Understanding The Symptoms: Schizotypal Vs. Schizoid

The difference between schizotypal personality disorder and schizoid personality disorder can be confusing, since they’re similar-sounding mental illnesses that both belong to the same broader category of personality disorders characterized by social challenges and/or avoidance. However, they’re each ultimately a unique disorder with their own set of symptoms and traits. Read on to understand the key differences between the two and how they tend to manifest.

Understanding schizotypal personality disorder

While both personality disorders discussed here tend to manifest as an individual having limited social interaction, the causes of this social avoidance are very different between the two. The  Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes those with schizotypal personality disorder as exhibiting “a pervasive pattern of social deficits marked by discomfort with close relationships, as well as eccentricities of behavior and perceptual distortions.” 

In other words, those with schizotypal personality disorder are typically prone to eccentric behavior and distorted thinking—including paranoia—which can make forming and maintaining close relationships difficult. To be diagnosed with schizotypal personality disorder, an individual must exhibit five or more of the following:

• Odd beliefs or magical thinking (such as belief in extrasensory perception (ESP), for example)

• Reports of strange bodily sensations

• Convoluted, distorted thinking and speech (metaphorical, overelaborate, stereotyped, etc.)

• Paranoid ideas

• A peculiar appearance

• A lack of close friends

• A sense of social anxiety, even around family

Those with schizotypal personality disorder may have episodes where they have delusions around sounds or feelings. Illogical thinking or beliefs in strange or extreme phenomena are also common. Roughly half of those with schizotypal personality disorder will experience an episode of major depression at some point in their life as well. Stress or traumatic events may exacerbate symptoms of schizotypal personality disorder.

Understanding schizoid personality disorder

Those with schizoid personality disorder have a reduced range of emotional expression and tend to limit their social interactions. However, this typically manifests in a very different way than in those with schizotypal personality disorder. People with schizoid personality disorder will exhibit at least four of the following symptoms:

• May have close relatives but no real good friends or confidants otherwise

• Does not enjoy and may avoid close relationships, including with family

• Usually viewed as a loner 

• Shows an apparent lack of care in relation to how others perceive them

• Displays emotional coldness or detachment

• Takes pleasure in very few activities, if any

• Indifference to praise or criticism from others

• Has little interest in seeking out sexual relationships

Those with schizoid personality disorder will often retreat into activities that require focus and little social interaction, such as computer games, math problems, coding, electronics, etc. Diagnosis of this condition is rare, because those experiencing it often do not seek out treatment. Note that on their own, some symptoms on this list may be personality traits and may not indicate a disorder. It’s typically when multiple are present and they are maladaptive, or have a negative impact on a person’s life, that a diagnosis may be considered.

Key similarities between the two disorders

In previous versions of the Diagnostic and Statistical Manual of Mental Disorders, personality disorders were grouped into clusters. For ease of understanding, we’ll use this classification here to describe how these two disorders are related. 

In past versions of the Diagnostic and Statistical Manual of Mental Disorders, both schizotypal personality disorder and schizoid personality disorder were classified as cluster A disorders. This designation refers to a grouping of disorders associated with behavior that many would describe as eccentric or even odd. Social awkwardness is typical in those with cluster A personality-type symptoms, and these individuals also tend to withdraw socially and experience distorted thinking. These symptoms tend to have a more dramatic effect on one’s life than the disorders in clusters B or C. 

Paranoid personality disorder is the other mental health condition included in the cluster A personality disorders group, in addition to schizotypal and schizoid. Personality disorders of any type are usually long-lasting (chronic), and often lifelong. Other than these similarities and the fact that they’re both on the schizophrenia spectrum, schizotypal and schizoid personality disorders are distinct. 

Key differences between the two disorders

Though schizoid and schizotypal personality disorders fall within the same cluster, they each come with a unique set of symptoms and challenges. Schizotypal personality disorder tends to cause discomfort in relationships, distorted thoughts and beliefs, and odd behavior. Schizoid personality disorder tends to cause a detachment from relationships and limited emotional expression.

People with schizotypal personality disorder often have a more challenging time in crowds and social situations than those with schizoid personality disorder. They also tend to stand out more, in contrast to the subdued nature of those with schizoid personality disorder. They may also seek out social relationships, with their interpersonal difficulties and social anxiety often causing troubles therein and anxiety disorders and/or depression potentially occurring as a result. In contrast, those with schizoid personality disorder typically do not seek close relationships at all and almost always prefer to do solitary activities.

It’s possible that the failed relationship endeavors often experienced by those with mental health conditions like schizotypal personality disorder are what prompt them to seek treatment more often than those with schizoid personality disorder. While both may live largely solitary lives, it is typically only those with schizotypal personality disorder who view their social challenges as an issue. Those with schizoid personality disorder often report enjoying math, computers, or electronics more than people and may have little desire to be more social.

What causes personality disorders?

Your personality is made up of your thoughts, actions, emotions, and traits. It’s a reflection of how you see yourself and others and is thought to be formed by a combination of “nature” and “nurture” Your temperament or emotional predisposition can be partially inherited, as can the genes that may contribute to the development of a mental health disorder(s). 

In addition, traumatic events, an unstable childhood, stressors, or societal pressures can also contribute to the formation of certain personality traits and/or disorders. To put it another way: Your inherited genes may make you more likely to develop a disorder—from schizoid and schizotypal personality disorders to anxiety and depression—while a dramatic life event may trigger the actual development of one.

Treatment for personality disorders

While personality disorders generally can’t be cured, there may be strategies an individual can use to help manage the effects over the course of their lifetime, which may be learned in cognitive behavioral therapy sessions. However, in many cases, the anti-social nature of a person experiencing a personality disorder can make it difficult for the development of an effective provider-client relationship to occur. 

One paper reviewed the literature on this topic and found that surprisingly little documentation is available on the pharmacologic treatments for cluster A personality disorders. A potential reason cited is that those with cluster A symptoms are less likely to reveal information or commit to working with cognitive behavioral therapists or other care providers, if they seek care at all. They may also feel paranoia and mistrust toward providers, which can make long-term care even more difficult.

The option of online therapy

If an individual with a cluster A personality disorder like the two outlined here is interested in seeking treatment, they may find online therapy methods more comfortable. Some studies suggest online cognitive behavioral therapy to be a promising potential treatment for certain personality disorders. This method may also be an option for family members of those with a cluster A personality disorder who may be having trouble understanding or coping with the behavior of their loved one. 

Either way, research suggests that virtual therapy may be as efficacious as in-person sessions for those experiencing a variety of mental health conditions and challenges. With a virtual therapy platform like BetterHelp, you can get matched with a licensed therapist whom you can meet with via phone, video call, and/or in-app messaging for support. Online therapy is also often a more cost-effective method than in-person sessions, representing an alternative for those who may experience financial barriers to other forms of care.