood. Adults with schizotypal personality disorder may have more difficulty in areas like work, romantic relationships, and leaving home. Because they tend to misinterpret others’ behavior, mistrust other people, and frequently experience paranoia, which can contribute to social anxiety, they may encounter various challenges in the workplace. In some cases, they may struggle to support themselves financially. Some people with this condition may continue to live with relatives into adulthood.
How is schizotypal personality disorder in adults treated?
Research on the best treatment for schizotypal personality disorder is limited. However, the following methods may be recommended.
Medication
Medication may be prescribed to treat co-occurring symptoms of SPD, such as depression and anxiety. Medications may also be helpful for cognitive distortions. According to studies, antipsychotics tend to be most commonly prescribed. Antidepressants and anti-anxiety medications may also be prescribed in certain circumstances.
Medication may be most effective in combination with psychotherapy. Because schizotypal personality disorder normally affects behavior, behavioral therapy is often recommended to reduce problematic or maladaptive behaviors. Individuals may find that medication makes it easier to consistently attend therapy if they are experiencing other symptoms, such as anxiety and depression.
Therapy
Therapy modalities like cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), schema therapy, and radically open dialectical behavior therapy (RO-DBT) with a mental health professional may help clients manage symptoms of SPD.
However, people with this condition may struggle to seek help, as they may not realize they have a personality disorder. This diagnosis may be made when they attend therapy for another challenge or when a loved one recommends they get help. However, those with SPD may resist support due to their mistrust of others, which usually extends to mental health professionals.
When someone with this condition does attend therapy, it may be effective in helping them understand their cognitive distortions and harmful beliefs about themselves and others. They may work through exercises like social roleplay, worksheets, or cognitive restructuring. Therapy may help individuals with SPD address challenging thoughts, fear, and paranoia.
Self-care and lifestyle changes
People with schizotypal personality disorder might benefit from lifestyle changes to improve their mental well-being and reduce the risk of co-occurring conditions or challenges like depression, anxiety, and schizophrenia. The following lifestyle changes and self-care habits may be beneficial:
- Exercise: Exercise can include walking, stretching, dancing, practicing yoga, or going to the gym, among other options. People with SPD may find that the endorphin release from exercise improves mood and daily function.
- Hygiene practices: Individuals may ensure they shower frequently, brush their teeth, wash their hands, keep their space clean, brush or care for their hair, and keep their body clean and moisturized to improve mental well-being and interactions with others.
- Partaking in hobbies: Hobbies can improve the quality of life, allowing individuals to have fun, even on their own. Those who don’t have a hobby might consider taking a course, crafting, playing music, or finding other skills they might enjoy.
- Spending time in nature: According to studies, nature can improve mental and physical well-being. Individuals might consider going on hikes, swimming in a natural body of water, journaling in the forest, or creating art inspired by nature.
Any self-care activity can be done alone and may be a way to reduce stress and cope more effectively with social interactions.
How to find support
If you or a loved one is living with symptoms of schizotypal personality disorder or another personality disorder, it may be helpful to seek support in therapy. However, reaching out for help might be difficult if you struggle with anxiety related to social interactions. If this is the case, online therapy through a platform like BetterHelp may be more accessible.
Through an online therapy platform, clients can choose between phone, video, or live chat sessions. Chat sessions generally allow clients to talk to a therapist without showing their face or hearing someone’s voice. This option might be helpful for clients with SPD who don’t enjoy speaking to others in this way. Online platforms may also offer tools like worksheets and journaling prompts for self-reflection.
Studies show that internet-based therapy can be effective in treating personality disorders. In a meta-analysis of 11 studies primarily focused on borderline personality disorder (BPD), researchers found that dialectical behavior therapy (DBT) delivered online was generally effective in increasing patient satisfaction and decreasing symptoms. More studies are recommended to examine how online therapy affects schizotypal personality disorder in particular, but online treatment appears to be promising.
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