Schizotypal Personality Disorder

What is schizotypal personality disorder?

Schizotypal personality disorder (STPD) is a mental health condition marked by a consistent pattern of intense discomfort with close relationships and social interactions. If you have STPD, you may have distorted views of reality, superstitions and unusual behaviors. Your relationships are likely hindered by these symptoms.

Schizotypal personality disorder is one of a group of conditions called “Cluster A” personality disorders, which involve unusual and eccentric thinking or behaviors. Personality disorders are chronic (long-term) dysfunctional behavior patterns that are inflexible, prevalent and lead to social issues and distress.

People with schizotypal personality disorder typically display unusual behavior, odd speech and magical beliefs. You might not realize your behavior is unusual or problematic.

Some people with schizotypal personality disorder later develop schizophrenia.

What is the difference among schizoid and schizotypal personality disorders and schizophrenia?

Schizoid personality disorder (ScPD) is a mental health condition marked by a consistent pattern of detachment from and general disinterest in social relationships. This is distinct from schizotypal personality disorder (STPD) because people with STPD have an intense discomfort with personal relationships, not a lack of interest in them.

People with STPD also have peculiar thoughts and behaviors, like magical thinking, whereas people with ScPD generally don’t.

Many researchers consider schizotypal personality disorder to be one of the schizophrenia spectrum disorders, which also includes brief psychotic disorder, schizophreniform disorder, schizoaffective disorder and delusional disorder.

However, schizotypal personality disorder is distinct from schizophrenia because people with STPD don’t have psychotic symptoms, such as hallucinations and delusions, which are hallmarks of schizophrenia.

Schizophrenia negatively impacts someone’s day-to-day function much more than schizotypal personality disorder.

Who does schizotypal personality disorder affect?

Most personality disorders, including schizotypal personality disorder (STPD), begin in the teen years when personality further develops and matures.

STPD affects people assigned male at birth slightly more than people assigned female at birth.

How common is schizotypal personality disorder?

Schizotypal personality disorder is relatively rare. It affects approximately 3% to 5% of people in the United States.

What are the signs and symptoms of schizotypal personality disorder?

People with schizotypal personality disorder experience intense discomfort and distress in social situations. You may have a lot of difficulties forming close relationships and maintaining them, partially due to a distorted interpretation of social interactions, as well as odd social behavior.

If you have schizotypal personality disorder, you may:

• Have intense social anxiety and poor social relationships.
• Not have close friends or confidants, except for first-degree relatives.
• Have peculiar behaviors and mannerisms.
• Have odd thoughts and speech, such as using excessively abstract or concrete phrases or using phrases or words in unusual ways.
• Have unusual perceptive experiences and magical beliefs, such as thinking they have special paranormal powers.
• Incorrectly interpret ordinary situations or happenings as having special meaning for them (idea of reference).
• Be paranoid and suspicious of others’ intentions.
• Have difficulty with responding appropriately to social cues, such as maintaining eye contact.
• Have a lack of motivation and underachieve in educational and work settings.

A person with STPD generally lacks awareness about how their thoughts and behaviors impact others.

What causes schizotypal personality disorder?

Personality disorders, including schizotypal personality disorder, are among the least understood mental health conditions. Researchers are still trying to figure out the exact cause of them, but believe they develop due to several factors.

Researchers think the cause of schizotypal personality disorder (STPD) is mainly biological and genetic because it shares many of the brain changes characteristic of schizophrenia. STPD is also more common among biological relatives of people with schizophrenia or Cluster A personality disorders, which suggests a genetic link.

How is schizotypal personality disorder diagnosed?

Personality continues to evolve throughout childhood, adolescence and early adulthood. Because of this, healthcare providers don’t typically diagnose someone with schizotypal personality disorder until after the age of 18.

Personality disorders, including schizotypal personality disorder, can be difficult to diagnose since most people with a personality disorder don’t think there’s a problem with their behavior or way of thinking and don’t think they need to change their behavior.

When they do seek help, it’s often due to co-existing conditions, such as anxiety or depression, not the disorder itself. Rates of these two mental health conditions are particularly high among people with schizotypal personality disorder.

When a mental health professional, such as a psychologist or psychiatrist, suspects someone might have schizotypal personality disorder, they often ask questions that’ll shed light on:

• Childhood history.
• Relationships.
• Work history.
• Reality testing.

Because a person suspected of having schizotypal personality disorder may lack insight into their behaviors, mental health professionals often work with the person’s family and friends to collect more details about their behaviors and history.

Mental health providers base a diagnosis of schizotypal personality disorder on the criteria for the condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

How is schizotypal personality disorder treated?

Psychotherapy (talk therapy) and low-dose antipsychotic (neuroleptic) medication are the main treatment options for schizotypal personality disorder.

Antipsychotic medication for schizotypal personality disorder

Healthcare providers sometimes prescribe low-dose antipsychotic (neuroleptic) medications for people with schizotypal personality disorder to treat the following symptoms:

• Cognitive peculiarities.
• Odd speech.
• Depression.
• Anxiety.
• Impulsivity.

Antipsychotic medications are particularly useful for people with moderately severe schizotypal symptoms and those experiencing mild, transient psychotic symptoms.

Psychotherapy for schizotypal personality disorder

Psychotherapy (talk therapy) is a term for a variety of treatment techniques that aim to help people identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to the person and their loved ones.

Types of psychotherapy that may benefit people with schizotypal personality disorder include:

• Group therapy: This is a type of psychotherapy in which a group of people meets to describe and discuss their problems together under the supervision of a therapist or psychologist. Group therapy may help someone with schizotypal personality disorder develop social skills because it addresses social anxiety and awkwardness. However, people with more severe symptoms may be disruptive in group therapy, especially if they have prominent paranoid thinking and behaviors.
• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A therapist or psychologist helps someone take a closer look at their thoughts and emotions to understand how their thoughts affect their actions. For someone with schizotypal personality disorder, a therapist may focus on reality testing and attention to interpersonal boundaries. They may also help the person recognize distorted thinking patterns, such as referential, paranoid or magical thinking.

Can schizotypal personality disorder be prevented?

While schizotypal personality disorder generally can’t be prevented, treating this condition can help you learn ways to alter unhelpful behaviors and thoughts if you're prone to this condition.

What is the prognosis (outlook) for schizotypal personality disorder?

Schizotypal personality disorder is a chronic condition that requires lifelong treatment.

If left untreated, the prognosis (outlook) for schizotypal personality disorder (STPD) is generally poor. It’s very common for people with STPD to have other mental health conditions, including:

• Social anxiety disorder.
• Depression.
• Obsessive-compulsive disorder.
• Substance use disorder.

About 30% to 50% of people have major depressive disorder when they’re diagnosed with STPD.

It’s essential that people with STPD receive treatment for these conditions.

A note from Cleveland Clinic

It’s important to remember that schizotypal personality disorder (STPD) is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions in your life. Mental health professionals can offer treatment plans that can help manage thoughts and behaviors.

The family members of people with STPD also experience stress, depression and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms.