What Is Schizotypal Personality Disorder And How Is It Treated?

Schizotypal personality disorder defined 

Schizotypal personality disorder (STPD) is listed in the DSM V, or Diagnostic and Statistical Manual of Mental Disorders. This manual is compiled by the APA or American Psychiatric Association and is used by mental health professionals to diagnose mental health disorders.

According to the DSM V, schizotypal personality disorder is described as 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." The Statistical Manual of Mental Disorders includes symptoms of this disorder, and for a proper diagnosis, at least five of the listed symptoms must be present.

• "A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships."

• Those who have STPD struggle socially; they rarely have close relationships.

• Social anxiety triggered by paranoia can be another interpersonal deficit, this paranoia is not focused on the self and is usually an irrational paranoia about others.

• A reduced capacity for close relationships in many cases stems from paranoid thoughts and behaviors that are not based on reality.

• "Cognitive and perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts."

• Cognitive and perceptual distortions include paranoid thoughts and behaviors. These perceptual distortions are rarely based on fact, and in many cases become delusional, not based on reality.

• In severe cases, individuals exhibit narcissistic thoughts and behaviors wherein they include most social interactions and events as having specific meaning for them, a delusional worldview where events and interactions are interpreted as revelations of personal destiny.

A schizotypal personality disorder may have a genetic component. Schizotypal disorders are more likely to show up in individuals who have a close relative with STPD. Although there seems to be a genetic link, researchers also believe that childhood problems may play a part. Abuse, neglect, and other hostile or neglectful behavior by parents or caregivers seem to contribute to the development of STPD. Research into the causes of schizotypal personality disorder is ongoing as researchers look for the genes that may be at fault, as well as social, familial, and environmental causes.

STPD is not schizophrenia and individuals with STPD are not destined to develop schizophrenia. Research shows that links between the two exist, but STPD can remain consistent over a lifetime without the development of schizophrenia. Those who have a family member with schizophrenia may be more susceptible to STPD, schizophrenia, and other personality disorders, but every situation is different.

If you or someone you know is experiencing abuse in any form, reach out right away to the National Domestic Violence Hotline at 1.800.799.SAFE (7233) for immediate support, advice, and assistance.

Symptoms of schizotypal personality disorder

Professionals use the symptoms of schizotypal personality disorder to evaluate an individual for a diagnosis. It can be important to understand that symptoms are similar across many mental health disorders and a proper diagnosis requires a licensed professional. The following is a list of symptoms associated with schizotypal personality disorder.

Schizotypal personality disorder diagnosis

There is no specific test given to individuals who may be living with STPD. Instead, a licensed professional assesses a person’s symptoms to provide a proper diagnosis of the disorder. The symptoms of STPD are often present in many other mental health conditions, especially depression and anxiety disorders. The main reference is severity and pervasiveness; showing signs of symptoms or struggling with symptoms is not enough for a diagnosis.

The doctor will interview the individual and then obtain a complete medical exam. The interview gathers information regarding the symptoms and their severity, and the medical exam takes place to rule out other possible causes for the person’s feelings, thoughts, and behaviors.

According to the DSM V, a preliminary diagnosis of a schizotypal personality disorder requires at least five symptoms to be present and persistent over at least two years. Once this is established, it is important to study the behavior the symptoms cause; this also helps the doctor get a deeper understanding of what is happening.

There are neuropsychological tests for personality disorders, but they are not used as an exclusive diagnosis of STPD. Neuropsychological tests do not exist specifically for STPD itself; rather, these tests are used to eliminate other possible disorders and gain insight into patient behaviors, thought patterns, and cognition. These types of tests are for reference, not for a complete diagnosis.

Schizotypal personality disorder treatment

There are two types of treatment for schizotypal personality disorder, medication-based treatment, and therapy/psychotherapy. At times, schizotypal personality disorder may require inpatient treatment to control medications and achieve a stable medicated outcome. Not all individuals with STPD require in-patient treatment and many people benefit from out-patient treatment alone. A combination of both medications and psychotherapy is another treatment option that can be effective. Working with a medical provider can help individuals find the treatment plan that is most effective for them, their needs, and their unique situation.

Medicine based treatments

Medicine-based treatments depend on which symptoms require medication. Since schizotypal personality disorder may present with delusions and paranoid delusions, antipsychotics may be prescribed to reduce psychotic episodes. Other medicines such as anti-anxiety drugs can be used to reduce anxiety in social situations. Mood stabilizers are utilized to lessen the emotional and behavioral problems often associated with STPD, and anti-depressants may be used to reduce symptoms of depression that may be present.

For most people with STPD, medication is necessary for symptom relief. Relieving anxiety symptoms can help those with obsessive-compulsive symptoms and relieving symptoms is what treatment is all about. Medicine-based treatment can also be used in conjunction with therapy. Without the support of medicine, some individuals would have trouble with therapy because of pervasive problems with social situations. The interpersonal nature of therapy can be overwhelming for those with this disorder; medicine can help them make use of therapy.

Therapy based treatments

The most prescribed form of therapy for STPD is CBT or cognitive behavioral therapy. CBT helps people alter their thoughts to become more positive and helpful than negative and unhelpful. Group therapy can also be beneficial. Although many individuals with STPD have anxiety issues related to interpersonal social interactions, group therapy can help them relate to others going through something like them. In conjunction with medications to reduce anxiety-related symptoms, group therapy seems to be one of the most effective therapies. Group therapy may also work as a form of CBT for individuals with STPD because they must work through issues related to social interaction. Group therapy for STPD should be structured and supportive.

For individuals with prevalent delusional issues and severe paranoid delusional issues, the most effective type of therapy is often individual, with a focus on refraining from exciting or provoking delusional, inappropriate thoughts. A supportive client-centered environment can be helpful for individuals with these symptoms. During sessions, it may become easier to adjust medications and work toward overcoming symptomatic obstacles as the client/doctor alliance strengthens. Finding the right mental health care professional for this type of therapy can be significant; STPD may impede interpersonal relationships, but with the right person, medication, and environment, this therapy can be very productive.

Online counseling with BetterHelp

If you’re living with schizotypal personality disorder, it can be vital to get the help you need. When this disorder is left untreated, its symptoms can worsen. Confiding in a therapist might feel intimidating, and you may be concerned about your ability to form a healthy relationship with them. Online counseling can give you more freedom when it comes to therapy, allowing you to choose when, where, and how you meet for sessions. BetterHelp is an online therapy platform that lets you pick between phone calls, video chats, or in-app messaging. You can use a laptop, cellphone, tablet, or computer to speak with your therapist and schedule sessions at a time that’s convenient for you. 

The efficacy of online counseling 

Online counseling can be a beneficial resource for addressing mental health concerns like personality disorders. In a review of eleven different studies, researchers found that three internet-delivered interventions “demonstrated significant decreases in borderline personality disorder symptoms.” Further, “usability and patient satisfaction were moderate to high in all studies.”