All About Schizotypal Personality Disorder

Schizotypal personality is a formal mental health condition mainly characterized by:

• magical thinking and odd beliefs
• unusual bodily perceptions
• difficulty forming and keeping relationships
• peculiar, eccentric, or atypical thoughts and behaviors

What’s odd and peculiar to you may not be odd to someone else. So, when we talk about odd beliefs or speech, we refer to thoughts and language that may not be usual or typical of your culture. It’s a point of reference and not a judgment.

The condition is one of 10 personality disorders identified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is a reference book published by psychiatrists that most mental health professionals use to make an accurate diagnosis.

Schizotypal personality disorder is included in cluster A, together with schizoid personality disorder and paranoid personality disorder.

These three conditions usually consist of emotions and behaviors that are considered:

• odd
• eccentric or suspicious
• detached

Schizotypal personality disorder is a unique case, though.

In the DSM-5, the condition is listed as both a personality disorder and a schizophrenia spectrum disorder. This is because some medical experts consider schizotypal personality an early symptom of schizophrenia.

This is not the case for everyone, though. Not all people with a schizotypal personality disorder develop schizophrenia.

To reach a diagnosis of schizotypal personality, a mental health professional will be looking for these characteristic symptoms:

• decreased emotional expression and apathy
• eccentric appearance and behaviors
• communication challenges
• social withdrawal

But since schizotypal personality is a formal mental health condition and every case is different, diagnosing it goes far beyond observing a few behaviors or attitudes.

This is why professionals will compare their observations with the DSM-5 criteria for schizotypal personality disorder. This refers to a persistent pattern of behaviors, thoughts, and emotions that repeat in your life over time and across situations.

The formal symptoms of schizotypal personality established by the DSM-5 are:

• ideas of reference
• odd beliefs or magical thinking that influences behavior
• unusual perceptual experiences and bodily illusions
• odd thinking and speech
• paranoid ideation
• inappropriate or constricted affect
• odd, eccentric, or peculiar behaviors
• lack of close friends or confidants
• excessive social anxiety that doesn’t diminish with familiarity

Not everyone with schizotypal personality disorder will experience all of these symptoms, and some symptoms may vary in intensity.

In general, though, for a diagnosis to be made, five or more of these nine symptoms need to show up repeatedly and across many situations.

To better understand the specifics of schizotypal personality disorder, here’s an overview of the most common symptoms:

Ideas of reference

As someone with schizotypal personality, you may interpret random external situations or events as being directly related or meaningful to you.

For example, if you’re in a public place with other people, you may feel they’re all acting in a specific way just for you. Or you could be watching the news and think that when the reporter touched their hair, it was a message for you to call someone specific.

Someone who’s not living with schizotypal personality could also show this personality trait in some situations. For example, you could be in a public place and feel that everyone’s talking about you.

The main difference with schizotypal personality is that this isn’t a one-off occurrence. Instead, this is your predominant way of thinking, and it frequently takes on an unrealistic aspect.

You may also often believe that something random happens because you caused it or because it’s your destiny. For example, you may think you missed the bus because you’re meant to stay where you are a bit longer to witness or experience something else.

Sometimes you’re aware that your understanding of reality may be distorted. This is why these ideas of reference aren’t the same as delusions.

In other words, someone else can talk you out of these beliefs and show you how two events really aren’t related. You’re usually willing to consider facts, even when they contradict your own beliefs.

With delusions, though, the person holds on tightly to their beliefs, despite the evidence.

Odd beliefs and magical thinking

Magical thinking refers to the belief that two or more unrelated events are connected in some way, despite the absence of an evident link. It also applies to believing that your thoughts and behaviors can directly affect or change the course of events.

Specifically, if you have a schizotypal personality, you may spend most of your time thinking about paranormal or supernatural events or firmly hold onto superstitions.

For example, you may believe you can read or influence other people’s minds. Or you may believe it rained this morning because you wished for it, or that every time you wear your yellow shirt, you’ll pass an exam.

Most people have indulged in this type of belief from time to time. So, the difference again is the extent to which magical thinking and superstition are part of your way of thinking and how it manifests repeatedly in many different situations.

Bodily illusions and unusual perceptions

Someone with schizotypal personality disorder may perceive events that others don’t.

For example, you may be in a room and feel someone is sitting next to you, but nobody else feels or sees it. Or you could be lying on the bed and feel you’re levitating.

Things may also look different to you than to other people, as if you had a filter on your eyes.

These perceptual experiences are different than hallucinations. In some cases, though, someone with schizotypal personality disorder may experience brief episodes of psychotic symptoms.

Odd thinking and speech

As someone with a schizotypal personality, you may tend to use an overelaborate, vague, and metaphorical speech. For example, you may tend to use words in unusual ways or add eccentric words that aren’t commonly used by others.

You might also spend some time developing theories about events or people that others find odd or peculiar. You may even be aware that other people have a hard time understanding the meaning of what you’re saying.

This frequent interaction — where other people aren’t sure of what you’re trying to say — may make relating to others difficult. These difficulties may explain, in part, why you often feel anxious, uncomfortable, or indifferent around people.

Suspicious or paranoid thoughts

As someone with schizotypal personality, you might tend to see other people suspiciously or often doubt their motives.

For example, if someone starts a casual conversation, you may think they have a secret agenda. Sometimes, it may be difficult for you to believe someone likes you or wants to get to know you. So when they approach you, you might feel suspicious.

You may also frequently believe other people are talking about you or doing something to you. This is the case with both familiar people or strangers.

Inhibited affect

If you have schizotypal personality disorder, you may have difficulty responding to other people’s cues or reading body language.

In some instances, it may be challenging to express yourself in a way that fits the situation. This may lead other people to perceive you as unnatural and uncomfortable.

For example, if you’re in a situation where someone would commonly be expected to feel joy, you may feel numb instead.

You may be aware of how your reaction may be different from the cultural norm. It’s not a conscious choice you’re making, though, but just how you feel.

Odd or eccentric behavior and appearance

You may prefer ways of dressing or behaving that aren’t usual or common in your culture. This may lead others to call you eccentric or peculiar.

This peculiarity could also involve subtle mannerisms. For example, when talking with someone else, you may keep your sight focused over their shoulder, or you might suddenly move your arms and hands in certain ways.

You might also prefer wearing clothing that appears odd to other people — for example, ones in much larger sizes or colors that don’t match.

Difficulty forming and keeping close relationships

You may feel uncomfortable in any type of relationship, particularly in those involving some degree of intimacy. An exception could be a first-degree relative, though.

Although you may desire closeness at times, you also withdraw when someone gets too close to you. The disconnectedness is actually a source of distress.

This is different from other disorders, such as schizoid personality disorder, where there’s an active effort to avoid relationships but without regret or distress about it.

You may also persistently feel that others judge you or don’t really accept you, which also makes you withdraw from social interactions.

Intense social anxiety from paranoid fears

If you have a schizotypal personality, you may have a general sense or feeling that you don’t fit in with people. This, in turn, makes you feel anxious.

This anxiety comes, in part, from how you feel others react to you, your appearance, your mannerisms, or your responses in different situations. You often feel judged or rejected.

But also, the anxiety is a result of some of your suspicious thoughts. As you tend to doubt other people’s motives, you get anxious because you feel you can’t trust anyone. This happens as you meet someone new but also after you become familiar with them.

In other words, familiarity with someone doesn’t decrease your anxiety or suspicions. Instead, it gives you more information to reinforce the idea that others don’t like you.

Although you feel you don’t belong, you’re not aware that your thoughts and behaviors might contribute to the situation.

There’s still no consensus within the medical community regarding the exact causes of schizotypal personality disorder.

In general, as with any other personality disorder, the cause of the condition might be a combination of different factors, such as:

• genetics and biology
• cultural and social influences
• early life experiences
• childhood relationships

Research has also suggested a link between developing the disorder and having a first-degree relative who’s also been diagnosed with it or with schizoid personality or schizophrenia. This doesn’t mean that it happens every time.

Only a trained mental health professional, like a psychologist or a psychiatrist, can diagnose schizotypal personality disorder accurately.

There aren’t any specific tests that can tell you whether you have schizotypal personality. Instead, a health professional will need to learn information about you, including:

• your experiences, thoughts, and emotions regarding different situations
• your self-perceived difficulties
• your relationship patterns
• your way of communicating
• your personal and family medical history

This information is often gathered during one or more talking sessions with you.

In some cases, your healthcare team might want to order laboratory tests. This way, they can make sure that some of your behaviors and thoughts are not caused by an underlying disease, injury, or substance use.

In general, schizotypal personality disorder doesn’t always progress to schizophrenia.

Some researchers estimate that between 24% and 40% of people with the disorder might eventually be diagnosed with schizophrenia.

Schizotypal personality and schizophrenia are often confused. One of the reasons for this misconception is that they may sometimes share some of the symptoms. These include:

• erratic or disorganized speech
• social withdrawal
• low motivation
• unusual perceptions
• paranoid thoughts

These similarities are why the DSM-5 considers schizotypal personality disorder a schizophrenia spectrum disorder. This means that schizotypal personality may be viewed in some cases as a less severe variation of schizophrenia.

However, there’s a difference between the two conditions, and it’s often found in the intensity, duration, and frequency of the symptoms.

Also, even though symptoms of schizotypal personality are often seen in people with schizophrenia, some symptoms of schizophrenia aren’t found in people with the personality disorder.

For example, persistent and prolonged psychotic symptoms such as hallucinations and delusions aren’t typical of schizotypal personality disorder.

In some instances, you might not feel inclined to seek help for schizotypal personality disorder. This is because you could be unaware of your symptoms.

It’s not uncommon that someone with the disorder seeks treatment only if symptoms from other conditions are causing them great distress — for example, depression or anxiety.

But schizotypal personality disorder can be treated.

Typically, psychotherapy will have goals such as:

• reducing distress
• developing social skills
• improving self-esteem
• increasing self-awareness of your role in distressing situations

These are all general goals. As you become an active participant in the treatment, you’ll be able to work with your therapist to come up with more specific objectives based on your case.

There aren’t any medications that are specifically prescribed for schizotypal personality. When drugs are used in treatment, it’s often to manage symptoms from co-occurring conditions. These drugs can include antidepressants or mood stabilizers.

Schizotypal personality disorder is a lifelong mental health condition. Treatment is effective in most cases, and developing coping skills is possible.