Schizotypal Personality Disorder

Schizotypal personality disorder is a serious mental illness that causes impairment in a person’s life. It is characterized by a lack of close relationships, paranoia, inappropriate social and emotional responses, social anxiety, eccentric thoughts and beliefs, distrust of others, and unusual ways of speaking. Someone with this personality disorder is likely to struggle in social situations, to have few friends, and to have a hard time at school or holding down a job. Treatment includes therapy and medications, but the condition is considered lifelong. If an individual is willing to get treatment, sticks with it, and has good support, symptoms can be managed.

What Is Schizotypal Personality Disorder?


Personality disorders are mental health conditions that cause an individual to behave and have thought patterns that are not typical, that are skewed, and that cause significant impairment in relationships, work, school, and home life. There are 10 different personality disorder types, including schizotypal. Schizotypal personality disorder is one of the cluster A personality disorders. These are grouped together because they are all characterized by unusual behaviors and eccentric patterns of thought.

Someone with schizotypal personality disorder may be described as odd or eccentric by others. They tend to have few relationships that are close or intimate. They struggle to determine what other people’s motivations or actions mean and can have inappropriate responses as a result. This type of personality disorder is often diagnosed in early or young adulthood. Symptoms can be managed with treatment, but the prognosis is not always positive, and making lasting changes is difficult for individuals.

Types of Schizotypal Personality Disorder


There is only one type of schizotypal personality disorder, but it may be confused with other conditions that have similar names, for instance schizophrenia. Schizophrenia is not a personality disorder but is a very serious mental illness. It causes psychosis, a loss of touch with reality that may include hallucinations and delusions. Schizotypal personality disorder may also cause this, but it is less common and less severe. Some experts actually consider the personality disorder to be a milder form of schizophrenia.

Another possible confusion is schizoid vs schizotypal personality disorders. These both belong to cluster A personality disorders and have some symptoms and behaviors in common. For instance, with both types of personality disorder close relationships are sparse and social interactions are limited and potentially awkward. The schizoid type tends to cause a person to be more emotionally limited and can make someone seem cold or as if they don’t care about other people.

Facts and Statistics


Schizotypal personality disorder is not the most common type of personality disorder, but it may be underreported.

  • According to a National Institutes of Health survey, nearly 15 percent of adults in the U.S. may have a personality disorder.
  • Other estimates are closer to nine percent for overall prevalence, and schizotypal personality disorder is not one of the most common types.
  • Few people, less than 40 percent, who have a personality disorder ever get treatment.
  • One study that used a national survey estimated that the prevalence of schizotypal personality disorder was 3.9 percent and higher in men than women.

Symptoms and Diagnosis of Schizotypal Personality Disorder


Schizotypal personality disorder is diagnosed by examining a patient and using the criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 categorizes the 10 personality disorders and lists the characteristic symptoms that must be seen in order to make a diagnosis. In addition to having at least five specific symptoms, a patient must exhibit symptoms that are inflexible, that don’t change over time or circumstances, and that cannot be better explained by another condition, a developmental stage, or medications or substance abuse. The symptoms of schizotypal personality disorder include:

  • Having few close relationships or friends outside of immediate family, which can make a person seem like a loner
  • Exhibiting unusual, eccentric behaviors, thoughts, and idiosyncrasies
  • Interpreting events or other people’s actions inaccurately, for instance believing that an event was not random, that it was personal to the individual
  • Believing in unusual things that are not real, like magic or special powers
  • Having odd perceptions, like illusions or sensing someone who is not there
  • Dressing or maintaining an appearance that is unkempt or unusual
  • Experiencing a high level of social anxiety
  • Speaking in ways that are unusual, like responding in odd ways to people or talking incessantly about things that are not relevant to a conversation or situation
  • Having paranoia and suspicions, particularly about the loyalties or intentions of others
  • Having limited or inappropriate emotional responses

Signs of this personality disorder may begin to manifest during the teenage years. Some early signs may include social anxiety, spending a lot of time alone, poor social skills, being bullied, or performing poorly in school.

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Causes and Risk Factors


What causes any personality disorder is not known and may never be fully understood. However, it is thought that a combination of factors trigger the development of schizotypal personality disorder. Because personality is shaped in childhood, many experts agree that events and factors that occur when a person is young most likely work together to contribute to personality disorders.

One very likely contributing factor is related to genetics. There is plenty of evidence that schizophrenia-related mental illnesses have a strong genetic component. They are much more common in people who have close family members with schizophrenia or a similar condition. Other factors that may contribute to schizotypal personality disorder are related to childhood and include:

  • Early traumatic experiences
  • Troubled relationships with parents or caregivers
  • Separation from caregivers
  • Neglect or abuse
  • A dysfunctional family dynamic

Co-Occurring Disorders


According to the National Institutes of Health, any type of anxiety disorder is the most common co-occurring mental illness with any personality disorder. Also commonly co-occurring with personality disorders are other mood disorders, like depression, impulse control disorders, other personality disorders, and substance use disorders. Substance use co-occurs commonly with many mental illnesses, often because drugs or alcohol are used to self-medicate. This may be higher with personality disorders because they so often go undiagnosed and untreated.

Schizotypal personality disorder is similar to schizophrenia and is often considered to be a milder form of the serious mental illness. There is also some evidence that a person who is diagnosed with this personality disorder is at risk of later being diagnosed with schizophrenia. Whether this means that it is a subtype or milder form of schizophrenia or that there are similar risk factors and genetic factors that explain the correlation is not well understood.

Treatment and Prognosis of Schizotypal Personality Disorder


Treatment for schizotypal personality disorder is possible but challenging. Many people with personality disorders find it difficult to recognize or accept that the way they think, behave, or view the world is at all incorrect or unhealthy. The best outcomes from treatment are in those patients who do accept this and are willing to accept help. Another difficulty of treatment specifically for schizotypal personality disorder is that individuals are uncomfortable forming a trusting relationship with a therapist.

The main aspects of treatment for this personality disorder are therapy and medication. There are no specific medications for it, but a psychiatrist may prescribe drugs for particular symptoms. For instance, antipsychotic medications can help manage paranoia and other symptoms of psychosis. Symptoms of depression and anxiety can also be managed with appropriate drugs, including anti-anxiety medications or antidepressants.

Therapy is important for treatment because there is no single drug that can help all patients or change problematic behaviors and thought patterns. Behavioral therapists can help patients recognize when they are having negative thoughts or those that are inaccurate and learn to change them. They can also help a patient figure out better social skills and learn how to better recognize and interpret social cues, how to react to others, and how to manage and change paranoid thoughts and distrust of others.

The prognosis for schizotypal personality disorder varies and depends on a number of factors, such as the severity of symptoms and an individual’s willingness to change or get professional help. Generally, this is considered to be a chronic and lifelong condition. The prognosis is improved when there is ongoing treatment, when there is good family support, and with practical support for things like a place to live, work skills, transportation, and finances.