What Is Schizotypal Personality Disorder

What is schizotypal personality disorder?

Is it the same as schizophrenia? 

Schizotypal personality disorder is a rare mental health condition often seen by intense discomfort with close relationships and social interactions. It falls under the cluster A of personality disorders which involves odd or eccentric behaviours with difficulty relating to others. These symptoms result in the person withdrawing from socialisation and avoiding close relationships.

There is an increased risk of developing other mental health conditions, such as anxiety, depression, substance abuse, and schizophrenia. Although thought to be the same as schizophrenia, it is actually classified as a different mental disorder and rarely includes psychosis episodes, such as hallucinations.

This article goes into detail about some information relating to schizotypal personality disorder, its causes, symptoms, diagnoses, and treatments.

Overview

Schizotypal Personality Disorder (SPD) is a rare personality disorder, only occurring in approximately 3% of the general population in the UK and is  more common in people assigned male at birth (PAMAB). It is one of the ten defined personality disorders. This disorder is commonly associated with major depressive disorder and  anxiety due to the person’s difficulty in socialisation and interpreting both their own and others’ emotions.

What are personality disorders?

Personality disorders are a category of mental health conditions where a person thinks, feels, and behaves very differently from the average person.²

 Their beliefs and behaviour are difficult to change, develop during adolescence or early adulthood, and can lead to distress.  According to the NHS, approximately 1 in 20 people have a personality disorder of varying severity. 

The American Psychiatric Association (APA) classify personality disorders into three main clusters according to the symptoms presented: 

Cluster A

Individuals with a cluster A personality disorder tend to have odd or eccentric behaviours (such as paranoia), and have difficulty relating to others. 

Cluster A includes:

• Schizotypal personality disorder
• Paranoid personality disorder
• Schizoid personality disorder

Cluster B

Individuals with a cluster B personality disorder tend to appear to have dramatic, emotional, or erratic behaviour. 

Cluster B includes:

• Antisocial personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder

Cluster C

Individuals with a cluster C personality disorder tend to appear anxious or fearful which leads to antisocial or withdrawn behaviour.

Cluster C includes:

• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-Compulsive personality disorder

What shapes personality?

Personality is a combination of characteristics and behaviours that comprise a person’s interests, emotional patterns, values, and abilities that develop due to their unique adjustments to events in their life.  

Personality is shaped during youth and is influenced by environment, genetics, and trauma. It is not entirely understood how and why personalities develop in different ways, however, it is a general understanding that personality influences behaviour.

Causes of schizotypal personality disorder

Like most personality disorders, schizotypal personality disorder emerges during adolescence and continues through adulthood. 

Components that lead to schizotypal personality disorder include:

• Genetic factors- You may be at an increased risk of schizotypal personality disorder if you have a relative with this disorder
• Trauma during childhood such as abuse, neglect, or violence
• Lack of support during trauma

If a child has parents that neglected them, they might not have learned how to experience or process their own or others emotions. This detachment and lack of control of emotions could contribute to the development of a personality disorder. 

Children of abusive parents might have grown up in a household with high tensions, leading to increased anxiety and paranoia in any situation. In a study, they found that there was a significant relationship between childhood trauma and schizotypal personality disorder. They reported that severe trauma also resulted in worse cognitive functions such as learning ability and memory.¹

Although studies have shown that there is a linked relationship between trauma and personality disorders, it is important to note that not all who experience trauma as a child will develop a personality disorder. Similarly, not all who have a personality disorder have experienced trauma. 

Signs and symptoms of schizotypal personality disorder

Personality characteristics

Symptoms of schizotypal personality disorder comprise 5 or more of the following:²

• Odd beliefs, such as performing rituals to prevent harm or the ability to control people
• Unusual brief perceptual episodes, such as having illusions
• Paranoid ideation and delusion
• Belief in special powers, such as mental telepathy
• Incorrect interpretations of events
• Discomfort in close relationships
• Eccentric behaviour
• Dressing in ill-fitting or dirty clothes

Patients who have SPD tend to not have close friends or confidants other than familial relatives. They tend to want close connections but are uncomfortable socialising with people and have a feeling of not belonging or feel there are large differences between them and others. They tend to incorrectly interpret ordinary events and are superstitious. This leads to the development of anxiety in social situations. Despite general beliefs, people diagnosed with schizotypal personality disorder do not always express psychosis.

Schizotypal personality disorder vs schizoid personality disorder vs schizophrenia

Although all three of these terms sound similar, they have key differences in their symptoms.

What is the difference between schizotypal personality disorder and schizoid personality disorder?

People with schizotypal personality disorder have intense discomfort from personal relationships but are still interested in having them. People with schizoid personality disorder  have no interest in having personal relationships, prefer to be alone, and restricted emotional expression. They also may appear emotionless or have no interest in sexual relationships. 

In contrast to schizotypal personality disorder, people with schizoid personality disorder do not have peculiar thoughts, such as a belief in having a special power.

They do have similar symptoms, such as difficulties expressing emotions or properly reacting to events. These disorders make it difficult to maintain a social life in school, work, or personal life. People with both disorders are also unlikely to experience psychosis, such as hallucinations or paranoia. Those with schizotypal and schizoid personality disorder are both more likely to develop schizophrenia.

What is the difference between schizotypal personality disorder and schizophrenia?

Schizotypal personality disorder and schizophrenia are commonly mistaken to be the same, however, these are two different types of disorders. Schizotypal is classified as a personality disorder. In contrast, schizophrenia is a psychotic disorder. 

While there is a possibility that people with schizotypal personality disorder may experience brief psychosis episodes, these are not as frequent or intense as those with schizophrenia. During these psychosis episodes, people with schizotypal personality disorder can usually recognise this shift in reality and use healthy techniques to ground themselves they have learned in therapy.³ It is more difficult to convince someone with schizophrenia of this shift in reality.

Diagnosis

People with schizotypal personality disorder are usually diagnosed from youth to early adulthood. General Practitioners (GP) are unable to diagnose a patient with a personality disorder. If you experience symptoms, your GP will refer you to a psychiatrist or psychologist who has more experience in diagnosing and treating mental health problems. Your mental health professional will ask questions relating to your symptoms, and personal and medical history. Based on this, they will recommend the best course of action for treatment.

Complications

Schizotypal personality disorder makes it difficult to create and maintain relationships in both a personal and professional setting. The stress of relating and interpreting others’ emotions can lead to other mental complications. 30-50% of patients with SPD have a major depressive disorder at the time of SPD diagnosis. 

Those diagnosed with schizotypal personality disorder have an increased risk of

• Anxiety
• Depression
• Suicidal thoughts, ideation, or attempts
• Psychotic episodes in response to intense emotions or stressful situations
• Schizophrenia
• Substance abuse

Treatment

There is no known way to prevent the development of schizotypal personality disorder, however, there are ways to manage and reduce symptoms.

Schizotypal personality disorder is often treated with medication such as

• Atypical antipsychotics - These drugs help reduce symptoms of anxiety and psychosis such as delusions, hallucinations, disruptive behaviour, and mania
• Antidepressants - These drugs help reduce symptoms of depression and levels of anxiety

If you experience symptoms of schizotypal personality disorder, your therapist may recommend psychotherapy, specifically cognitive-behavioural therapy. This therapy supports the patient in socialisation  to improve interpersonal relationships and awareness of their own behaviour. A therapist will help in crisis management, self-awareness during issues, understanding social cues and other support for daily problems.

Psychotherapy  involves understanding your feelings, thoughts, and actions with a psychologist professional. 

Cognitive-behavioural therapy is a form of talking therapy where you and your therapist help you understand your negative feelings and actions and implement  healthy alternatives to replace the negative reactions. Your therapist will help you identify current issues and how to improve your day-to-day life. 

There is no cure for schizotypal personality disorder, it is a lifelong disorder that may improve over time with help of medication or therapy. 

How to support someone with schizotypal personality disorder

If someone you know is diagnosed with schizotypal personality disorder, here are a few positive tips on how to support them.

• Be patient with them
• Talk compassionately and calmly
• Learn their triggers
• Take care of yourself

FAQs

Summary

Schizotypal personality disorder is one of the many personality disorders. It is a rare disorder, presenting in  approximately 3% of the UK population. It is classified as a cluster A personality disorder, with behaviours that are seen as odd or eccentric. 

Symptoms of schizotypal personality disorder include anxiety, belief in special powers, incorrect interpretation of events, and ill-fitting clothes. Although thought to be the same as schizophrenia, people with schizotypal personality disorder have little to no psychosis events such as illusions or hearing voices.  Those with schizotypal personality disorder are at a higher risk to develop other illnesses, including depression, anxiety, schizophrenia, and substance abuse. 

You can be diagnosed by a mental health professional that may recommend medication such as antipsychotics and antidepressants. They may also recommend psychotherapy to improve interpersonal relationships and understand your emotions and triggers.