Schizotypal Personality Disorder (STPD): Symptoms, Causes, & Treatments

What Is Schizotypal Personality Disorder (STPD)?

Schizotypal personality disorder (STPD) is a Cluster A personality disorder characterized by eccentric behavior and difficulty connecting with others socially. Individuals with STPD may experience less severe and frequent episodes of psychosis or delusional thinking than seen in schizophrenia. STPD severity and functional impairment can manifest along a continuum.

Schizotypal Personality Disorder Vs. Schizophrenia

Schizotypal is a personality disorder, whereas schizophrenia is a psychotic disorder. Schizophrenia typically involves long-lasting psychosis symptoms, like hallucinations and delusions. These symptoms may present in schizotypal personality disorder but are brief and not as intense or frequent.

Another difference is that symptoms of schizophrenia often manifest in the late twenties, whereas symptoms of schizotypal personality disorder can appear as early as childhood or adolescence.

Schizoid Vs. Schizotypal Personality Disorder

The primary difference between schizoid and schizotypal personality disorder is the desire for social interaction. People with schizoid personality disorder do not seek social relationships. Conversely, those with schizotypal personality disorder often want closeness with others but struggle due to their odd behaviors.

Another dissimilarity is that schizotypal individuals experience odd beliefs and perceptions, whereas those with schizoid do not. Lastly, while those with schizotypal struggle in social, occupational, and personal domains of functioning, individuals with schizoid may function reasonably well.

Schizotypal Personality Disorder Symptoms

Schizotypal personality disorder includes disruptions in social, emotional, and psychological functioning. Schizotypal traits include patterns of odd beliefs and thinking, paranoia, social anxieties, and constricted or inappropriate affect with others. These challenges often contribute to difficulties with communication and periods of social isolation.

Below are the symptoms of schizotypal personality disorder:

1. Extreme Social Anxiety

Individuals with schizotypal personality disorder may struggle with intense social anxiety. They often desire close relationships with others but struggle to form such connections because of their strange mannerisms or communication methods. They may also exhibit paranoid perceptions of others, adding to their extreme social anxiety. Unfortunately, these feelings of paranoia do not decrease with familiarity.

2. Paranoia

Those with schizotypal personality disorder may grow suspicious of the intentions of others. Paranoia may cause them to mistrust others or avoid forming close relationships, even when they desire friendship or partnership.

3. Odd Beliefs

Individuals with schizotypal personality disorder often hold odd beliefs related to cultures or societies. For instance, some may believe they possess special powers, like telepathy, or engage in “magical thinking.” Sometimes, their speech or dress styles may also appear eccentric or strange to others.

4. Ideas of Reference

Ideas of reference are when an individual connects a random event with a specific meaning. These inferences mark a departure from reality in that unrelated events directly affect or are affected by the individual. An example would be believing a page in the newspaper represented a secret message to the individual.

5. Distorted Perceptions

Individuals with schizotypal personality disorder struggle with distorted perceptions, whether through sight, sound, or touch. Only the person can recognize these distortions, and outsiders are often unaware of these experiences.

6. Odd Communication

Whether through patterns of speech or word choice, individuals with schizotypal personality disorder communicate in eccentric or strange ways relative to current cultures. Sometimes, this causes barriers to forming close social relationships because others do not understand these interactions.

7. Flat, Inappropriate, or Restricted Affect

Schizotypal individuals may exhibit blunted or flat affect in their interactions with others. They may also present as incongruent, meaning they laugh at something inappropriate or remain apathetic in distressing situations. This behavior is sometimes confusing or frustrating for outside parties.

8. Social Isolation

Sometimes, paranoia causes an individual to self-isolate. Those with schizotypal personality disorder may question the intentions of others or fear rejection based on their odd behavior or speech patterns. Over time, these anxieties can lead to loneliness.

9. Odd Behavior & Appearance

Individuals with schizotypal personality disorder may present with unusual behavioral patterns. They may overlook social norms, cues, or expectations, leading others to question their ability to maintain relationships. Many people with schizotypal may feel ostracized by society, further fueling their social anxiety and self-isolation.

Signs of Schizotypal Personality Disorder

Signs of schizotypal personality disorder vary depending on the person. Many children with STPD traits may appear socially awkward and isolated, fall behind in school, or become victims of teasing and bullying.¹

In adult populations, males often present with flat affect, emotional volatility, and incongruent emotional responses, such as laughing when something bad happens. Females may score higher on social anxiety symptoms and odd belief subscales.¹

Signs of schizotypal personality disorder may include:^{2, 3}

• Avoidance of people and mistrust of people
• Lack of close friends or confidants
• Magical thinking
• Spending a lot of time alone without expressing loneliness or desire for interaction
• Unusual physical appearance
• Brief experiences of visual, tactile, or auditory hallucinations
• Ignoring social norms
• Flat affect or restricted range of facial expressions
• Difficulty maintaining employment
• Difficulty in school
• Believing they have special powers

How Is Schizotypal Personality Disorder Diagnosed?

A mental health professional will evaluate to determine if someone meets schizotypal personality disorder DSM 5 criteria through clinical interviews and assessments. A specific schizotypal test does not exist, but evaluators may use the Schizotypal Personality Disorder Questionnaire (SPQ), Structured Interview for Schizotypy (SIS), or SPQ-Brief Response during a diagnostic exam.^1,4,5

What Causes Schizotypal Personality Disorder?

One specific causation does not influence schizotypal personality disorder. Instead, a complex interplay between genetic and environmental factors can result in the onset of symptoms. The more risk factors present, the higher the likelihood of developing the disorder.

Possible schizotypal personality disorder causes include:

• Biologic factors: Having a relative with schizophrenia or a related psychotic disorder increases the risk of schizotypal personality disorder.
• Genetic factors: Research suggests that the Val allele gene may influence schizotypal and related disorders.
• Childhood trauma: Childhood trauma can change how the brain responds to relationship challenges. For instance, children may learn to mistrust others or develop strange behaviors due to traumatic experiences.
• Natural temperament: A more sensitive or irritable temperament can put an individual at risk for developing schizotypal personality disorder.
• Co-occurring mental illness: Co-occurring mental illness can add or exacerbate symptoms of schizotypal personality disorder.
• Chronic stress: Distress puts undue pressure on emotional and physical capacities for handling life events. Long-term periods of stress may worsen pre-existing or dormant schizotypal symptoms.
• Uninvolved or neglectful parents: Children consider their parents or caregivers a safe base for developing relationships and trust. Having uninvolved parents may put individuals at risk for trust issues and poor social skills.

Complications of Schizotypal Personality Disorder

Untreated schizotypal personality disorder may exacerbate personal, behavioral, relational, or occupational issues. Many may suffer unintended consequences when they do not address these challenges. In the long term, poor symptom management can contribute to depressive symptoms, co-occurring disorders, and relationship problems.

Long-term effects of schizotypal personality disorder may include:

• Depression: Living with schizotypal traits may cause or worsen symptoms of depression due to the inability to form close and lasting relationships.
• Obsessive-compulsive disorder (OCD): Individuals with schizotypal may develop cognitive or behavioral compulsions to deal with their paranoid or delusional thoughts.
• Substance use: Some individuals with schizotypal traits may use substances to calm social anxieties or paranoia.
• Social anxiety disorder: Individuals may develop a social anxiety disorder if they do not address their communication challenges.
• Difficulties maintaining employment: Social and cognitive symptoms of schizotypal personality disorder may lead to issues finding and maintaining employment. Individuals may also only seek jobs with little to no social interaction.
• Relationship problems: A major domain of difficulty for individuals with schizotypal personality disorder is social relationships. Forming close bonds with others is difficult due to their odd beliefs and perceptions.

Schizotypal Personality Disorder Treatment Options

Treatment for schizotypal personality disorder typically focuses on teaching individuals healthy coping skills, improving communication, and addressing unusual behaviors. Some clients may benefit from combined therapeutic and medical treatments, such as psychotherapy and antidepressants.

Therapy Options

Various options for treatment are available for schizotypal personality disorder. The type of therapy an individual seeks may depend on the frequency and intensity of symptoms. Additionally, specific communication or behavioral challenges may also affect the recommended type and length of treatment.

Therapy for schizotypal personality disorder may include:

• Family therapy: People with schizotypal personality disorder often push others away and self-isolate, causing rifts between them and loved ones. Family therapy can benefit everyone by providing psychoeducation, coping skills, and improved communication strategies.
• Group therapy: Group therapy allows individuals to practice social skills and trust in a controlled setting.
• Cognitive behavioral therapy (CBT): Cognitive behavioral therapy involves teaching more adaptive thoughts, emotions, and coping skills.
• Couples therapy: Couples therapy may be helpful when schizotypal traits impact a romantic relationship. These modalities can help the individual improve communication patterns and intimacy.
• Social skills training: Social skills training can help those with schizotypal personality disorder build a toolkit for developing and maintaining healthy relationships.

Medication

Medication for schizotypal personality disorder may consist of antipsychotics, antidepressants, or stimulants. Treatment may also use a combination of these medications to achieve better cognitive and emotional balance by regulating mood, calming paranoid thoughts, or reducing unwanted behaviors.

Living With Schizotypal Personality Disorder

Living a functioning and fulfilling life with schizotypal personality disorder is possible. Coping with schizotypal traits helps prevent symptoms from affecting your quality of life and relationships.

Below are ways to cope with schizotypal personality disorder:

• Keep up with your treatment plan: Follow your treatment plan. Your care team will explore which medications and coping mechanisms best suit your needs and situation.
• Maintain healthy self-care: You are more vulnerable to symptoms when you neglect healthy self-care. Following a self-care routine offers your brain and body the best fighting chance against the disorder.
• Seek social support from loved ones: Support systems offer a cushion against the stress of your symptoms. Loved ones can provide essential objective insight into your experience and help you develop coping skills.
• Prioritize your physical well-being: Maintain a healthy diet and physical habits to support a positive mind-body connection.
• Focus on improving your relationships: Maintaining relationships can seem challenging, but using social skills learned in treatment helps you slowly build solid relationships with others.
• Set goals and follow through: Setting small and achievable goals throughout treatment will help you realize your capacity for change. Your care team can aid in preventing obstacles along the way.
• Explore new hobbies: New hobbies can offer much-needed relief from symptoms of schizotypal personality disorder. Giving your brain a break and changing focus can help prevent ruminative episodes.
• Give back to your community: Getting out in the community can connect you to society, strengthen relationships, and help you feel less alone.
• Maintain a routine: Maintaining a schedule can provide a sense of control amidst chaos or stress.

Final Thoughts

Although schizotypal personality disorder can cause issues in multiple areas of functioning, leading a fulfilling life is still possible. Seeking early intervention at the first sign of symptoms can help you avoid exacerbations. Reaching out can help you know you are not alone and hope is on the horizon.