Schizotypal Personality Disorder is the third and last in the cluster A of personality disorders. Schizotypal Personality Disorder (SPD, sometimes referred to as STPD) should not be confused with Schizoid Personality Disorder (ScPD).
The SPD core characteristics are odd behaviors, speech patterns, thoughts, perceptions, and beliefs. Individuals with SPD often appear strange or eccentric. They may exhibit suspicion toward others that may develop paranoia.
The prevalence of SPD is similar to other cluster A personality disorders. However, the literature on it is scarce. A study of an American sample indicated the prevalence rate was as high as 4,6%. However, some reports suggest a lower number (e.g., 0.6% in a Norwegian population sample). It is evident that the prevalence rates are approximately 1% higher for males than females.
Cause and risk factors
The exact cause for developing SPD is unknown; however, as with most PDs, genetic and environmental factors play a role. It is more common for individuals to develop SPD if they have first-line family members diagnosed with schizophrenia or another Cluster A PD.
SPD is typically diagnosed in early adulthood. Some of the traits of SPD can be noticeable during the teenage years, but it is unlikely that an individual will obtain an official diagnosis before adulthood.
Signs and symptoms
The SPD is a multidimensional condition that manifests itself in various contexts. It affects an individual's cognitive and perceptual functioning with an especially high negative impact on social relationships. An individual suffering from SPD will exhibit at least several symptoms over multiple dimensions:
- Social anxiety
- Lack of close friends outside of immediate family
- Pronounced avoidance and uncomfort with intimacy
- Limited emotional responses, appearing narrow on the emotional spectrum
- Emotionally distant, cold, unconcerned
- Awkward when communicating or relating to others
Beliefs and perceptions
- Have odd, eccentric, unusual, or magical thinking, e.g., being overly superstitious or thinking of themselves as psychic, belief in superpowers, or telepathy
- Tendency to misinterpret reality (e.g., mistaking noises for voices)
- Have distorted perceptions about themselves, other, or the world
- Tendency to be suspicious and paranoid (e.g., paranoid thoughts or doubts about others' loyalty, being overly distrustful without cause)
- Preoccupation with daydreaming, “zoning out,” fantasizing/imagining
Appearance (immediately observable traits)
- Dress oddly or unusually (e.g., in a particular color, because that "allows" to communicate with spirits, wear odd jewelry often associated with a superstitious belief)
- Speaking oddly or unusually (using particular formulations or words)
- Acting in an odd or unusual manner
SPD is a very heterogeneous disorder, meaning it can manifest in very different individuals. For this reason, it is essential to seek professional evaluation. SPD is a life-long disorder that leads to increased severity of symptoms. However, symptomatology and general well-being can improve with medications and therapy.
Help and treatment
People with SPD are unlikely to recognize that they need treatment. However, they often know that others hold their behaviors and beliefs odd. It is common for individuals with SPD to believe that they are behaving in line with the “true” reality, whereas everyone else is acting differently just because they do not have the “ability,” “gift” they possess to understand the world as they do. A good example of this comes from a case study, where the notes from the initial clinical interview with the individual with SPD state:
“He recognized that others find his beliefs and behaviors odd, but he attributes that to their lack of awareness.”
It is, therefore, usually the case that individuals with SPD seek help only at the urging or referral of friends or family members. Alternatively, they might contact a dedicated clinician for other comorbid conditions, such as depression. Suppose you think a close one exhibits similar behaviors, extreme beliefs, or is acting weird. In that case, you might gently suggest contacting a primary care doctor, who eventually would refer them to a mental health professional.
The primary treatment for SPD is therapy. Given the characteristics of SPD, it might take time to build a relationship with a therapist. Therefore the initial progress might be slow. It is important to encourage a loved one with SPD to stick with treatment, even if, at first, they do not exhibit progress. In addition to therapy, psychiatrists might prescribe medication, such as antipsychotics, stimulants, antidepressants, etc., to tend to the symptoms or other comorbid conditions. Successful therapy will primarily address relationship styles and patterns of thinking and behavior.
There are several misguided beliefs about the SPD. A common misperception is that individuals with SPD are violent. They are at increased risk of self-harm. If SPD is violent, it's often caused by a comorbid condition, not the PD itself.
In addition, individuals with SPD rarely, if not at all, suffer from hallucinations; again, if verbal, auditory, or tactile hallucinations are present, they are likely caused by an additional mental health disorder, not SPD. However, individuals with SPD suffer from delusions, i.e., odd beliefs and impressions that are upheld even if the evidence and facts (reality) contradict them.
In times of extreme stress and anxiety, an individual with SPD may experience psychotic episodes (which might involve hallucinations). However, they are short, infrequent, and mild compared to schizophrenic psychotic episodes. It is important to stay calm and call for help if your loved one is experiencing an episode.