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Schizotypal personality disorder
Specialty	Psychiatry, psychology

Schizotypal personality disorder is a personality disorder characterized by a need for social isolation, anxiety in social situations, odd behavior and thinking, and often unconventional beliefs. People with this disorder feel extreme discomfort with maintaining close relationships with people, and therefore they often do not. People who have this disorder may display peculiar manners of talking and dressing and often have difficulty in forming relationships. In some cases, they may react oddly in conversations, not respond or talk to themselves. They frequently misinterpret situations as being strange or having unusual meaning for them; paranormal and superstitious beliefs are not uncommon. People with this disorder seek medical attention for things such as anxiety, depression, or other symptoms. Schizotypal personality disorder occurs in less than 3% of the general population and is slightly more common in males.

The term "schizotypal" is derived from "schizotype," and was coined by Sandor Rado in 1956 as an abbreviation of one phenotype of a "schizophrenic genotype". Schizotypal personality disorder may in some cases be a precursor to schizophrenia. However, a study done by Haznedar et al. (2004) suggests that they may be two distinct disorders.

Causes

Genetic

Schizotypal personality disorder (STPD) is widely understood to be a "schizophrenia spectrum" disorder that is on axis I. Relatives of individuals with schizophrenia much more often suffer STPD than do relatives of people with other mental illnesses or people without mentally ill relatives. Schizotypal PD may also be considered an "extended phenotype" that helps geneticists track the familial or genetic transmission of the genes that are implicated in schizophrenia.

Social and environmental

Parenting styles, early separation, trauma/maltreatment history (especially early childhood neglect) can cause schizotypal traits.

Children with STPD have difficulty learning to interpret and appropriately respond to social cues and therefore may have irrational beliefs. Childhood abuse can alter the brain functioning.

A variously intense attention impairment characterizes schizotypal personality disorders. Study suggest that attention deficits could serve as a marker of biological susceptibility to schizotypal personality disorder. Interpersonal cues and attentive communication are in complicated socialization essential for quality interaction, perhaps causing the schizotypal individuals to withdraw from most social interactions and thereby become .

Robert Sapolsky hypothesizes that schizotypal individuals practice shamanism.

Comorbidity

Axis I

STPD usually co-occurs with major depressive disorder, dysthymia, and generalized social phobia. Furthermore, sometimes STPD can co-occur with obsessive-compulsive disorder, and its presence appears to affect treatment outcome adversely.

Some persons with STPD go on to develop schizophrenia, however most of them do not. Although STPD symptomatology has been studied longitudinally in a number of community samples, the results received do not suggest any significant likelihood of the development of schizophrenia.

In case of methamphetamine use, persons with STPD are at great risk of developing permanent psychosis.

Axis II

In most instances, STPD co-occurs with the schizoid, paranoid, avoidant, and borderline personality disorders.

Diagnosis

DSM-IV-TR

The American Psychiatric Association defined Schizotypal Personality Disorder as a "pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts".

ICD

The World Health Organization's ICD-10 does not have a diagnosis of schizotypal personality disorder, but (F21) Schizotypal disorder. In ICD-10, Schizotypal disorder is classified as a clinical disorder associated with schizophrenia rather than a personality disorder as with DSM-IV. The DSM-IV designation of schizotypal as a personality disorder is controversial.

The ICD definition is:

A disorder characterized by eccentric behavior and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies have occurred at any stage. There is no dominant or typical disturbance, but any of the following may be present:

• Inappropriate or constricted affect (the individual appears cold and aloof);
• Behavior or appearance that is odd, eccentric or peculiar;
• Poor rapport with others and a tendency to withdraw socially;
• Odd beliefs or magical thinking, influencing behavior and inconsistent with subcultural norms;
• Suspiciousness or paranoid ideas;
• Obsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents;
• Unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization;
• Vague, circumstantial, metaphorical, over-elaborate or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence;
• Occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations and delusion-like ideas, usually occurring without external provocation.

The disorder runs a chronic course with fluctuations of intensity. Occasionally it evolves into overt schizophrenia. There is no definite onset and its evolution and course are usually those of a personality disorder. It is more common in individuals related to people with schizophrenia and is believed to be part of the genetic "spectrum" of schizophrenia.

Diagnostic guidelines

This diagnostic rubric is not recommended for general use because it is not clearly demarcated either from simple schizophrenia or from schizoid or paranoid personality disorders. If the term is used, three or four of the typical features listed above should have been present, continuously or episodically, for at least 2 years. The individual must never have met criteria for schizophrenia itself. A history of schizophrenia in a first-degree relative gives additional weight to the diagnosis but is not a prerequisite.

Includes

• Borderline schizophrenia
• Latent schizophrenia
• Latent schizophrenic reactions
• Prepsychotic schizophrenia
• Prodromal schizophrenia
• Pseudoneurotic schizophrenia
• Pseudopsychopathic schizophrenia
• Schizotypal personality disorder
• Schizoid personality disorder

Excludes

• Asperger's syndrome

Subtypes

Theodore Millon proposes two subtypes of schizotypal. Any individual with schizotypal personality disorder may exhibit either one of the following somewhat different subtypes (Note that Millon believes it is rare for a personality with one pure variant, but rather a mixture of one major variant with one or more secondary variants):

Differential diagnosis

There is a high rate of comorbidity with other personality disorders. McGlashan et al. (2000) stated that this may be due to overlapping criteria with other personality disorders, such as avoidant personality disorder, paranoid personality disorder and borderline personality disorder.

There are many similarities between the schizotypal and schizoid personalities. Most notable of the similarities is the inability to initiate or maintain relationships (both friendly and romantic). The difference between the two seems to be that those labeled as schizotypal avoid social interaction because of a deep-seated fear of people. The schizoid individuals simply feel no desire to form relationships, because they see no point in sharing their time with others.

Treatment

Pharmacological treatment

STPD is rarely seen as the primary reason for treatment in a clinical setting, but it occurs often as a comorbid finding with other mental disorders. In order to decide which type of medication should be used, Paul Markovitz distinguishes two basic groups of schizotypal patients:

• Schizotypal patients who appear to be almost schizophrenic in their beliefs and behaviors (aberrant perceptions and cognitions) - they are usually treated with low doses of antipsychotic medications, e.g. thiothixene. However, it must be mentioned that long-term efficacy of neuroleptics is doubtful.

• Schizotypal patients who are more obsessive-compulsive in their beliefs and behaviors - in this case SSRIs, e.g. fluoxetine, appear to be more effective.

Psychotherapy

According to Theodore Millon, the schizotypal is one of the easiest personality disorders to identify but one of the most difficult to treat with psychotherapy. Persons with STPD usually consider themselves to be simply eccentric, creative, or nonconformist. As a rule, they underestimate maladaptiveness of their social isolation and perceptual distortions. It is not so easy to develop rapport with people who suffer from STPD due to the fact that increasing familiarity and intimacy usually increase their level of anxiety and discomfort. In most cases they do not respond to informality and humor.

Group therapy is recommended for persons with STPD only if the group is well structured and supportive. Otherwise it could lead to loose and tangential ideation. Support is especially important for schizotypal patients with predominant paranoid symptoms, because they will have a lot of difficulties even in highly structured groups.

Prognosis

There are dozens of studies showing that individuals with schizotypal PD score similar to individuals with schizophrenia on a very wide range of neuropsychological tests. Cognitive deficits in patients with schizotypal PD are very similar to, but quantitatively milder than, those for patients with schizophrenia.

See also

• DSM-IV codes (personality disorders)
• ICD-10 codes (personality disorders)
• Paranoid personality disorder
• Schizoid personality disorder
• Schizophrenia
• Schizotypy
• Boundaries of the mind

References

1. Schacter, Daniel L., Daniel T. Gilbert, and Daniel M. Wegner. Psychology. Worth Publishers, 2010. Print.
2. Internet Mental Health - schizotypal personality disorder
3. ^ Millon, Theodore (2004). Personality Disorders in Modern Life. John Wiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471-23734-5. Cite error: The named reference "Millon 11" was defined multiple times with different content (see the help page).
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7. Deidre M. Anglina, Patricia R. Cohenab, Henian Chena (2008) Duration of early maternal separation and prediction of schizotypal symptoms from early adolescence to midlife, Schizophrenia Research Volume 103, Issue 1, Pages 143-150 (August 2008)
8. Howard Berenbaum, Ph.D., Eve M. Valera, Ph.D. and John G. Kerns, Ph.D. (2003) Psychological Trauma and Schizotypal Symptoms, Oxford Journals, Medicine, Schizophrenia Bulletin Volume 29, Number 1 Pp. 143-152
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11. "Dr. Robert Sapolsky's lecture about Biological Underpinnings of Religiosity"
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19. PERSONALITY DISORDERS DSM-IV
20. Schizotypal personality disorder -International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
21. Millon, Theodore - Personality Subtypes
22. McGlashan, T.H., Grilo, C.M., Skodol, A.E., Gunderson, J.G., Shea, M.T., Morey, L.C., et al. (2000). The collaborative longitudinal personality disorders study: Baseline axis I/II and II/II diagnostic co-occurrence. Acta Psychiatrica Scandinavica, 102, 256-264.
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American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association. Retrieved from http://psychcentral.com/disorders/sx33.htm

External links

• ICD-10 diagnostic criteria for Schizotypal Disorder.
• Link collection for resources on Schizotypal Disorder.
• Video lecture by Stanford professor Robert Sapolsky on schizotypal personality and "metamagical thinking".
• .

• Abnormal psychology
• Cluster A personality disorders
• Personality disorders
• Psychiatric diagnosis
• Schizophrenia
• Anxiety