Symptoms, Risk Factors, and Treatment for Schizotypal Personality Disorder

Imagine feeling like an outsider, struggling to connect with others, and often misunderstood by those around you. This is the reality for many living with schizotypal personality disorder (SPD). 

SPD can be challenging to manage due to its individual complexity. However, anyone experiencing symptoms of SPD should know that there are effective treatments for this disorder. To help understand SPD better, let’s explore its symptoms, risk factors, and treatment options. 

What is schizotypal personality disorder? 

SPD is a complex personality disorder that usually includes social isolation and eccentric thoughts, speech, mannerisms, dress, and/or beliefs. Individuals with SPD tend to be extremely uncomfortable with relationships. The peculiar aspects of this disorder, like odd beliefs or mannerisms, can add to this difficulty. 

SPD usually isn’t diagnosed until early adulthood. Up to this point, personality traits are still developing. SPD is rare among the general population. It’s estimated to occur in 3%–5% of adults in the U.S.

Those with this condition may have a hard time building and maintaining friendships, romantic partnerships, and other kinds of relationships. They might also struggle in other areas of their lives where interpersonal connections are important, like work or school. 

Symptoms of schizotypal personality disorder

Some people may experience a couple or even a few symptoms of SPD occasionally. However, an official diagnosis involves having a consistent pattern of several symptoms that appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), which include:

• Lack of social relationships or poor quality relationships 
• Strong social anxiety 
• Odd or peculiar mannerisms and/or behaviors 
• Unusual or eccentric speech and/or thoughts 
• Beliefs that everyday events have some kind of special meaning 
• Belief in superstitions, clairvoyance, or other paranormal or special powers 
• Disheveled appearance or odd sense of style
• Low motivation, leading to poor performance at school or work
• Trouble responding or reacting to social cues in appropriate ways 

Schizotypal personality disorder vs. schizophrenia 

SPD may seem similar to schizophrenia, making it easy to confuse the two. But there are notable differences. 

Schizophrenia includes episodes where people have delusions, hallucinations, or other psychotic symptoms. Psychosis usually doesn’t occur in people with SPD.

Schizophrenia also typically affects people’s everyday activities and functioning in maladaptive ways. For example, their symptoms might prevent them from being able to hold down a job. 

SPD isn’t as likely to have severe impacts on daily life. Those with SPD may also be able to recognize that their thoughts and beliefs are distorted, unlike those with schizophrenia. 

SPD also differs from schizoid personality disorder, which includes avoidant behaviors and a lack of interest in others. Those with SPD are interested in other people, but extremely anxious about interacting with others. 

Risk factors for schizotypal personality disorder 

What causes SPD? Like other personality disorders, there is no universally recognized single cause, but certain factors may raise the risk of having SPD. Below, we’ll go over a few different risk factors associated with this disorder. 

As you read, keep in mind that having one or more risk factors doesn’t mean someone is guaranteed to have this condition; a formal diagnosis from a licensed mental health professional is still required.

Genetic and neurobiological factors 

Genetics may play a significant role in the development of SPD. Research shows that this disorder is found more often in relatives of individuals with certain personality disorders or schizophrenia. However, researchers have not yet identified the root causes of this disorder.

Brain structure is another risk factor for SPD. Changes in the brain in those with this condition are similar to brain changes in individuals with schizophrenia. Data suggests that people with SPD have less gray matter in certain areas of the brain, like the temporal and frontal lobes. 

Psychological factors 

Certain psychological characteristics might make a person more vulnerable to developing SPD, such as comorbidity of other mental health disorders, like substance use disorder, depression, or obsessive-compulsive disorder.

Environmental factors 

Childhood experiences and other external or outside influences may increase one’s risk of having SPD. Traumatic experiences, abuse, and neglect are all examples of environmental factors associated with this disorder. 

Experiencing social isolation as a child is also a risk factor. For example, if a person grew up with a parent who was emotionally detached, this might result in a greater risk of developing SPD. In this case, they may not have learned how to connect with others. They might experience severe social anxiety, or be suspicious of other people’s intentions.

What are the treatments for schizotypal personality disorder?

Like paranoid personality disorder and other personality disorders, SPD is a chronic condition. It can have a negative impact on certain areas of a person’s life, like preventing them from forming close relationships. But the right treatment of schizotypal personality disorder can help improve their quality of life. 

Talk therapy, or psychotherapy, is a common type of treatment for SPD. This can be done in multiple ways, like individual sessions or family therapy (depending on the person’s age and how their condition affects their family life). 

Managing co-occurring conditions is another part of treating SPD. Below, we’ll walk through various treatment options for this disorder. Keep in mind that there’s not a one-size-fits-all approach to treatment. A supportive, understanding therapist can help someone find the right treatment for their individual needs.

Cognitive behavioral therapy 

Having distorted thoughts and behaviors is a hallmark of SPD. An example is someone believing that they have a “sixth sense” or can read people’s minds. Or they might assume the worst about people’s intentions toward them. 

Cognitive behavioral therapy, or CBT, can help with learning to recognize and change these behaviors and thoughts. This type of therapy involves exploring distorted thought patterns, identifying them, challenging them, and making adaptive changes. 

For example, someone with SPD might learn to recognize and challenge paranoid thoughts about others. Instead of seeing others as a threat, they can learn to trust them — or at least be more comfortable interacting with them. 

Dialectical behavioral therapy 

Dialectical behavioral therapy, or DBT, was originally developed to treat borderline personality disorder. But it can be helpful for managing SPD. It focuses on helping people learn to regulate their emotions. It also involves learning to tolerate distress. Those with SPD might use maladaptive ways to cope with difficult emotions and stress.

Let’s say that someone with SPD has a social function to attend. Severe social anxiety about being around others might cause considerable distress. They might feel terrified before going and while they are there. Or they might be so stressed that they avoid going. In either case, SPD symptoms may get worse. 

DBT teaches how to handle challenging emotions and tolerate stressful situations. Instead of resorting to maladaptive — or potentially harmful — coping mechanisms, it involves working on building adaptive ones. 

Social skills training 

Odd or eccentric behaviors, speech, and mannerisms can make it incredibly tough for those with SPD to build relationships. The social anxiety and paranoid thoughts that are often part of this disorder can make any social interaction even more difficult. 

They might have a hard time communicating with others due to peculiar speech patterns. Or they might avoid eye contact during conversations. 

No matter what social struggles those with SPD face, social skills training can help. This type of training helps people work on building communication skills. They learn to actively listen to others and recognize social cues. They also learn how to improve other social skills, making it easier to handle social situations and form relationships. 

Group therapy 

Social isolation is a big part of living with SPD. But group therapy can help individuals with this disorder feel less isolated. With this type of therapy, a group of people with the same or similar conditions and struggles meet in a session led by a therapist or other qualified mental health professional. Group therapy offers an opportunity to practice social and communication skills in a supportive environment.

Family therapy 

Communication and social challenges that are usually part of SPD can cause stress within families. Those who have this disorder might have a hard time communicating with loved ones. Family members might not understand what they’re going through.

Family therapy offers a way for families to work together to help a loved one manage SPD. Family members can learn more about this condition in order to understand it better. Family therapy also helps loved ones learn how they can offer assistance and support. 

Medication

SPD treatment might involve medication management. While the FDA hasn’t approved a drug for treating SPD specifically, many medication managers use various medications to treat its symptoms. For example, antidepressants might help improve some SPD symptoms.

Managing co-occurring conditions helps improve emotional and mental well-being overall. For those with co-occurring conditions, it’s best to discuss treatment options with a psychiatrist or medication manager.  

Can someone live a healthy life with schizotypal personality disorder?

Yes! People with SPD can enjoy healthy lives where they can have close friends and feel at ease in social situations. The key is to find the right approach to managing this condition. This depends on what the person’s symptoms are, their severity, and other factors — like whether they have any co-occurring conditions. 

Therapy can reduce social isolation and help improve social skills. It can also help someone with the condition to better manage their emotions, learn adaptive coping mechanisms, or modify distorted thoughts and behaviors. This can make it easier to build relationships and function adaptively in daily life.