All about Schizotypal Personality

People with schizotypal personality disorder are peculiar, eccentric, and oddly bizarre in how they think, behave, and relate to others, even in how they dress. Their peculiar ideas may include magical thinking and beliefs in psychic phenomena, such as clairvoyance and telepathy. They may have unusual perceptual experiences in the form of illusions. Though their speech is not incoherent, the content sounds strange to others. Their effect is constricted and inappropriate. They are often suspicious of other people and may have ideas of reference: beliefs that others' behavior or a random object or event refers to them. Unable to experience pleasure, their lives are characterized by a sense of blandness that robs them of the capacity for enthusiasm. Like people with a schizoid personality disorder, these individuals find it difficult to establish close relationships because they experience discomfort around others—in part, due to their suspiciousness. In fact, oddness, aloofness, and social withdrawal have been found by researchers to be the most striking characteristics defining this disorder (Fossati et al., 2001).

The social isolation, eccentricity, peculiar communication, and poor social adaptation associated with schizotypal personality disorder place it within the schizophrenic spectrum (Camisa et al., 2005). According to this view, schizotypal personality disorder symptoms represent a latent form of schizophrenia, meaning that people with schizotypal symptoms are vulnerable to developing a full-blown psychosis if exposed to difficult life circumstances that challenge their ability to maintain contact with reality. This position was first developed in the early 1980s after the publication of a 15-year follow-up study of people who met the criteria for schizotypal personality disorder, schizophrenia, or borderline personality disorder. At the end of the follow-up period, the schizotypal individuals were functioning more like people diagnosed with schizophrenia than those with borderline personality disorder (McGlashan, 1983). Two decades later, researchers continue to look at the relationship between schizotypal symptoms and the subsequent development of schizophrenia, with particular attention to learning why these individuals do not initially develop full-blown psychosis in the form of schizophrenia (Seeber & Cadenhead, 2005).

Features

This diagnosis is given to people who show a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships and who experience cognitive or perceptual distortions and behavioral eccentricities, as indicated by five or more of the following:

• Ideas of reference
• Odd beliefs or magical thinking which influence their behavior (e.g., belief in mind reading)
• Unusual perceptual experiences, including bodily illusions
• Odd thinking and speech
• Suspiciousness or paranoid ideation
• Inappropriate or constricted affect
• Behavior or appearance that is odd or eccentric
• Lack of close friends or confidants other than immediate relatives
• Excessive social anxiety tends to be associated with paranoid fears.

A concept originating in the writings of Sandor Rado, schizotypal personality disorder was first officially included in DSM-III, where it was separated from a borderline personality disorder to distinguish two forms of what had been referred to as borderline schizophrenia. This distinction separated effectively unstable individuals (i.e., those with borderline personality disorder) from those with cognitive aberrations (i.e., those with schizotypal personality disorder). Some researchers consider a schizotypal personality disorder to reflect a schizophrenia spectrum disorder, and the DSM-IV criteria reflect a level of adaptation between schizoid personality and schizophrenia.

The disorder resembles the residual phase of chronic schizophrenia, distinguished primarily by a past episode of active schizophrenia. However, the relatives of schizophrenic patients who display schizotypal personality disorder tend to exhibit social isolation and poor rapport rather than the psychotic-like symptoms of referential ideation or perceptual distortion. Thus, although the disorder appears with greater than expected frequency in the relatives of schizophrenic patients, it is not merely a milder form of schizophrenia. The disorder can also be distinguished from schizoid personality disorder by the degree of affective constriction in the latter disorder, in contrast to the marked social anxiety and cognitive distortions associated with the former.