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Schizotypal Personality Disorder

Definition :
Schizotypal personality disorder is a serious condition in which a person usually has few to no intimate relationships. Such people tend to turn inward rather than interact with other people, and experience extreme anxiety in social situations.

People with schizotypal personality disorder often have trouble engaging with others and appear emotionally distant. They find their social isolation painful, and eventually develop distorted perceptions about how interpersonal relationships form. They may also exhibit odd behaviors, respond inappropriately to social cues and hold peculiar beliefs.

As a result, people with schizotypal personality disorder often find themselves drifting from one activity to the next, failing to connect with people as they meander through life.

Schizotypal personality disorder is a chronic condition. The pattern typically begins in early adulthood and endures throughout life. There's no cure for schizotypal personality disorder, but psychotherapy and some medications may help alleviate symptoms.

Your personality is the sum total of the ways you think, feel, behave and react to your environment. It derives from a combination of genetics and early life experience. When someone chronically feels or behaves in an inappropriate way, that person is suffering from a personality disorder.

In normal development, children progress through several stages of social awareness and learn to accurately interpret the cues and intentions of others. For schizotypal personalities this social cognition is impaired, leading to development of illogical beliefs, magical thinking and paranoid thoughts, such as a nagging suspicion that one is being harassed, persecuted or treated unfairly.

The exact reason or cause of this impairment is unknown. Some experts contend that childhood abuse, neglect or stress results in the brain dysfunction that gives rise to schizotypal symptoms. Both genetics and environmental circumstances appear to play a role in development of the disorder.

A family history — such as having a parent who has schizophrenia or schizotypal personality — increases your chances of developing the condition. A number of environmental factors also may contribute, such as a neglectful or abusive childhood home.

Risk Factors :
Personality development is affected by genetic tendencies as well as environmental factors, such as stressful childhood experiences. Factors that increase the risk of developing the schizotypal personality disorder include :

  • Having a relative who has schizophrenia
  • Living in a childhood environment of deprivation or neglect
  • Experiencing child abuse or mistreatment
  • Undergoing a childhood trauma
  • Having an emotionally detached parent

When to seek medical advice :
Because personality tends to become entrenched as people age, it's best to seek treatment for a personality disorder as early as possible.

People with schizotypal personality are likely to seek help only at the urging of friends or relatives. If you suspect a friend or family member may suffer from the disorder, be on the lookout for certain symptoms. You might gently suggest that the person seek medical attention, starting with a primary care physician or mental health professional.

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.

There are no laboratory tests for personality disorders, so diagnosis typically comes after a thorough clinical interview. The doctor will ask questions about symptoms and mental well-being, and take a medical, psychiatric and social history. A physical examination will help rule out other conditions, and a mental health professional will likely be consulted for further evaluation.

For a diagnosis of schizotypal personality disorder, at least five of the following criteria must be met :

  • Incorrect interpretations of events, including a feeling that something innocuous has a direct personal meaning
  • Odd beliefs or magical thinking that's inconsistent with cultural norms
  • Unusual perceptions, including illusions
  • Odd thinking and speech patterns
  • Suspicious or paranoid thoughts, such as the belief that someone's "out to get them"
  • Flat emotions, appearing aloof and isolated
  • Odd, eccentric or peculiar behavior or appearance
  • Lack of close friends or confidants other than relatives
  • Excessive social anxiety that doesn't diminish with familiarity

In addition, the person must never have met the criteria for any other schizophrenic disorder. To distinguish schizotypal personality from schizophrenia, the doctor looks for the presence of psychosis and experiences with hallucinations or delusions.

Complication :
People with schizotypal personality are at an increased risk of :

  • Developing schizophrenia
  • Suffering from a major depression
  • Anxiety disorder, characterized by prolonged worry or uneasiness
  • Dysthymia, a low-grade depressed mood that continues for more than two years
  • Panic disorder, characterized by sudden bouts of heart-pounding terror
  • Social phobia, characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations.
  • Avoidant personality disorder, characterized by a pervasive pattern of social inhibition and feelings of ineptness
  • Obsessive-compulsive disorder, characterized by recurrent, unwanted thoughts and repetitive behaviors
  • Borderline personality disorder, characterized by a constant state of emotional turmoil

Treatment for schizotypal personality disorder may be with a combination of medication and one or more of several types of therapy.

  • Medications. There's no specific drug treatment for the disorder; however, doctors may prescribe antidepressant or antipsychotic medications to help alleviate associative conditions such as anxiety, depression or other mood disorders. For example, treatment for distorted thinking may be with the prescription medications risperidone (Risperdal) and olanzapine (Zyprexa).
  • Psychotherapy. Building a trusting rapport in therapy may help people with schizotypal personality disorder contradict the mistrust or discomfort they have with developing interpersonal relationships.
  • Behavioral therapy. People with schizotypal personalities often need to learn specific interpersonal skills and new behaviors, as they often have difficulty responding appropriately to social cues. For example, they might learn to express appropriate feelings or adjust facial expressions and voices in reaction to certain stimuli.
  • Cognitive therapy. People with schizotypal personality disorder may respond to exercises that focus on interrupting distortions in thought. For example, this type of therapy may use reasoning exercises to clarify social confusion and overcome self-defeating thoughts, especially in interpersonal situations.
  • Family therapy. Treatment can be more effective when family members are involved. Seeking professional counseling as a group may help diminish angry confrontations or emotional distancing in the home. Family therapy may also offer the affected person reassurances of a support structure and a boost in morale.

Because schizotypal personality disorder originates with the family and childhood environment, early intervention may help diminish the development of problem behaviors.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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