What Is Schizotypal Personality Disorder?

Schizotypal personality disorder (STPD) is a chronic mental health condition that involves social isolation and difficulty forming close relationships. People with STPD exhibit odd and eccentric behavior, fears, preoccupations, ideas, appearance, and speech. 

Like other personality disorders, STPD involves long-term, unhealthy patterns in thinking and behavior. These patterns significantly affect someone’s functioning in work, school, relationships, and other aspects of daily life.

This article will discuss STPD, including symptoms, causes, risk factors, treatment, and more.

Facts About Schizotypal Personality Disorder

Schizotypal personality disorder (STPD) is a chronic mental illness that involves eccentric mannerisms in the way someone behaves, looks, talks, and thinks. 

People with STPD often feel detached from others and have a hard time forming close relationships. They might find it difficult to relate to others or express their emotions in healthy ways. Others might think they seem aloof or distant.

Many people with STPD have odd beliefs, preoccupations that others consider strange, and disturbed or distorted thinking patterns. For example, someone with STPD may feel very strongly about superstitions or supernatural phenomena. They may feel paranoid that someone is “out to get them.”

Definition of Eccentric in Mental Health

In the "Diagnostic and Statistical Manual of Mental Disorders, 5th edition" (DSM-5), STPD falls within the category of Cluster A personality disorders. In addition to STPD, other Cluster A personality disorders include paranoid personality disorder (PPD) and schizoid personality disorder (SPD).

Cluster A personality disorders are characterized by odd or eccentric behavior. In the DSM-5, “eccentric” may be used to refer to ideas, beliefs, and actions that fall outside of cultural norms and may be perceived by others as peculiar, inappropriate, or strange. Examples may include:

• Eccentric patterns of speaking, such as speech that is overly vague, abstract, repetitive, metaphorical, or detailed
• Ways of expressing emotion that seem too “flat” or extreme for the situation
• Magical thinking, such as superstitions, bizarre fantasies, or a preoccupation with the supernatural (i.e., clairvoyance, aliens, or telepathy)
• Dressing in ways that seem “out of place” or inappropriate (such as wearing clothes that are dirty, don’t fit well, or aren’t right for the occasion)

Statistics

A few key statistics to know about the prevalence of STPD include:

• About 9.1% of U.S. adults meet the criteria for a personality disorder in any given year.
• Estimates suggest that just under 4% of U.S. adults will meet the diagnostic criteria for STPD during their lifetime.
• About 4.2% of men in the U.S. have STPD, in comparison to around 3.7% of American women.

STPD Symptoms

People with STPD often struggle to maintain close relationships with people outside their immediate family. They may also find it hard to “fit in” at work or school.

Some of the most common signs and symptoms of STPD include:

• Odd beliefs, preoccupations, and fears
• Odd patterns in thinking, speech, and behavior 
• Emotional withdrawal
• Paranoia
• Eccentric or unkempt appearance
• Difficulty in expressing thoughts or emotions
• Difficulty in speaking coherently
• Lack of close relationships
• Social isolation
• Incoherent self-image

Schizotypal vs. Schizophrenia

STPD is related to several other mental health conditions, especially schizophrenia. While STPD and schizophrenia are related in some ways, they are distinct conditions.

Schizophrenia is a brain disorder that causes disturbed patterns of thinking, pattern, and perception. It also causes episodes of psychosis—a break from reality. 

STPD and schizophrenia share symptoms like distorted thinking, odd ways of speaking and behaving, strange beliefs, and difficulties in expressing emotions and developing relationships. 

However, STPD does not cause symptoms of psychosis, such as hallucinations (seeing or hearing things that aren’t there) or delusions (long-term false personal beliefs). This is an important distinction between STPD and schizophrenia, although the two conditions are sometimes confused with each other.

People with STPD are at a higher risk of developing schizophrenia at a later date. Studies have shown between 20% and over 40% conversion from STPD to schizophrenia. However, it’s important to remember that many people who have STPD will not eventually develop schizophrenia or any other psychotic disorder.

Causes and Risk Factors

There is no single known cause of STPD. Researchers have identified several possible factors that may contribute to the development of STPD, including:

• Genetics: Twin studies suggest that, in some cases, STPD may be passed down in families due to certain genetic variations. 
• Brain structure: Early research has found that both children and adults with STPD have differences in brain structure and function, such as in parts of the frontal lobe (a part of the brain that helps with thinking, decision-making, language, and movement).
• Comorbid conditions: Many people with STPD have at least one other mental health condition. Research indicates that about two-thirds of people with STPD have at least one other personality disorder. Many people with STPD also have borderline personality disorder (BPD).
• Environment: Research suggests that a history of chronic stress and/or traumatic life events, especially during childhood, may put someone more at risk of developing STPD.
  

DSM-5 Diagnostic Criteria

According to the criteria in the DSM-5, someone must have five or more of the following symptoms to be diagnosed with STPD:

• Ideas of reference (i.e., seeing coincidences as linked or as personally significant)
• Excessive social anxiety, especially anxiety that seems to be related to paranoia and doesn’t go away with time
• Magical thinking and odd beliefs 
• Unusual perceptual experiences
• Odd, eccentric, or peculiar behavior or appearance
• Lack of close relationships outside of first-degree relatives
• Odd thinking and speech
• Inappropriate or constricted (“flat”) emotional expression
• Suspiciousness or paranoia

To meet the criteria for STPD, these symptoms must not be better explained by a different condition, such as autism spectrum disorder (ASD). They must also cause emotional distress and/or significant problems with daily functioning.

STPD Treatment

A mental health therapist can diagnose you with STPD using the criteria in the DSM-5. They may perform other assessments, such as a physical or neurological examination, to rule out any other possible underlying causes for your symptoms. 

Treatment for STPD typically involves talk therapy, medication, or a combination of both. 

Talk therapy: Research suggests that many people with STPD struggle with finding healthy ways to cope with challenges. Psychotherapy can help people with STPD develop more effective coping skills and stress management techniques. 

Medication: There is no medication currently approved by the Food and Drug Administration (FDA) for STPD. However, medication may be prescribed for the off-label treatment of certain STPD symptoms or for comorbid mental health conditions. Studies have shown that antipsychotic medications may reduce paranoia and anxiety.

Meanwhile, Tenex (guanfacine)—which is sometimes used to treat attention deficit hyperactivity disorder (ADHD)—has been found to be effective in reducing disturbed thinking patterns among people with STPD.

Situational Coping Strategies

Because STPD is usually a long-lasting condition, it can be difficult to treat. In addition to treatments like psychotherapy or medication, many people with STPD are able to improve their symptoms with social skills training. 

Social skills training (SST) is a type of behavioral therapy that is often used to treat symptoms of conditions like schizophrenia, ASD, or personality disorders. It often takes place in a group setting. 

SST can help people target and modify negative behaviors, improve their communication skills, manage stress, and set healthy goals. With social skills training, many people with STPD and other disorders are able to increase the quality of their relationships and employment outcomes.

Relationships

People with STPD often wrestle with loneliness, social isolation, and feeling misunderstood.

Studies suggest that people with STPD are less likely to marry and have children, even if they want to do so. Those who are married often experience conflicts within their relationships. Meanwhile, children and adolescents with STPD may struggle to fit in with their peers and get along with their parents.

Social skills training is effective in helping people with STPD improve their social functioning and reduce social anxiety. SST can help you build stronger connections with others through improved communication skills and a greater ability to read social cues.

If you have STPD, you should also consider telling your loved ones about your diagnosis and encouraging them to educate themselves about your symptoms. Peer support groups, whether online or in-person, can help you build a strong support system.

Employment

Many people with STPD have trouble finding long-term employment and feeling satisfied at work. People diagnosed with STPD are both less likely to be employed at any given time and more likely to report experiencing problems at work.

Social skills training may help people with STPD build skills and traits essential to success at many jobs, such as working memory, goal-setting, communication, motivation, optimism, and reading social cues.

Because most jobs involve some level of day-to-day stress, SST can also help people with STPD develop better stress management techniques that they can use at work.

If you have STPD, it may also be useful to consider working towards a career that fits your particular personality traits. Employed people with STPD often seek out occupations that involve less social contact and fewer cognitively complex tasks.

Summary

Schizotypal personality disorder is a long-lasting mental health condition that involves odd and eccentric patterns of behavior, thinking, and appearance. Many people with STPD feel socially isolated and find it hard to develop close relationships with people outside their immediate families.

While STPD symptoms often overlap with those of schizophrenia, people with STPD do not experience symptoms of psychosis (a break from reality), such as hallucinations or delusions. 

There is no single known cause of STPD. Genetics, comorbid mental health conditions, brain structure, and environmental factors—such as trauma and chronic stress—all likely play a role in the development of STPD.

Treatment for STPD typically involves talk therapy, medication, or a combination of both. Social skills training may help to improve relationships and prospects for employment.

A Word From Verywell

If you have schizotypal personality disorder, don’t be afraid to reach out to a healthcare provider about your concerns. Your symptoms can improve with talk therapy, stress management techniques, and social skills training.