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Schizotypal personality disorder

Definition

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 likely to endure, though symptoms may improve with age. Medications and therapy also may help.

Symptoms

People with schizotypal personality disorder have difficulty forming close relationships and have peculiar beliefs and behaviors.

Schizotypal personality disorder signs and symptoms can include:

  • Being a loner and lacking close friends outside of the immediate family
  • Incorrect interpretation of events, including feeling that external events have personal meaning
  • Peculiar, eccentric or unusual thinking, beliefs or behavior
  • Dressing in peculiar ways
  • 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
  • Persistent and excessive social anxiety
  • Peculiar style of speech, such as loose or vague patterns of speaking or rambling oddly and endlessly during conversations
  • Suspicious or paranoid ideas, hypersensitivity, and constant doubts about the loyalty and fidelity 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 often becomes the subject of bullying or teasing.

Schizotypal personality 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 personalities may experience brief psychotic episodes with delusions or hallucinations, they are not as frequent, prolonged or intense as in schizophrenia.

Another key distinction between schizotypal personality disorder and schizophrenia is that people with the 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, schizotypal personality disorder can benefit from similar treatments as schizophrenia and is sometimes considered a variant of schizophrenia.

When to see a doctor
Because the potential for personality change becomes less pliable 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

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. For people with schizotypal personalities, something goes wrong during this process, leading to illogical beliefs, unusual thinking and paranoid feelings. What exactly goes wrong isn't known, but it's likely that one or more factors cause problems with the way the brain functions, and genetics may play a role.

Risk factors

Factors that appear to increase the risk of schizotypal personality disorder include:

  • Having a relative who has schizophrenia or schizotypal personality disorder
  • Experiencing neglect or abuse, trauma, or family dysfunction during childhood

Complications

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

  • Temporary psychotic episodes, usually in response to stress
  • Major depression
  • Anxiety disorder, characterized by prolonged worry or uneasiness
  • Work, school and social problems
  • Schizophrenia, rarely

Preparing for your 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.

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

What you can do

  • List 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.
  • List 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.
  • Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names and dosages of any medications, herbs or supplements you're taking.
  • 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.
  • List the questions you want to ask your doctor to make the most of your appointment.

For schizotypal personality disorder, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • 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?
  • If you're recommending medications, what are the possible side effects?
  • I have these other health conditions. How can I best manage them together?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask questions 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 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?
  • 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 your family members or friends expressed concern about your behavior?
  • Have any of your close relatives been diagnosed or treated for mental illness?

If you need immediate help
If you are concerned that you might harm yourself or someone else, go to an emergency room or call 911 or your local emergency number immediately.

Tests and diagnosis

Doctors diagnose personality disorders based on a thorough interview about your symptoms as well as your personal and medical history. Often people with schizotypal personality disorder seek help because of other symptoms such as anxiety, depression or angry outbursts or for treatment of substance abuse. A physical exam will help rule out other medical conditions, and a mental health provider will likely be consulted for further evaluation.

To be diagnosed with schizotypal personality disorder, a person must meet the symptom criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.

For a diagnosis of schizotypal personality disorder, at least five of the following criteria must be met:

  • Incorrect interpretations of events, such as a feeling that something which is actually harmless or inoffensive 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 you
  • 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, to be diagnosed with schizotypal personality disorder, a person must never have met the criteria for any other schizophrenic disorder.

Treatments and drugs

Treatment for schizotypal personality disorder often includes a combination of medication and one or more types of psychotherapy.

Medications
There are no medications approved by the Food and Drug Administration for the treatment of schizotypal personality disorder. However, doctors may prescribe antipsychotic, antidepressant or anti-anxiety medications to help relieve certain symptoms, such as psychotic episodes, or related conditions, such as depression or anxiety. For example, prescription medications such as risperidone (Risperdal) or olanzapine (Zyprexa) may help reduce distorted thinking.

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, for example, learning specific social skills and behaviors (behavior therapy) or identifying and changing distorted thought patterns (cognitive therapy).

Treatment can be more effective when family members are involved (family therapy). Seeking professional counseling as a group may help reduce fighting or emotional distance and improve trust in the home.

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

Updated: 4/11/2013

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