Schizotypal Personality Disorder

What is "schizotypal personality disorder"?

Schizotypal personality disorder is very interesting. I think it's characterized by patients who also prefer to be alone. However, unlike the schizoid personality disordered patient, they will endure some intense amount of anxiety if forced into social settings. They also have a mean streak of paranoia running through them; and I think this is what makes them rather interesting. On top of that, they're often quite eccentric or unusual and this can be observed readily by the casual observer.

What are the signs of schizotypal personality disorder?

Patients with schizotypal personality disorder are very uncomfortable in social settings, so they will endorse a great deal of anxiety if they have to be around other people. Now, familiarity will not reduce their social anxiety, so this isn't a social anxiety that they're self-conscious or they're worried about what other people think. It is a social anxiety that's based on paranoid concerns. So, the more you hang out with them, it's not like they're going to finally relax and get comfortable with you. Again, since they tend to be rather paranoid, that's what creates the social anxiety. These people are also very eccentric. They will manifest peculiarities in their appearance, their thought process, and even their speech at times; they can have idiosyncratic little speech quirks. They have magical thinking, believe in ESP, or behave like "I'm not going to make a move until I consult my horoscope." That's not to say that people who believe in astrology have schizotypal personality disorder. It's in the context of all of the rest of the symptoms that you'll see this stuff.

What causes schizotypal personality disorder?

The schizotypal personality disorder appears to be more common in the first degree relatives of patients with schizophrenia. Patients who later on go on to develop schizophrenia may actually meet criteria for schizotypal personality disorder prior to that.

What are the dangers of schizotypal personality disorder?

The social dysfunction is pretty clear with schizotypal personality disorder. They're very anxious and uncomfortable around others and prefer to be alone. I think occupationally, again, they could do okay if they could be guaranteed some social isolation. The patient I had talked about earlier, as an example of schizotypal personality disorder worked for a grounds crew for a local school district. And basically his supervisor figured out very quickly that they'd come to a school, and maybe the rest of them would do some group project together where they had to work collaboratively; but he'd send my patient off on a solo job to do by himself. Which worked beautifully, and he was considered a good employee.

Who is at risk for schizotypal personality disorder?

Schizotypal personality disorder is more common in the first degree relatives of patients with schizophrenia. It may also be a premorbid condition; in other words, the person met criteria for schizotypal personality disorder prior to the development of schizophrenia.

What are the treatments for schizotypal personality disorder?

Patients with schizotypal personality disorder can become extremely anxious and/or depressed and may actually benefit from trials of antidepressant medication. Whether or not they're going to present for treatment or not is a whole other thing and they're probably reluctant to do so. There aren't any known specific treatments though for the personality disorder itself. They can also become transiently psychotic when they're under great stress, becoming more overtly paranoid. In which case, for that brief period of time for the acute episode, they may benefit from low dose anti-psychotic medication as well.