Schizotypal Personality Disorder

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, schizotypal personality disorder (SPD) is listed as a cluster A personality disorder. Also called “eccentric” personality disorders, these conditions are characterized by unconventional thoughts and behaviors. The symptoms of schizotypal personality disorder can interfere with a person’s ability to form close relationships and function in social and work settings. 

As described by researchers in a study titled “Schizotypal Personality Disorder: A Current Review”, schizotypal personality disorder is a “multi-dimensional construct”, with three primary categories of symptoms: cognitive symptoms, interpersonal difficulties, and eccentric behaviors. Based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, schizotypal personality disorder may be diagnosed if five or more symptoms are present.

Cognitive symptoms

Individuals with SPD often exhibit unusual thinking patterns and beliefs, including:

• Ideas of reference: Interpreting unrelated events as personally significant or believing others are talking or thinking about them
• Odd or magical beliefs: Holding peculiar, superstitious beliefs or believing in magical thinking, such as thinking they have special powers or can influence events
• Unusual perceptual experiences: Perceiving things differently from others, such as feeling detached from one's body or sensing things that others cannot
• Suspiciousness or paranoia: Believing that others are out to harm them or being overly distrustful of others

Interpersonal difficulties

The Diagnostic and Statistical Manual of Mental Disorders states that schizotypal personality disorder is a “pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships”. People with SPD typically experience difficulty in social contexts due to:

• Social anxiety: Feeling uncomfortable or anxious in social situations, particularly with unfamiliar people
• Difficulty reading social cues: Misinterpreting others' intentions, emotions, or body language
• Lack of close friends: Having difficulty connecting with others emotionally or forming close relationships

Eccentric behaviors

People with SPD might exhibit unusual speech patterns, beliefs that are perceived as peculiar or superstitious, and behaviors that appear odd or out of context, significantly impacting their ability to interact socially.

• Odd speech patterns: Using vague or elaborate speech or speaking in a manner that seems overly formal or stilted
• Odd/eccentric behavior: Dressing in a peculiar or unconventional way that draws attention or stands out from societal norms, or reacting in ways that seem inappropriate or out of context to the situation, such as showing a lack of emotion or displaying emotions that do not match the circumstances

According to the Diagnostic and Statistical Manual of Mental Disorders, symptoms of schizotypal personality disorder must arise by early adulthood. While the symptoms of SPD may overlap with those of other disorders, including schizophrenia and schizoid personality disorder,⁴ this disorder is distinct. Only medical professionals, such as psychiatrists and psychologists, can make a proper diagnosis.

Note that while people with SPD may exhibit behaviors that seem unusual, these symptoms stem from their distorted cognitive perceptions.

Understanding the risk factors associated with SPD can provide valuable insights into its origins and development.

Genetic factors

According to researchers in the above-mentioned “Current Review”, there is evidence to suggest that genetics may play a role in the development of schizotypal personality disorder (SPD):

• Family history: Individuals with a family history of schizophrenia or other psychotic disorders may be at an increased risk of developing SPD.
• Genetic predisposition: Research has identified specific genes that may be associated with the development of SPD, but more studies are needed to confirm these findings.

Biological factors

Several biological factors may contribute to the development of SPD:

• Brain structure and function: Studies have shown that people with SPD may have differences in the structure and function of their brain, particularly in areas related to perception, emotion regulation, and social behavior.
• Neurotransmitter imbalances: Neurotransmitters are chemical messengers in the brain, and imbalances in these chemicals may play a role in the development of SPD. Researchers are still investigating the specific neurotransmitters involved and their effects on the disorder.

Environmental factors

Environmental factors, particularly those experienced during early life, can also influence the development of SPD:

• Childhood adversity: Experiencing trauma, neglect, or abuse during childhood may increase the risk of developing SPD.
• Parenting style: A lack of emotional support, inconsistent discipline, or overly controlling parenting may contribute to the development of SPD.

While these factors may increase the risk of developing schizotypal personality disorder (SPD), they do not necessarily cause the disorder. Many individuals with these risk factors do not develop SPD, and the presence of multiple risk factors does not guarantee the development of the disorder. The causes of SPD tend to be complex and multifaceted, and further research is needed to fully understand the interplay between these factors and their impact on the disorder.

Symptoms of SPD can be varied, and treatment typically involves a comprehensive approach that addresses the individual's specific needs and preferences. The ultimate goal of treatment of schizotypal personality disorder is usually to help individuals with SPD lead fulfilling lives by improving their interpersonal skills, reducing their discomfort in social situations, and managing their unusual thoughts and behaviors.

Medication

While there is no specific medication for SPD, some individuals may benefit from medications to help manage co-occurring conditions or specific symptoms:

• Antidepressants: These medications may help manage symptoms of depression and social anxiety that may accompany SPD. Data supporting their efficacy is limited.
• Antipsychotics: In some cases, low doses of antipsychotics may be used to reduce severe anxiety, unusual thoughts, or paranoia. However, evidence is limited to confirm the efficacy of antipsychotics for SPD.
• Anti-anxiety medications: Some medications may alleviate symptoms of anxiety, especially in stressful or overwhelming situations.
• Guanfacine: As an alpha-2 adrenergic agonist, it has been shown to increase cerebral blood flow and improve memory. It is also used in the treatment of other disorders, such as attention-deficit hyperactivity disorder, Tourette’s syndrome, and more.

It's recommended that individuals considering medication work closely with their healthcare provider to determine the most appropriate treatment plan and monitor for any potential side effects.

Other treatment options

In some cases, alternative or complementary treatments may be helpful for individuals with SPD:

• Group therapy: Group therapy can provide a safe space where individuals can practice their social skills and connect with others who share similar experiences.
• Art or music therapy: As an outlet for self-expression and a way to explore emotions and thoughts creatively, art or music therapy can be beneficial for individuals with SPD.

Self-care

According to the American Psychiatric Association, incorporating self-care practices into daily life can be an essential part of managing SPD:

• Stress management: Learning techniques to manage stress, such as mindfulness, meditation, and deep breathing, may help individuals with SPD better manage their symptoms.
• Healthy lifestyle: Eating a balanced diet, getting regular exercise, and getting enough sleep may help to improve mood and overall well-being.
• Supportive relationships: Building and maintaining supportive relationships with trusted friends, family members, or therapists can be a powerful form of self-care.

No matter what approach an individual chooses, recovery is often a process that takes time. While there typically is no one-size-fits-all approach, each individual's needs can be taken into account to determine the best course of treatment.

Therapy can be a valuable resource for individuals with schizotypal personality disorder. Online therapy can be especially beneficial for those with SPD who may experience social anxiety or find it difficult to build face-to-face relationships. They can connect with a therapist in a way that’s most comfortable for them, whether via audio, video, or live chat. If you're living with SPD or any other mental health condition, consider reaching out to a therapist at BetterHelp for personalized assistance.  

Other resources available to individuals living with SPD include support groups, online resources, and more. Mental health organizations such as the Personality Disorder Awareness Network and the National Alliance on Mental Illness (NAMI) provide education and support to those affected by SPD or other mental health conditions. Joining a local NAMI chapter may be a great way to connect with others who understand the challenges of SPD.

The National Institute of Mental Health (NIMH) is another resource for information on personality disorders and other mental health conditions, offering articles, research, and links to resources and support. Additionally, the American Psychiatric Association provides a fact sheet and Q&A on personality disorders.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. 

Please see our Get Help Now page for more immediate resources.

The study “Schizotypal Personality Disorder: A Current Review” notes that schizotypal personality disorder is not as well studied as other personality disorders. In recent years, though, research into schizotypal personality disorder has uncovered new insights into the causes and potential treatments for this complex disorder. While the exact origins of STPD remain unclear, emerging studies suggest that a combination of genetic, neurological, and environmental factors contribute to its development.

In the past decade, increasing data has surfaced, revealing genetic markers linked to schizotypy, which shares some symptoms of STPD. This research could help researchers identify at-risk individuals and provide early interventions to mitigate the disorder's impact.

One review, published in 2018, investigated the effectiveness of social skills training for individuals with SPD. This is based on previous research in which individuals who participated in social skills training had a lower transition rate from SPD to other psychotic disorders.

Here are some key statistics on schizotypal personality disorder:

• According to estimates from “Schizotypal Personality Disorder: A Current Review”, SPD affects approximately 4% of the population.
• Compared to women (3.7%), men are more likely to develop SPD (4.2%).
• The likelihood of individuals with SPD eventually developing a more severe mental illness within the schizophrenia spectrum, such as schizophrenia itself, ranges from 20% to over 40%.
• Clinical research has found that the severity of SPD symptoms can decrease. In one study, the remission rate for schizotypal personality disorder was as high as 61%, according to a blind 24-month assessment. 

These statistics shed light on the complexity of SPD and underscore the importance of seeking help from a mental health professional. According to these statistics, long-term remission may be possible with the right treatment plan and ongoing support.