In-depth look at Schizotypal Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.

Schizotypal personality disorder is characterized by an ongoing pattern in which the affected person distances him- or herself from social and interpersonal relationships. Affected people typically have an acute discomfort when put in circumstances where they must relate to others. These individuals are also prone to cognitive and perceptual distortions and a display a variety of eccentric behaviors that others often find confusing.

People with schizotypal personality disorder are more comfortable turning inward, away from others, than learning to have meaningful interpersonal relationships. This preferred isolation contributes to distorted perceptions about how interpersonal relationships are supposed to happen. These individuals remain on the periphery of life and often drift from one aimless activity to another with few, if any, meaningful relationships.

A person with schizotypal personality disorder has odd behaviors and thoughts that would typically be viewed by others as eccentric, erratic, and bizarre. They are known on occasion to have brief periods of psychotic episodes. Their speech, while coherent, is marked by a focus on trivial detail. Thought processes of schizotypals include magical thinking, suspiciousness, and illusions. These thought patterns are believed to be the schizotypal's unconscious way of coping with social anxiety. To some extent, these behaviors stem from being socially isolated and having a distorted view of appropriate interpersonal relations.

What are the signs and symptoms of Schizotypal Personality Disorder?

Classic schizotypal personalities are apt to be loners, having few to no intimate relationships. They exhibit extreme anxiety in social situations, often associated more with distrust and an inability to communicate with others than with a negative self-image. They view themselves as alien or forlorn, and this isolation causes pain as they disengage more and more from relationships and the outside world.

People with schizotypal personalities often have odd patterns of speech and ramble endlessly on subjects tangent to a topic of conversation. They may dress in peculiar ways and have very strange ways of viewing the world around them. Often they harbor unusual ideas, such as believing in the powers of ESP or a "sixth sense." At times, they believe they can magically influence people's thoughts, actions and emotions.

In adolescence, signs of a schizotypal personality may begin as a gravitation toward solitary activities or a high level of social anxiety. The child may be an underperformer in school or appear socially out-of-step with peers, and as a result often becomes the subject of bullying or teasing.

Symptoms of schizotypal personality disorder include:

• Incorrect interpretation of events, including feeling that external events have personal meaning

• Peculiar thinking, beliefs or behavior

• Belief in special powers, such as telepathy

• Perceptual alterations, in some cases bodily illusions, including "phantom pains" or other distortions in the sense of touch

• Idiosyncratic speech, such as loose or vague patterns of speaking or tendency to go off on tangents

• Suspicious or paranoid ideas

• Flat emotions or inappropriate emotional responses

• Lack of close friends outside of the immediate family

• Persistent and excessive social anxiety that doesn't abate with time

Schizotypal personality disorder can easily be confused with schizophrenia, which is characterized by intense psychosis, a severe mental state characterized by a loss of contact with reality. While schizotypal personalities may experience brief psychotic episodes with delusions or hallucinations, they are not as pronounced, frequent or intense as in schizophrenia.

Both disorders, along with schizoid personality disorder, belong to what's generally referred to as the "schizophrenic spectrum." Schizotypal personality falls in the middle of the spectrum, with schizoid personality disorder on the milder end and schizophrenia on the more severe end.

DSM IV Criteria for Schizotypal Personality Disorder

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, as indicated by five (or more) of the following:

• ideas of reference (excluding delusions of reference)

• odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations)

• unusual perceptual experiences, including bodily illusions

• odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)

• suspiciousness or paranoid ideation

• inappropriate or constricted affect

• behavior or appearance that is odd, eccentric, or peculiar

• lack of close friends or confidants other than first-degree relatives

• excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self