# Schizotypal personality disorder



## David Baxter PhD (Oct 11, 2008)

Schizotypal personality disorder
By Mayo Clinic Staff 
Oct. 10, 2008 

Schizotypal personality disorder is a serious condition in which a person usually has few to no intimate relationships. These people tend to turn inward rather than interact with others, and experience extreme anxiety in social situations. 

People with schizotypal personality disorder often have trouble engaging with others and appear emotionally distant. They find their social isolation painful, and eventually develop distorted perceptions about how interpersonal relationships form. They may also exhibit odd behaviors, respond inappropriately to social cues and hold peculiar beliefs. 

Schizotypal personality disorder typically begins in early adulthood and may endure throughout life. There's no cure for schizotypal personality disorder, but psychotherapy and some medications may help. Some research suggests that positive childhood experiences may help reduce symptoms of schizotypal personality disorder in affected young people. 

*Symptoms*
People with classic schizotypal personalities are apt to be loners, having few to no intimate relationships. They exhibit extreme anxiety in social situations, often associated more with distrust and an inability to communicate with others than with a negative self-image. They view themselves as alien or outcast, and this isolation causes pain as they disengage more and more from relationships and the outside world. 

People with schizotypal personalities often have odd patterns of speech and ramble endlessly on tangents to a topic of conversation. They may dress in peculiar ways and have very strange ways of viewing the world around them. Often they harbor unusual ideas, such as believing in the powers of ESP or a sixth sense. At times, they believe they can magically influence people's thoughts, actions and emotions. 

In adolescence, signs of a schizotypal personality may begin as a gravitation toward solitary activities or a high level of social anxiety. The child may be an underperformer in school or appear socially out-of-step with peers, and as a result often becomes the subject of bullying or teasing. 

Symptoms of schizotypal personality disorder include: 


Incorrect interpretation of events, including feeling that external events have personal meaning 
Peculiar thinking, beliefs or behavior 
Belief in special powers, such as telepathy 
Perceptual alterations, in some cases bodily illusions, including phantom pains or other distortions in the sense of touch 
Idiosyncratic speech, such as loose or vague patterns of speaking or tendency to go off on tangents 
Suspicious or paranoid ideas 
Flat emotions or inappropriate emotional responses 
Lack of close friends outside of the immediate family 
Persistent and excessive social anxiety that doesn't abate with time
Schizotypal personality disorder can easily be confused with schizophrenia, which is characterized by intense psychosis, a severe mental state characterized by a loss of contact with reality. While people with schizotypal personalities may experience brief psychotic episodes with delusions or hallucinations, they are not as pronounced, frequent or intense as in schizophrenia. 

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

Both disorders, along with schizoid personality disorder, belong to what's generally referred to as the schizophrenic spectrum. Schizotypal personality falls in the middle of the spectrum, with schizoid personality disorder on the milder end and schizophrenia on the more severe end. 

*When to see a doctor*
Because personality tends to become entrenched as people age, it's best to seek treatment for a personality disorder as early as possible. 

People with schizotypal personality 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, be on the lookout for certain signs. You might gently suggest that the person seek medical attention, starting with a primary care physician or mental health provider. 

*Causes*
Your personality is the sum total of the ways you think, feel, behave and react to your environment. It derives from a combination of genetics and early life experience. When someone chronically feels or behaves in an inappropriate way, that person has a personality disorder. 

In normal development, children progress through several stages of social awareness and learn to accurately interpret the cues and intentions of others. For people with schizotypal personalities this social cognition is impaired, leading to development of illogical beliefs, magical thinking and paranoid thoughts, such as a nagging suspicion that one is being harassed, persecuted or treated unfairly. 

The exact reason or cause of this impairment is unknown. Some experts contend that childhood abuse, neglect or stress results in the brain dysfunction that gives rise to schizotypal symptoms. Both genetics and environmental circumstances appear to play a role in development of the disorder. 

A family history ? such as having a parent who has schizophrenia or schizotypal personality disorder ? increases your chances of developing the condition. A number of environmental factors also may contribute, such as a neglectful or abusive childhood home. 

*Risk factors*
Personality development is mostly affected by genetic tendencies. Environmental factors, such as stressful childhood experiences, also may play a role. Factors that increase the risk of developing the schizotypal personality disorder include: 


Having a relative who has schizophrenia
Living in a childhood environment of deprivation or neglect 
Experiencing child abuse or mistreatment 
Undergoing a childhood trauma 
Having an emotionally detached parent
*Complications*
People with schizotypal personality disorder are at an increased risk of: 


Schizophrenia 
Major depression 
Anxiety disorder, characterized by prolonged worry or uneasiness 
Dysthymia, a low-grade depressed mood that continues for more than two years 
Panic disorder, characterized by sudden bouts of heart-pounding terror 
Social phobia, characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations 
Avoidant personality disorder, characterized by a pervasive pattern of social inhibition and feelings of ineptness 
Obsessive-compulsive disorder, characterized by recurrent, unwanted thoughts and repetitive behaviors 
Borderline personality disorder, characterized by a constant state of emotional turmoil
*Preparing for your appointment*
You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist. 

Here's some information to help you prepare for your appointment, and what to expect from your doctor. 

*What you can do *

*Be aware of any pre-appointment restrictions*. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. 
*Write down any symptoms you're experiencing*, including any that may seem unrelated to the reason for which you scheduled the appointment. 
*Write down key personal information*, including any major stresses or recent life changes. 
*Make a list of all medications*, as well as any vitamins or supplements, that you're taking. 
*Take a family member or friend along*, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot. 
*Write down questions* to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For schizotypal personality disorder, some basic questions to ask your doctor include: 


What is likely causing my symptoms or condition?
Other than the most likely cause, what are possible causes for my symptoms or condition? 
How will you determine my diagnosis? 
Is my condition likely temporary or chronic? 
What treatments do you recommend for this disorder? 
What are the side effects of medications commonly used for this condition? 
How long will it take for medications to noticeably improve my symptoms? 
If the first medication we try isn't effective, what will you recommend next? 
Would talk therapy help me? 
How much improvement can I expect if I follow your recommended treatment plan? 
I have these other health conditions. How can I best manage them together? 
Are there any restrictions that I need to follow? 
Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist? 
Is there a generic alternative to the medicine you're prescribing me? 
Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something. 

*What to expect from your doctor*
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask: 


When did you first begin experiencing symptoms? 
Have your symptoms been continuous, or occasional? 
What do you suspect is causing your symptoms? 
Does anything seem to either improve your symptoms or make them worse? 
How satisfied are you with your performance at work and school? 
Do you have close relationships with family members? How about friends? 
If you're not satisfied with work, school or relationships, what do you think is causing your problems? 
Do you feel comfortable in social situations? Why or why not? 
Have you ever thought about harming yourself or others? Have you ever actually done so? 
Have you ever felt that you could influence other people and events through your thoughts or your actions? 
Have your family members or friends expressed concern about your behavior? 
Have any of your close relatives been diagnosed or treated for mental illness?
*What you can do in the meantime*
While you're waiting for your appointment, it may be helpful to ask friends or family members if they have felt concerned about your behavior. You'll also want to find out about your family's medical history, including any history of mental illness. If you have fantasies about hurting yourself or someone else, go to an emergency room or call 911 or your local emergency number immediately. 

*Tests and diagnosis*
There are no laboratory tests for personality disorders, so diagnosis typically comes after a thorough clinical interview. The doctor will ask questions about symptoms and mental well-being, and take a medical, psychiatric and social history. A physical examination will help rule out other conditions, and a mental health provider will likely be consulted for further evaluation. 

For a diagnosis of schizotypal personality disorder, at least five of the following criteria must be met, according to criteria spelled out in the _Diagnostic and Statistical Manual of Mental Disorders (DSM)_, published by the American Psychiatric Association: 


Incorrect interpretations of events, including a feeling that something innocuous has a direct personal meaning 
Odd beliefs or magical thinking that's inconsistent with cultural norms 
Unusual perceptions, including illusions 
Odd thinking and speech patterns 
Suspicious or paranoid thoughts, such as the belief that someone's "out to get them" 
Flat emotions, appearing aloof and isolated 
Odd, eccentric or peculiar behavior or appearance 
Lack of close friends or confidants other than relatives 
Excessive social anxiety that doesn't diminish with familiarity 
In addition, the person must never have met the criteria for any other schizophrenic disorder. To distinguish schizotypal personality disorder from schizophrenia, the doctor looks for the presence of psychosis and experiences with hallucinations or delusions.
*Treatments and drugs*
Treatment for schizotypal personality disorder may be with a combination of medication and one or more of several types of therapy: 


*Medications*. There's no specific drug treatment for the disorder; however, doctors may prescribe antidepressant or antipsychotic medications to help alleviate associative conditions such as anxiety, depression or other mood disorders. For example, treatment for distorted thinking may be with the prescription medications risperidone (Risperdal) and olanzapine (Zyprexa). 
*Psychotherapy*. Building a trusting rapport in therapy may help people with schizotypal personality disorder contradict the mistrust or discomfort they have with developing interpersonal relationships. 
*Behavior therapy*. People with schizotypal personalities often need to learn specific interpersonal skills and new behaviors, as they often have difficulty responding appropriately to social cues. For example, they might learn to express appropriate feelings or adjust facial expressions and voices in reaction to certain stimuli. 
*Cognitive therapy*. People with schizotypal personality disorder may respond to exercises that focus on interrupting distortions in thought. For example, this type of therapy may use reasoning exercises to clarify social confusion and overcome self-defeating thoughts, especially in interpersonal situations. 
*Family therapy*. Treatment can be more effective when family members are involved. Seeking professional counseling as a group may help diminish angry confrontations or emotional distancing in the home. Family therapy may also offer the affected person reassurances of a support structure and a boost in morale.
*Prevention*
Until recently, doctors have generally believed that once a personality disorder has developed it will last throughout life. However, new research has suggested that the symptoms of conditions such as schizotypal personality disorder may improve significantly over time. Factors that appear most likely to reduce the symptoms of this disorder include positive relationships with friends and family as well as a sense of achievement at school, work and in extracurricular activities. 

Researchers believe that these experiences may create a protective effect by fostering ? among other positive traits ? self-confidence, a belief in one's ability to overcome difficulty and a sense of social support. These findings also indicate that early interventions such as youth programs that foster personal achievement and strong community relationships may help prevent personality disorders in at-risk children. The earlier these kinds of interventions reach a child in any challenging situation, the better his or her chances of doing well.


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## a_squared (Oct 17, 2009)

Can schizotypal or schizoid personality disorders develop into schizophrenia, if untreated?


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## David Baxter PhD (Oct 17, 2009)

Sometimes, individuals with Schizotypal PD or Schizoid PD may later be diagnosed with schizophrenia, in which case the personality disorder is seen as "premorbid", i.e., disorder of personality with emerging schizophrenia.

But as far as I know. this is not inevitable. Individuals with one of these personality disorders may appear to be eccentric to others but not necessarily develop schizophrenia.

I should note that this is a little beyond my fund of knowledge so don't take this answer as conclusive.


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## SilentNinja (Oct 30, 2009)

before i left, my psych had brought up schizotypal i seemed to match all but one of the critera for it... i do not have any psychosis as in i dont hear or see things, Can you have Schizotypal without the psychosis symptoms? Im very curious, Im still trying to get the courage to go back it was the hardest thing i done in my life, having to sit there and try explain while someone stares at you, I didnt trust her either, I know they say info is kept private but she was the gossip type and i think she was making fun of me in her head ( honestly! )


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## forgetmenot (Oct 30, 2009)

I think it would be a good idea to go back and see your doctor. I know how hard it is when you are uncomfortable with people.  Is there anyway you can have someone go with you for support  It is important to get diagnosed by a proper psychiatrist so your treatment is correct.
I hope you do get the courage to go back.


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## SilentNinja (Oct 30, 2009)

Thanks, yeah my mum came along, she waited in the waiting room, My appointments was 45 mins every fortnight, had been going 6 months, and it was still questions... questions...  I left when she said to me you must be getting frustrated becaue i cant work you out, I didnt think that was very nice, and she usually text on her phone while i was sitting, and didnt want to understand me. This put me off alot, and it still goes round and round my head and makes me upset. I even tried writing stuff down but she wouldnt read it... told me i had to use words. It was a horrible experience. Hopefully soon i can try again, maybe after xmas. thanks.


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## forgetmenot (Oct 30, 2009)

I think the doctor was just wanting to see what your reactions would be to what she was doing.  If it bothers you that she is texting on her phone next time ask her why she is doing this.  It could be she was texting notes about you.  I think your doctor means well and wants to help you but it takes time thats all.  I am glad you are here and can talk with us because it does help to have someone to talk to about what you are going through. Do try and go back and see you doctor even if you take you mom in with you next time if your comfortable with that and your doctor is.


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## a_squared (Oct 30, 2009)

> Can you have Schizotypal without the psychosis symptoms?


You can.

As David wrote above:

Diagnostic criteria (DSM-IV-TR = 301.22)
The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines schizotypal personality disorder as:

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated *by five (or more) of the following*: 
-Ideas of reference (excluding delusions of reference) 
-Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, bizarre fantasies or preoccupations) 
-Unusual perceptual experiences, including bodily illusions 
-Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) 
-Suspiciousness or paranoid ideation 
-Inappropriate or constricted affect 
-Behavior or appearance that is odd, eccentric, or peculiar 
-Lack of close friends or confidants other than first-degree relatives 
-Social anxiety that tends to be associated with paranoid fears rather than negative judgments about self. 


The ICD10 criteria for diagnosing Schyzotypal personality disorder:

F21 Schizotypal Disorder
A disorder characterized by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, _thought no definite and characteristic schizophrenic anomalies have occurred at any stage. _There is no dominant or typical disturbance, *but any of the following *may be present: 

(a) inappropriate or constricted affect (the individual appears cold and aloof); 
(b) behaviour or appearance that is odd, eccentric, or peculiar; 
(c) poor rapport with others and a tendency to social withdrawal; 
(d) odd beliefs or magical thinking, influencing behaviour and inconsistent with subcultural norms; 
(e) suspiciousness or paranoid ideas; 
(f) obsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents; 
(g) unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization; 
(h) vague, circumstantial, metaphorical, overelaborate, or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence; 
(i) occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation. 

The disorder runs a chronic course with fluctuations of intensity. Occasionally it evolves into overt schizophrenia. There is no definite onset and its evolution and course are usually those of a personality disorder. It is more common in individuals related to schizophrenics and is believed to be part of the genetic "spectrum" of schizophrenia.


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## David Baxter PhD (Oct 30, 2009)

SilentNinja said:


> i do not have any psychosis as in i dont hear or see things, Can you have Schizotypal without the psychosis symptoms?



Yes. You may not ever experience hallucinations. Individuals with Schizotypal Personality are eccentric in  some ways but not out of touch with reality to the extent that an individual with schizophrenia would be.



SilentNinja said:


> Im very curious, Im still trying to get the courage to go back it was the hardest thing i done in my life, having to sit there and try explain while someone stares at you,



I know that can be hard and unnerving. You did well. 



SilentNinja said:


> I didnt trust her either, I know they say info is kept private but she was the gossip type and i think she was making fun of me in her head ( honestly! )



I think that's just your anxiety talking. She is a professional and if she were to gossip about you or make fun of you she wouldn't last long in her job.


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