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SCHIZOTYPAL PERSONALITY DISORDER
This is a new diagnostic category, used only for about 20 years, introduced to describe people characterized by markedly unusual experiences and behavior, clearly different from the average. This difference may consist of magical thinking, heightened vividness, illusions (especially involving one’s own body), unusual vocabulary, unusual associations and digressions, the use of traps with an unclear purpose, and excessively specific or abstract expressions. There may also be a weakening of emotionality of the anhedonic type, causing anxiety and anger to become generalized. Social contact is poorer; there is avoidance of people and solitude, with increased anxiety or anger in the presence of others. Striking facial expressions, movements and gestures, various postures, and clothing may attract the attention of others. At the same time, a person does not develop psychotic disorders and does not completely lose contact with reality, as is the case in schizophrenia. Because of different behavior and beliefs, they often lead a solitary life. Often there are no friends or partners other than close family members. This is because they feel insecure in social situations and sometimes even deny the need for them—so they avoid them.
Causes
Schizotypal disorders are included in the schizophrenia spectrum. These individuals often have first-degree relatives with schizophrenia, which points to the involvement of genetic factors in the development of this condition. People with this diagnosis are more likely to have cognitive and perceptual deficits, as well as traumatic childhood experiences. The onset of schizotypal personality disorder in adolescence is sometimes associated with frequent exposure to stressful life events.
Diagnosis
In the DSM-5 classification, schizotypal disorder (schizotypal personality) is included in the chapter Schizophrenia Spectrum and Other Psychotic Disorders, as well as in the chapter Personality Disorders. To diagnose the disorder, the general criteria for personality disorders and both criteria for this disorder must be met:
A. A pattern of behavior characterized by deficits in social and interpersonal skills, cognitive and perceptual distortions, and eccentric behavior, beginning in early adulthood and present in various contexts. At least five symptoms from the list are present:
- ideas of reference, excluding delusions,
- odd beliefs or magical thinking that influences behavior and is inconsistent with the norms of a given culture (e.g., superstition, belief in clairvoyance, and in children and adolescents, bizarre fantasies and interests),
- unusual sensory experiences, including bodily illusions,
- odd thinking and speech (e.g., vague, overelaborate, metaphorical, ornate, or stereotyped),
- suspiciousness and paranoid attitudes,
- inappropriate or constricted affect,
- behavior or appearance that is bizarre, eccentric, or peculiar,
- lack of close friends or confidants other than first-degree relatives,
- excessive social anxiety that does not diminish with familiarity and that is associated more with paranoid fears than with negative judgments about oneself.
B. Symptoms are not exclusive to schizophrenia, bipolar disorder, or a depressive episode with psychotic symptoms or another psychotic disorder, and are not due to another medical condition.
During diagnosis, they should be differentiated from schizophrenic disorders, which is difficult because these individuals sometimes experience temporary and brief quasi-psychotic episodes (auditory hallucinations, patterned hallucinations, delusions). Psychotic disorders, including schizophrenia, are common in the family history of people with schizotypal personality disorder.
Treatment
Most people with a schizotypal disorder do not need treatment or do not feel a need for treatment. When these individuals come into contact with medical institutions, an individualized approach is recommended, including psychotherapeutic and, if necessary, pharmacological interventions. Treatment includes antipsychotics and antidepressants.
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