What Is Schizotypal Personality Disorder And How Is It Treated?

Personality disorders can cause significant functional difficulties and behavioral challenges, often heavily impacting relationships. Schizotypal personality disorder is one such condition, causing extreme social difficulty and discomfort, often leading to avoidance of social situations. Understanding this condition can be a step toward reducing stigmas surrounding personality disorders and getting help if you or a loved one is impacted. 

Schizotypal personality disorder defined 

Schizotypal personality disorder (STPD) is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This manual is compiled by the American Psychiatric Association and is used by mental health professionals and some doctors to diagnose mental health disorders.

According to the DSM-5, schizotypal personality disorder causes 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." As one of three cluster A personality disorders, schizotypal personality disorder is characterized by suspicion of others, odd beliefs or magical thinking, and flat affect. 

What causes schizotypal personality disorder? 

Schizotypal personality disorder may have a genetic component. Schizotypal disorders are more likely to show up in individuals who have a close relative with STPD. Although there seems to be a genetic link, researchers also believe that childhood problems may play a part. Abuse, neglect, and other hostile or neglectful behavior by parents or caregivers seem to contribute to the development of STPD. Research into the causes of schizotypal personality disorder is ongoing as researchers look for the genes that may be at fault, as well as social, familial, and environmental causes.

Is schizotypal disorder the same as schizophrenia? 

Schizotypal personality disorder is not the same as schizophrenia. In addition, people with schizotypal personality disorder are not destined to develop a psychotic disorder. Research shows that links between the two exist, but STPD can remain consistent over a lifetime without the development of schizophrenia. Those who have a family member with schizophrenia may be more susceptible to STPD, schizophrenia, and other personality disorders, but every situation is different.

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Symptoms of schizotypal personality disorder

Professionals use the symptoms of schizotypal personality disorder to evaluate an individual for a diagnosis. However, symptoms can look similar across many mental health disorders, so a proper diagnosis requires a licensed professional. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes symptoms of schizotypal personality disorder. For a proper diagnosis, at least five of the symptoms quoted below must be present:

Schizotypal personality disorder diagnosis

There is no specific test given to individuals who may be living with STPD. Instead, a licensed professional assesses a person’s symptoms to provide a proper diagnosis of the disorder. The main reference is severity and pervasiveness; showing signs of symptoms or struggling with symptoms is not enough for a diagnosis. 

According to researchers in an article titled “Schizotypal Personality Disorder: A Current Review,” diagnosing STPD can be difficult because its symptoms often overlap with those of other conditions, including social anxiety disorder, bipolar disorder, and other personality disorders. 

Schizotypal personality disorder has many characteristics with schizophrenia spectrum disorders. Like these disorders, schizotypal personality disorder is marked by odd beliefs or magical thoughts, impaired social skills, and difficulty expressing emotion. Additionally, STPD and schizophrenia have similar etiologies, according to the American Psychiatric Association. Some experts believe that schizotypal personality disorder (and schizoid personality disorder, another cluster A personality disorder) should be classified as schizophrenia spectrum disorders. However, unlike schizophrenia spectrum disorders, schizotypal personality disorder typically does not involve psychosis. 

The doctor will interview the individual and then obtain a complete medical exam. The interview gathers information regarding the symptoms and their severity, and the medical exam takes place to rule out other possible causes for the person’s feelings, thoughts, and behaviors.

According to the DSM-5, a preliminary diagnosis of a schizotypal personality disorder requires at least five symptoms to be present and persistent over at least two years. Once criteria are established, the provider may study the behavior the symptoms cause to make a final diagnosis. 

Neuropsychological tests exist for personality disorders, but they are not used exclusively to diagnose schizotypal personality disorder. Instead, these tests often eliminate other possible disorders and gain insight into patient behaviors, thought patterns, and cognition. These types of tests are for reference, not for a complete diagnosis.

Schizotypal personality disorder treatment

Like many personality disorders, schizotypal personality disorder can be challenging to treat. At times, symptoms may require inpatient treatment to control medications and achieve a stable medicated outcome. Many people with schizotypal personality disorder, however, do not require in-patient treatment, effectively addressing their symptoms through out-patient treatment alone. 

The treatment of schizotypal personality disorder typically involves a combination of both medications and psychotherapy. Working with a medical provider can help individuals learn more about their treatment options so they can find an approach that fits their needs.

Medicine-based treatments

Medicine-based treatments depend on which symptoms are being treated. Since schizotypal personality disorder may present with delusions and paranoid delusions, antipsychotics may be prescribed to reduce psychotic episodes. Other medicines, such as anti-anxiety medications, can be used to reduce anxiety in social situations. Mood stabilizers are utilized to lessen the emotional and behavioral problems often associated with STPD, and anti-depressants may be used to reduce symptoms of depression that may be present. In “Schizotypal Personality Disorder: A Current Review,” researchers state that stimulants have shown promise in addressing difficulty focusing and similar attention-related symptoms. 

Medication is commonly prescribed for symptom relief for people with STPD. Relieving anxiety symptoms can help those with obsessive-compulsive symptoms, and relieving symptoms is often the goal of treatment. Medicine-based treatment can also be used in conjunction with therapy. Without the support of medicine, some individuals may have trouble with therapy because of pervasive problems with social situations. The interpersonal nature of therapy can be overwhelming for those with this disorder; medicine can help them make use of therapy without as much fear. 

The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action (including starting, stopping, or changing medications) without consulting a qualified medical professional.

Therapy-based treatments

Psychotherapeutic treatment of schizotypal personality disorder can be complicated by the fact that individuals with the disorder often struggle to form close relationships. According to researchers in the above-mentioned “Schizotypal Personality Disorder: A Current Review”, the odd thinking and magical beliefs of STPD can make it hard for participants and professionals to form a therapeutic alliance. 

The most prescribed form of therapy for STPD is cognitive-behavioral therapy (CBT). CBT helps people alter their thoughts to become more positive and helpful than negative and unhelpful. Group therapy can also be beneficial. Although many individuals with STPD have anxiety issues related to interpersonal social interactions, group therapy can help them relate to others going through similar experiences. In conjunction with medications to reduce anxiety-related symptoms, group therapy seems to be one of the most effective therapies. Group therapy may also work as a form of CBT for individuals with STPD because they must work through issues related to social interaction. Group therapy for STPD should be structured and supportive.

For individuals with prevalent delusional issues and severe paranoid delusional issues, the most effective type of therapy is often individual, with a focus on refraining from exciting or provoking delusional, inappropriate thoughts. A supportive client-centered environment can be helpful for individuals with these symptoms. During sessions, adjusting medications and working toward overcoming symptomatic obstacles may become easier as the client/doctor alliance strengthens. Finding the right mental health care professional for this type of therapy can be significant; STPD may impede interpersonal relationships, but with the right person, medication, and environment, this therapy can be productive.

Alternative support options

If you’re living with schizotypal personality disorder, seeking support can be advantageous. When this disorder is left untreated, its symptoms can worsen. Confiding in a therapist might be intimidating, and you may be concerned about your ability to form a healthy relationship with them. Online counseling can give you more freedom regarding therapy, allowing you to choose when, where, and how you meet for sessions. Through an online platform like BetterHelp, you can pick between phone calls, video chats, or in-app messaging. You can use a laptop, cellphone, tablet, or computer to speak with your therapist and schedule sessions at a convenient time. 

Online counseling can be a beneficial resource for addressing mental health concerns like personality disorders. In a review of 11 different studies, researchers found that three internet-delivered interventions “demonstrated significant decreases in borderline personality disorder symptoms.” Further, “usability and patient satisfaction were moderate to high in all studies.”