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Schizotypal personality disorder

Overview

People with schizotypal personality disorder are often described as odd or eccentric and usually have few, if any, close relationships. They generally don't understand how relationships form or the impact of their behavior on others. They may also misinterpret others' motivations and behaviors and develop significant distrust of others.

These problems may lead to severe anxiety and a tendency to turn inward in social situations, as the person with schizotypal personality disorder responds inappropriately to social cues and holds peculiar beliefs.

Schizotypal personality disorder typically is diagnosed in early adulthood and is likely to endure, though treatment, such as medications and therapy, can improve symptoms.

Symptoms

Schizotypal personality disorder typically includes five or more of these signs and symptoms:

  • Being a loner and lacking close friends outside of the immediate family
  • Incorrect interpretation of events, such as a feeling that something which is actually harmless or inoffensive has a direct personal meaning
  • Peculiar, eccentric or unusual thinking, beliefs or mannerisms
  • Dressing in peculiar ways, such as appearing unkempt or wearing oddly matched clothes
  • Belief in special powers, such as mental telepathy or superstitions
  • Unusual perceptions, such as sensing an absent person's presence or having illusions
  • Persistent and excessive social anxiety
  • Peculiar style of speech, such as vague or unusual patterns of speaking, or rambling oddly during conversations
  • Suspicious or paranoid thoughts and constant doubts about the loyalty of others
  • Flat emotions or limited or inappropriate emotional responses

Signs of schizotypal personality disorder, such as increased interest in solitary activities or a high level of social anxiety, may be seen in the teen years. The child may be an underperformer in school or appear socially out of step with peers, and as a result is often bullied or teased.

Schizotypal personality disorder vs. schizophrenia

Schizotypal personality disorder can easily be confused with schizophrenia, a severe mental illness in which people lose contact with reality (psychosis). While people with schizotypal personality disorder may experience brief psychotic episodes with delusions or hallucinations, the episodes are not as frequent, prolonged or intense as in schizophrenia.

Another key distinction is that people with schizotypal personality disorder usually can be made aware of the difference between their distorted ideas and reality. Those with schizophrenia generally can't be swayed away from their delusions.

Despite the differences, people with schizotypal personality disorder can benefit from treatments similar to those used for schizophrenia. Schizotypal personality disorder is sometimes considered to be on a spectrum with schizophrenia, with schizotypal personality disorder viewed as less severe.

When to see a doctor

People with schizotypal personality disorder are likely to seek help only at the urging of friends or relatives. If you suspect a friend or family member may have the disorder, you might gently suggest that the person seek medical attention, starting with a primary care physician or mental health provider.

If you need immediate help

If you're concerned that you might harm yourself or someone else, go to an emergency room or call 911 or your local emergency number immediately. Or call a suicide hotline number. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

Causes

Personality is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of inherited tendencies and environmental factors.

In normal development, children learn over time to accurately interpret social cues and respond appropriately. What exactly goes wrong for a person with schizotypal personality disorder isn't known for certain, but it's likely that changes in the way the brain functions and genetics may play a role.

Risk factors

Your risk of schizotypal personality disorder may be greater if you have a relative who has schizophrenia or another psychotic disorder.

Complications

People with schizotypal personality disorder are at an increased risk of:

  • Depression
  • Anxiety
  • Work, school, relationship and social problems
  • Other personality disorders
  • Problems with alcohol or drugs
  • Suicide attempts
  • Temporary psychotic episodes, usually in response to stress
  • Schizophrenia

Diagnosis

People with schizotypal personality disorder may seek help from their primary care provider because of other symptoms such as anxiety, depression or angry outbursts or for treatment of substance abuse.

After a physical exam to help rule out other medical conditions, your primary care provider may refer you to a mental health provider for further evaluation.

Diagnosis of schizotypal personality disorder typically is based on:

  • Thorough interview about your symptoms
  • Your personal and medical history
  • Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Treatment for schizotypal personality disorder often includes a combination of medication and one or more types of psychotherapy. Many people can be helped by work and social activities that are a fit for their personality style.

Psychotherapy

Psychotherapy, also called talk therapy, may help people with schizotypal personality disorder begin to trust others by building a trusting relationship with a therapist.

Psychotherapy may include:

  • Cognitive-behavioral therapy — identifying and changing distorted thought patterns, learning specific social skills, and modifying problem behaviors
  • Supportive therapy — offering encouragement and fostering adaptive skills
  • Family therapy — involving family members, which may help reduce fighting or emotional distance and improve trust in the home

Medications

There are no medications approved by the Food and Drug Administration specifically for the treatment of schizotypal personality disorder. However, doctors may prescribe an antipsychotic, a mood stabilizer, an antidepressant or an anti-anxiety drug to help relieve certain symptoms, such as psychotic episodes, depression or anxiety. Some medications may help reduce distorted thinking.

Preparing for an appointment

You're likely to start by seeing your primary care doctor. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist.

Take a family member or friend along, if possible. With your permission, someone who has known you for a long time may be able to answer questions or share information with the doctor that you don't think to bring up.

Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

  • Any symptoms you or your family noticed, and for how long. Ask friends or family members if they've felt concerned about your behavior and what they've noticed.
  • Key personal information, including traumatic events in your past and any current, major stressors. Find out about your family's medical history, including any history of mental illness.
  • Your medical information, including other physical or mental health conditions with which you've been diagnosed.
  • All medications you take, including the names and dosages of any medications, herbs, vitamins or other supplements you're taking.
  • Questions you want to ask your doctor to make the most of your appointment.

Examples of questions you may want to ask your doctor include:

  • What is likely causing my symptoms?
  • What are other possible causes for my symptoms?
  • Is my condition likely temporary or chronic?
  • What treatments are most likely to be effective for me?
  • How much can I expect my symptoms to improve with treatment?
  • How often will I need psychotherapy, and for how long?
  • Are there medications that can help?
  • Is there a generic alternative to the medicine you're prescribing?
  • If you're recommending medications, what are the possible side effects?
  • I have these other health conditions. How can I best manage them together?
  • Are there any brochures or other printed material I can take? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over points you want to spend more time on. Your doctor may ask:

  • What are your symptoms?
  • When did you or your family first notice these symptoms?
  • How are your symptoms affecting your life?
  • Have your family members or friends expressed concern about your behavior?
  • Do you feel comfortable in social situations? Why or why not?
  • Do you have any close relationships?
  • If you're not satisfied with work, school or relationships, what do you think is causing your problems?
  • Have you ever thought about harming yourself or others? Have you ever actually done so?
  • Have you ever felt that other people can control your thoughts or that you could influence other people and events through your thoughts?
  • Have any of your close relatives been diagnosed or treated for mental illness?

Coping and support

Symptoms of conditions such as schizotypal personality disorder may improve over time through experiences that help foster — among other positive traits — self-confidence, a belief in one's ability to overcome difficulty and a sense of social support.

Factors that appear most likely to reduce the symptoms of this disorder include:

  • Positive relationships with friends and family
  • A sense of achievement at school, work and in extracurricular activities

Last updated: April 1st, 2016

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