What is Schizotypal Personality Disorder?
Schizotypal personality disorder (STPD) is an illness characterized by unusual thought processes, social behavior, and, often, speech patterns. People with STPD typically don’t have close relationships, and they may be suspicious of others. They may have delusions or beliefs that are out of touch with reality. Their mistrust of others often causes them severe anxiety and leads to social isolation.
STPD is one of a group of conditions called Cluster A personality disorders. This group also includes paranoid personality disorder and schizoid personality disorder.
Symptoms of Schizotypal Personality Disorder
Common symptoms of STPD include:
- Eccentric thought processes
- Unusual speech (e.g., metaphorical, vague, stilted)
- Paranoia or suspicion of others’ motives
- Lack of close relationships
- Social anxiety, often caused by paranoia
- Feeling that inconsequential occurrences have special significance for them
- Belief in clairvoyance, ESP, telepathy, or other paranormal phenomena
- Hearing non-existent voices or other perceptual hallucinations
Difference from Schizoid Personality Disorder and Schizophrenia
Schizotypal personality disorder has some characteristics in common with both schizoid personality disorder and schizophrenia. For example, people with all three conditions may have trouble interacting socially, and others often see their behavior as odd. However, there are some critical differences between STPD and the other two conditions, including:
- People with schizoid personality disorder aren’t disconnected from reality and typically don’t experience hallucinations, delusions, or paranoia. However, people with schizotypal personality disorder may experience all of these symptoms.
- Episodes of disconnection from reality in STPD are usually briefer and less intense than schizophrenia.
- People with STPD can sometimes accept that their beliefs don’t reflect reality. However, this is typically not true with schizophrenia.
What Causes Schizotypal Personality Disorder?
The exact cause of STPD has not been discovered. People with STPD often have a family history of schizophrenia, leading scientists to suspect a biological cause shared by the disorders. However, no definite association with any neurological disorder has been identified.
Is Schizotypal Personality Disorder Hereditary?
Scientists have not yet been able to identify a specific genetic component that increases the risk of STPD. Inherited genes may increase an individual’s susceptibility to STPD, but the disorder’s actual development may result from external triggering circumstances.
How Is Schizotypal Personality Disorder Detected?
STPD typically is not diagnosed before early adulthood, but some symptoms may appear in childhood. Early warning signs can include:
- Strong preference for being alone
- Extreme social anxiety
- Lack of friends
- Poor performance at school
- Being bullied by peers
How Is Schizotypal Personality Disorder Diagnosed?
Diagnosis of STPD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that STD or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.
Diagnostic steps may include:
- A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
- Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.
The results of the psychological assessments will be compared to the diagnostic criteria for STPD in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for STPD include:
- Discomfort with and lack of close relationships.
- Odd behaviors and misperceptions of reality.
- At least five symptoms are present.
- The symptoms begin by early adulthood.
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How Is Schizotypal Personality Disorder Treated?
There is no cure for STPD. However, psychotherapy may be helpful, and some medicines may be used to treat symptoms of other co-existing disorders.
People with STPD are unlikely to seek treatment on their own. Instead, they may be encouraged to seek treatment by others, or they may seek treatment on their own for another disorder, such as depression.
The most commonly used therapeutic approach is cognitive-behavioral therapy (CBT). This type of treatment focuses on teaching the patient to recognize inaccurate perceptions about themselves and others and develop strategies for dealing with these misperceptions when they occur.
In some cases, medications may help control co-existing problems such as anxiety, depression, or psychotic disconnections from reality. The drugs used to treat these symptoms include selective serotonin reuptake inhibitors (SSRIs) and atypical antipsychotic medications.
How Does Schizotypal Personality Disorder Progress?
People with STPD have trouble forming and maintaining relationships, and their eccentric social behavior may prevent them from functioning normally. Many people with the disorder can perform reasonably well at work, especially if they can work alone. However, they are unlikely to seek treatment, and their behavior may have increasingly severe consequences over time.
Long-term adverse effects of STPD can include:
- Unemployment or homelessness
- Financial difficulties
- Legal difficulties
- Social isolation
- Substance abuse
- Suicide attempts
How Is Schizotypal Personality Disorder Prevented?
There is no known way to prevent STPD, but early intervention may help someone with the disorder learn to form more healthy relationships with other people.
Schizotypal Personality Disorder Caregiver Tips
Many people with schizotypal personality disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with STPD:
- Many people with STPD also have other personality disorders (e.g., avoidant, schizotypal, or paranoid personality disorders).
- Between a third and a half of people with STPD suffer from depression.
- Many people with STPD have a family history of schizophrenia, and people with STPD may develop schizophrenia.
- Anxiety disorders are common in people with STPD.
- Alcoholism and substance abuse are commonly co-morbid with STPD.
- People with STPD are at increased risk of suicide.
Schizotypal Personality Disorder Brain Science
Researchers have used magnetic resonance imaging (MRI) to examine the brains of people with STPD and compare them to people with schizophrenia. Studies have found many structural similarities in the brains of people with both disorders, and the structural anomalies are distinct from the structures of healthy brains. The parts of the brain affected include:
- Superior temporal gyrus
- Temporal horn region of the lateral ventricles
- Corpus callosum
- Septum pellucidum
- Cerebrospinal fluid (CSF) volume
Not only do these similarities suggest that there may be identifiable neurological causes of both schizophrenia and STPD, but they also lend support to the theory that STPD is a relatively mild form of schizophrenia.
Schizotypal Personality Disorder Research
Title: Compassion and Metacognition in Schizotypal Personality (CMBT)
Study chair: Simone Cheli
The purpose of this study is to assess the safety and efficacy of a newly developed psychotherapy for schizotypal personality disorder. This new form of psychotherapy integrates compassion-focused therapy and metacognitively oriented psychotherapy.
After being informed about the study and potential risks, all patients giving written informed consent will undergo a psychological assessment to determine eligibility for study entry. Patients who meet the eligibility requirements will be randomized in a double-blind manner in a 1:1 ratio to new integrative psychotherapy or treatment as usual (cognitive behavioral therapy plus standard psychopharmacological treatment). One month after the conclusion of the two forms of treatment (both lasting six months), patients will have access to the final follow-up assessment.
Title: Early Intervention of Prodromal Schizophrenia Using an NMDA Enhancer
Contact: Hsien-Yuan Lane, MD, PhD
China Medical University Hospital
Several lines of evidence suggest that NMDA hypotheses have been implicated in schizophrenia. Previous studies found that some NMDA-enhancing agents were able to benefit the treatment of schizophrenia. Whether an NMDA-enhancer (NMDAE) can benefit the treatment of prodromal schizophrenia deserves study. Therefore, this study aims to compare NMDAE and placebo in the treatment of prodromal schizophrenia.
The subjects with prodromal schizophrenia first receive six weeks of health-promotion intervention (including exercise and education). A total of 48 subjects who do not respond sufficiently to the health-promotion program are recruited to this 12-week, randomized, double-blind, placebo-controlled trial, which aims to compare the treatment response of NMDAE vs. placebo in a 1:1 ratio. Clinical performances and side effects are measured at weeks -6 (before the screening phase), 0 (baseline of the drug trial), 2, 4, 6, 9, and 12. Cognitive functions are assessed at baseline and endpoint of treatment by a battery of tests.
The efficacies of NMDAE and placebo will be compared. Chi-square (or Fisher’s exact test) will be used to compare differences of categorical variables and t-test (or Mann-Whitney test if the distribution is not normal) for continuous variables between treatment groups. Mean changes from baseline in repeated-measure assessments will be assessed using the generalized estimating equation (GEE). All p values for clinical measures will be based on two-tailed tests with a significance level of 0.05.
Title: Death Number Perception in Depression, Anxiety, and Schizotypal Personality in General Population (Covid-19 Pandemic) (DeathPercep)
Principal Investigator: Simone Cheli
France has been put on lockdown for eight weeks to prevent the spread of the COVID-19 virus between 17/03/2020 and 11/05/2020. During this lockdown, which is likely to have psychopathological repercussions on the population, the public authorities and the media informed the population about the number of deaths occurring each day. While the functioning of autobiographical memory following traumatic events remains a debate in the literature, the impact of the daily announcement of mass deaths on the memory system in the general population and the relationship between long-term memory and delusional thinking in certain psychopathologies have yet to be explored in the literature.
The investigators wish to demonstrate that self-reported recall of recorded deaths may represent this distortion of perception, symptomatic of these pathologies, by an online questionnaire.
Indeed, it has been reported that under continued stress, delusions and psychotic experiences can occur in the general population. In addition, this phenomenon is found in individuals suffering from depression, anxiety, and schizotypal personality disorder.
The investigators wish to demonstrate that self-reported recall of recorded deaths may represent this distortion of perception, symptomatic of these pathologies.
Thus, using an online longitudinal questionnaire, the investigators wish to explore :
- how mass deaths impact the memory system over several trimesters in the general population.
- whether the long-term memory of people suffering from depression and anxiety disorders and people suffering from schizotypal personality disorder contains a recollection of a distorted pattern in relation to the actual number of deaths.
The primary goals of this project are: Determine, in the context of mass deaths, the level and proportion of real or conceived recall of the number of deaths in the general population based on cognitive and affective empathy profiles over four trimesters.
Also, the investigators want to determine:
- the proportion of real or conceived recall numbers of deaths by COVID-19 among people suffering from depression and anxiety in the context of mass death.
- the proportion of real or conceived recall number of deaths by COVID-19 among people with schizotypal personality disorder.
- the dynamics of this real or conceived recall for four trimesters following the end of lockdown.