People diagnosed with schizotypal personality disorder (SPD) are not schizophrenic but exhibit behaviors and beliefs considered odd or strange by mainstream society. In contrast to someone suffering schizophrenia, those diagnosed with SPD do not experience visual or audio hallucinations nor are they disconnected from the real world. Instead, their preoccupation with unusual ideas and fears is so strong they have difficulty maintaining relationships.
- Family members and co-workers often assume that a person with SPD is introverted, preferring to be alone because they seem so uncomfortable around other people.
It is a mental disorder that is reasonably well understood despite the fact that it is actually moderately difficult to diagnose. What makes it difficult to diagnose is the fact that the symptoms of SPD are difficult to observe. People suffering from SPD tend to be reclusive, often hiding the symptoms from friends or family who might notice the problem.
According to the DSM-5, there are many traits associated with schizotypal personality disorder. Almost every trait associated with the disorder is also associated with at least one other mental disorder, though. Because of this, when diagnosing the disorder, medical professionals usually looks for the presence of at least five or more of the following traits:
- Being reclusive and lacking personal attachments beyond family
- A likelihood to interpret neutral events as having personal meaning
- Eccentricity in beliefs and mannerisms
- Dressing in particularly unusual ways
- Odd superstitions or belief in the supernatural
- Flashes of perception that are out of touch with reality
- Persistent, sometimes paralyzing, social anxiety
- Illogical patterns of speech
- Regular distrust of other people
- Inappropriate emotional responses, with flat emotional responses being the most common identifier
Some of these traits are present in almost everybody and the presence of multiple of these traits may not necessarily indicate SPD. Other mental disorders, particularly schizophrenia, can also cause these traits to be present in a person.
In addition to having little to no close friends or acquaintances, people with SPD may also:
- Dress oddly or have little interest in how they look
- Avoid social settings
- Seem emotionally disconnected from specific situations (laughing at funerals, for example)
- Speak robotically, rapidly or mumble unintelligibly
- Hold unusual beliefs (the government is monitoring their thoughts, extraterrestrials are going to take over the world and other conspiracy-type ideologies)
- Be depressed, anxious and fearful
- Suffer concomitant paranoid personality disorder
Psychiatrists attribute development of SPD to one or more of the following: genetics; substance addiction; organic brain disorders and childhood trauma/neglect. Children experience severe stress due to living in a dysfunctional household suffer from the consequences of too much CRF, or corticotropin -releasing factor, in their blood stream. CRF elevates enzymes that influence the production of norepinephrine, a neurotransmitter and hormone responsible for rate of heart contractions, the “fight or flight” response and neurotransmitter dysregulation in the brain.
Most people see the word “schizotypal” and simply assume that it is synonymous with schizophrenia. And while there are some similarities between the two disorders, they are anything but identical.
Schizophrenia is a severe mental disorder that causes the person suffering from it to perceive reality in a different way than the average person. Usually this altered perception includes hallucinations that are not caused by pharmaceutical substances. In addition to having altered perceptions of the world, schizophrenics are likely to experience delusions that are completely irrational.
- In short, the two disorders share similarities, but the differences are actually quite sharp, especially when being diagnosed by a trained psychiatrist.
People with schizotypal personality disorder, conversely, are not subject to full on hallucinations that overwhelm their perception of the world. They do experience flashes of altered perceptions, but not in such a way that overwhelms them. SPD also tends to be characterized by discomfort with personal relationships and a belief system that is unusual or eccentric. It is not uncommon for someone suffering from this disorder to have metaphysical or supernatural beliefs that otherwise are completely logical.
The most important difference between the two disorders is that the former is always severe while the latter can range from mild to severe, though it is important to note that even the most severe cases of SPD are still less debilitating than schizophrenia. Additionally, while many schizophrenics avoid personal interactions in reaction to their hallucinations or as a result of their delusions, schizophrenia, unlike SPD, does not automatically result in discomfort with social interactions.
In addition to cognitive behavioral therapy and life skills counseling, treatment for SPD often includes medications such as:
- Abilify—treats mood as well as certain mental disorders such as schizophrenia or bipolar disorder. It is frequently used in conjunction with other medications for the treatment of depression
- Effexor—in addition to regulating serotonin levels, Effexor also contains an extra boost of norepinephrine to alleviate depression.
- Celexa and Lexapro—both concentrate on returning serotonin levels to an optimal amount in the brain
- Paxil and Zoloft—prescribed for relieving depression, anxiety, panic, obsessive-compulsive disorders and post-traumatic stress disorder often diagnosed in people with SPD.
To effectively treat people with a co-morbid diagnosis of schizotypal personality disorder and substance addiction, the addiction will need addressed first to determine if any symptoms may be attributed to the addiction. Patients will need to enter a medically supervised detoxification program before accurate psychological examinations can be implemented. In addition, neuroimaging scans may also be helpful to detect addiction-related brain disorders that could be mostly responsible for one or more SPD symptoms.
Building a framework of trust is the key to treatment for SPD. Such trust is often built through psychotherapy, where the therapist first builds one-on-one trust with the patient and then works to expand that trust to others. There is no specific form of psychotherapy that is a magic bullet for this disorder. However, cognitive-behavioral therapy, supportive therapy, and family therapy have all resulted in successful treatment in specific cases.
Drugs may also play a part in treatment, but not directly. There is no medication currently approved for treatment of SPD, but some medications can provide supplementary assistance by relieving symptoms of depression, anxiety, or helping to improve cognitive abilities.
Among the seven primary personality disorders most at risk for a substance addiction, SPD ranks fourth, behind dependent, antisocial and histrionic personalities. Studies have found that people with schizotypal personality disorder tend to use marijuana and alcohol due to their depressant affects on the central nervous system. Since many people with SPD experience anxiety and depression due to their unsubstantiated fears and paranoid thinking styles, they tend to seek suppression of anxious feelings and unsettling thoughts. Rarely do those with SPD gravitate toward stimulating drugs like meth, cocaine or Adderall.