Schizotypal Personality Disorder

It has been suggested that the schizotypal personality is one of the schizophrenic spectrum disorders because schizophreniaOpens in new window occurs with increased frequency in family members of the schizotypal.

Schizotypal personality disorder is characterized by peculiar perceptions and strange beliefs (e.g., odd beliefs and magical thinkingOpens in new window, unusual perceptual experiences, suspiciousness), interpersonal deficits (e.g., absence of close friends), and disorganized behavior (e.g., odd speech). Yet, none of these deviations reach psychotic proportions as those seen in schizophreniaOpens in new window.

Clinical Presentation

The Schizotypal Personality Disorder is typically recognized by the following behavior and interpersonal styles, cognitive styles, and emotional styles.

Behaviorally, schizotypals are noted for their eccentric, erratic, and bizarre mode of functioning. Their speech is markedly peculiar without being incoherent.

Occupationally, they are inadequate, either quitting or being fired from jobs after short periods of time. Typically, they become drifters, moving from job to job and town to town. They tend to avoid enduring responsibilities, and in the process lose touch with a sense of social propriety.
Interpersonally, they are loners with few if any friends. Their solitary pursuits and social isolation may be the result of intense social anxiety , which may be expressed with apprehensiveness. If married, their style of superficial and peripheral relationg often leads to separation and divorce in a short period of time.

The cognitive style of schizotypals is described as scattered and ruminative, and is characterized by cognitive slippage. Presentations of superstitiousness, telepathy, and bizarre fantasies are characteristic.

Schizotypals may describe vague ideas of reference and recurrent illusionsOpens in new window of depersonalizingOpens in new window, derealizingOpens in new window experiences without the experience of delusionsOpens in new window of reference, or auditoryOpens in new window or visual hallucinationsOpens in new window.

Their affective style is described as cold, aloof, and unemotional with constricted affect. They can be humorless individuals and difficult to engage in conversation, probably because of their general suspicious and mistrustful nature. In addition, they are hypersensitive to real or imagined slights.

DSM-5 Characterization

Individuals with schizotypal personality disorder are characterized by an unremitting pattern of social and interpersonal deficits, with significant discomfort and limited capacity for relationships, as well as by perceptual distortions and eccentric behavior.

They experience ideas of reference as well as unusual beliefs and thinking that influence their behavior, and that are inconsistent with their subculture. They also experience unusual perception, such as bodily illusions, and odd speech thinking.

These individuals are prone to suspiciousness and paranoid ideation. They exhibit inappropriate or constrictred emotions, and behavior that is odd, peculiar, or eccentric.

With few exceptions, they lack close friends or confidants ecept for first-degree relatives. When they are around others, they experience excessive social anxietyOpens in new window that is not diminished by familiarity and is associated with suspicion and fears (American Psychiatric Association, 2013).

Case Example: Ms B.
Ms. B. is a 46-year-old single female who was referred to a community mental health clinic by her mother because Ms. B. had no interests, friends, or outside activities and was considered by neighbors to be an “odd duck.” Ms. B.’s father had recently retired, and because of a limited pension, the parents were having difficulty in making ends meet, since Ms. B. had been living with them for the past eight years after she had been laid off from an assembly-line job she had held for about ten years. The patient readily admitted she preferred to be alone but denied that this was a problem for her. She believed that her mother was concerned about her because of what might happen to the patient after parent’s deaths. Ms. B. was an only child who had graduated from high school with average grades but was never involved in extracurricular activities while in school. She had never dated, and mentioned she had a female friend whom she had not talked with in four years. Since moving back with her parents, she stayed in her room, preoccupied with books about astrology and charting her astrological forecast. On examination, she was an alert, somewhat uncooperative female appearing older than her stated age, with moderately disheveled hair and clothing. Her speech was monotonal and deliberate. She achieved poor eye contact with the examiner. Her thinking was vague and tangential, and she expressed a belief that her fate lay in “the stars.” She denied specific delusions or perceptual abnormalities. Ms B.’s affect was constricted, except for one episode of anger when she thought the therapist was being critical.

Case Example: Ms B.

Ms. B. is a 46-year-old single female who was referred to a community mental health clinic by her mother because Ms. B. had no interests, friends, or outside activities and was considered by neighbors to be an “odd duck.” Ms. B.’s father had recently retired, and because of a limited pension, the parents were having difficulty in making ends meet, since Ms. B. had been living with them for the past eight years after she had been laid off from an assembly-line job she had held for about ten years.

The patient readily admitted she preferred to be alone but denied that this was a problem for her. She believed that her mother was concerned about her because of what might happen to the patient after parent’s deaths. Ms. B. was an only child who had graduated from high school with average grades but was never involved in extracurricular activities while in school. She had never dated, and mentioned she had a female friend whom she had not talked with in four years.

Since moving back with her parents, she stayed in her room, preoccupied with books about astrology and charting her astrological forecast. On examination, she was an alert, somewhat uncooperative female appearing older than her stated age, with moderately disheveled hair and clothing. Her speech was monotonal and deliberate. She achieved poor eye contact with the examiner. Her thinking was vague and tangential, and she expressed a belief that her fate lay in “the stars.” She denied specific delusions or perceptual abnormalities. Ms B.’s affect was constricted, except for one episode of anger when she thought the therapist was being critical.

Biopsychosocial – Adlerian Conceptualization

The following biopsychosocial formulation may be helpful in understanding how the Schizotypal Personality Disorder is likely to have developed.

This personality disorder is described by Millon (2011) as a syndromal extension or deterioration of the SchizoidOpens in new window or the Avoidant Personality DisordersOpens in new window.

As such, a useful procedure is to describe the biological and temperamental features of both of these subtypes.

The schizoid subtypeOpens in new window of a schizotypal personality is characterized by a passive-infantile pattern, probably resulting from low autonomic-nervous-system reactivity and parental indifference that led to impoverished infantile stimulation.
The avoidant subtypeOpens in new window, on the other hand, is characterized by the fearful infantile temperamental pattern (Milton, 1981). This probably resulted from the child’s high autonomic-nervous-system reactivity, combined with parental criticalness and depreciation that was further reinforced by sibling and peer depreciation.

Both subtypes of the schizotypal personality have been noted to have impaired eye-tracking motions, which is a characteristic shared with schizophrenic individuals.

Psychologically, the schizotypals view themselves, others, the world, and life’s purpose in terms of the following themes. They tend to view themselves by some variant of the theme: “I’m on a different wavelength than others.”

They commonly experience being selfless; that is, they experience feeling empathy, estranged, and disconnected or dissociated from the rest of life.

Their world-veiw is some variant of the theme: “Life is strange and unusual, and others have special magical intentions.” As such, they are likely to conclude: “Therefore, observe caution while being curious about these special magical intentions of others.” The most common defense mechanismOpens in new window utilized by them is undoing, the effort to neutralize “evil” deeds and thoughts by their eccentric, peculiar beliefs and actions.

Socially, predictable patterns of parenting and environmental factors can be noted for the Schizotypal Personality Disorder. The parenting patterns noted previously of the cold indifference of the schizoid subtype, or the depreciating and derogatory parenting style and family environment of the avoidant subtype are noted.

In both cases, the level of functioning in the family of origin then would be noted in the Schizoid Personality DisorderOpens in new window or the Avoidant Personality DisorderOpens in new window. Fragmented parental communications are a feature common to both subtypes of the Schizotypal Personality Disorder. The parental injunction is likely to have been “You’re a strange bird.”

Treatment Considerations

Individuals with Schizotypal Personality Disorder find it very difficult to engage and remain in a psychotherapeutic relationship. Typically, they are on medication and may be referred for adjunctive psychotherapy. Accordingly, the focus of treatment is on “management” rather than on “treatment.”

Thus, instead of attempting personality restructuring, the realistic treatment goal for the schizotypal personality is to increase the individual’s ability to function more consistently, even though on the periphery of society.

Specifically, successful management will likely incorporate psychoeducational or social-skills training with supportive psychotherapeutic methods. Reid (1989) noted that if these patients can remain in long-term treatment, they may be able to increase their ability to function more consistently and with less disease. He reports that homogeneous groups can occasionally be a useful adjunct to individual treatment.

In terms of medication, low-dose neuroleptics have been found to be useful for the schizotypal personality, even in the absence of psychotic features. Yet, it should be noted that medication compliance is particularly a problem with the Schizotypal Personality Disorder.

Specialties

Schizotypal Personality Disorder

Clinical Presentation

DSM-5 Characterization

Biopsychosocial – Adlerian Conceptualization

Treatment Considerations

See also: