Overview
Schizotypal Personality Disorder is characterized by problems with interpersonal relationships, perceptual distortions, odd beliefs and erratic behavior, leading to dysfunction in various areas of life and causing distress.
The prevalence of the disorder presents a male predominance, and its causal factors are attributed to genetics, neuroanatomical abnormalities, neurobiological processes as well as environmental correlates.
A significant association with Schizophrenia has also been established in both the aetiology as well as the developmental course of Schizotypal Personality Disorder.
The treatment for the disorder can be challenging, and is highly individualistic. Pharmacological and psychotherapeutic approaches may be considered after thorough assessment of the individual’s symptomatology.
Signs and Symptoms
The signs and symptoms of Schizotypal Personality Disorder include:
- Lack of close personal relationships (other than those with first-degree relatives)
- Believing that casual incidences, events, or coincidences have some sort of relation to oneself, and holds a special meaning for them
- Preoccupation with superstitions or supernatural phenomena (not within the norm of a one’s culture)
- Believing that one has magical powers or abilities
- Anxiety in social situations
- Atypical speech, such as overly concrete or vague content, or incoherence
- Perceptual errors (such as sensing the presence of others or hearing murmurs)
- Inability to connect or relate to others
- Constantly being overly tense or suspicious about others’ motives
- Transient psychotic episodes
- Depressive episodes
Risk Factors
There is a male preponderance in the prevalence of Schizotypal Personality Disorder, with an estimated 1% of the general population being affected by the disorder.
Studies have reported a genetic basis for the disorder, with moderate heritability. Environmental correlates include prenatal complications, psychological trauma, and chronic stress.
Structural studies have reported abnormalities in the anatomy as well as functioning of the brain among those with Schizotypal Personality Disorder.
There is an interaction of environmental and genetic correlates, and the influence that trauma has on the course of schizotypal symptom development is determined in part by genetic factors.
A strong association with Schizophrenia has been established, with a higher incidence of Schizotypal Personality Disorder among relatives of those diagnosed with Schizophrenia.
This association is largely due to the genetic, experienced, and neurobiological characteristics that both the disorders share.
An increased risk for schizophrenia among adolescents with Schizotypal Personality Disorder has been observed, though a second subtype of the disorder, which is not genetically linked to Schizophrenia, has also been hypothesized.
Cognitive and perceptual deficits are the primary observations in this deficit, and it is causally linked to childhood trauma and maltreatment.
Diagnosis
The diagnosis of Schizotypal Personality Disorder can be challenging due to the fact that its symptoms can often overlap with those of other disorders.
It is more common for individuals with the disorder to approach health practitioners due to depressive symptoms, attentional or cognitive problems, social anxiety, and interpersonal issues.
The process relies on screening instruments, diagnostic interviews and questionnaires, and diagnostic criteria.
The diagnostic criteria for Schizotypal Personality Disorder in the DSM-5 indicate the following:
There is a pattern of social and interpersonal problems, marked by discomfort and reduced capacity for close relationships as well as cognitive or perceptual distortions and eccentricities of behavior, starting in early adulthood and present in various contexts. 5 or more of the following are observed:
- Ideas of reference (excluding delusions of reference)
- Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”: in children and adolescents, 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
- Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
Schizotypal Personality Disorder is not diagnosed if these symptoms are present during the course of underlying disorders such as Schizophrenia, Bipolar Disorders, depressive disorder with psychotic features, other psychotic disorders, or Autism Spectrum Disorder.
In a few cases, Schizotypal Personality Disorder precedes the onset of Schizophrenia, and it thus termed “premorbid” Schizotypal Personality Disorder”.
There is also a significant comorbidity with major depressive disorder, with 30-50% of individuals having experienced at least one depressive episode during admittance to a clinical setting.
Treatment
A combination of medication and psychotherapy may be effective in the management of Schizotypal Personality Disorder, depending on the manifestation and severity of symptoms.
Due to a paucity of clinical trials, there is no pre-established route of medication, and prescriptions are based on prominent symptomatology.
Attentional and cognitive symptoms may be managed with the help of stimulants, anxiety symptoms may be managed with the help of benzodiazepines, and symptoms involving psychosis may be managed with antipsychotics.
The course of psychotherapy for the management of Schizotypal Personality Disorder can be difficult to determine. While symptomatic experiences may require psychotherapeutic intervention, the process itself is subject to a number of limitations.
Due to the complications in forming interpersonal alliances that arise in the phenomenology of the disorder, patients of Schizotypal Personality Disorder may not be able to form an appropriate relationship with the therapist.
Additionally, they may experience problems with relation to the continuity between sessions, the expression and communication of emotions which determines the efficacy of therapeutic intervention, as well as with their ability to abstractly think of their own mental states.
Dissociative symptoms and problems with perception that are experienced by patients, accompanied by a difficulty in recognizing reality, can make the psychotherapeutic process cumbersome.
The type of intervention that proves to be most effective is largely individualistic.
Differential Diagnosis
1. Other mental disorders with psychotic symptoms: Schizotypal personality disorder can be distinguished from delusional disorder, schizophrenia, and a bipolar or depressive disorder with psychotic features because these disorders are all characterized by a period of persistent psychotic symptoms.
2. Neurodevelopmental disorders: There may be great difficulty differentiating children with schizotypal personality disorder from children whose behavior is characterized by marked social isolation, eccentricity, or peculiarities of language and whose diagnoses would probably include milder forms of autism spectrum disorder or language communication disorders.
3. Personality change due to another medical condition: Schizotypal personality disorder must be distinguished from personality change due to another medical condition, in which the traits that emerge are due to the effects of another medical condition on the central nervous system.
4. Substance use disorders: Schizotypal personality disorder must also be distinguished from symptoms that may develop in association with persistent substance use.
5. Other personality disorders and personality traits: Other personality disorders may be confused with schizotypal personality disorder because they have certain features in common.
These disorders are paranoid personality disorder, avoidant personality disorder, narcissistic personality disorder, borderline personality disorder. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features
Specialist
Individuals are most likely to seek intervention for mood related or attentional/cognitive symptoms, and may approach psychiatrists, clinical psychologists, or therapists for the same.
The diagnosis and further treatment is determined upon careful assessment by a qualified mental healthcare practitioner.
