Schizotypal Personality Disorder: Symptoms & Treatment

Schizotypal personality disorder (STPD) is a mental health condition that causes atypical behavioral patterns that influence interpersonal relationships, thoughts, and appearance. People with STPD are often described as eccentric in how they behave, perceive things, talk, and think. Research estimates that about 4% of Americans live with STPD.

There are several different types of personality disorders, and this STPD is categorized as a cluster A personality disorder. Regardless of which personality disorder a person has, symptoms often begin during the teenage years or early adulthood, occur long-term, and typically present with problems and uncertainty with how people see themselves.

Each personality disorder can influence certain traits and behaviors. The unique symptoms of schizotypal personality disorder include:

• Atypical behaviors that are out of the norm
• Eccentric appearance
• Difficulty conveying ideas
• Trouble connecting in relationships
• Odd, suspicious, or paranoid thoughts
• Belief in magical thinking or supernatural powers
• Incorrectly interpreting reality or ordinary situations
• Social anxiety
• Detachment from others
• Tendency to experience negative emotions like sadness, worry, and poor self-image

STPD falls under the schizophrenia spectrum disorders and shares similar symptoms as schizophrenia (such as odd thoughts and behavior). However, these are two distinct conditions. Unlike people who have received a diagnosis of schizophrenia, people with STPD typically don’t hallucinate, are not detached from reality, and don’t experience delusions.

The exact cause of schizotypal personality disorder is unclear. However, research theorizes the following factors may be involved in its development:

• Genetics: Mutations (changes) of certain genes, such as the CACNA1C gene, which plays an important role in behavior, learning, and memory, may be associated with STPD. Evidence also shows that people with a family history of STPD are at a higher risk of developing the condition themselves.
• Environmental factors: Exposure to influenza during pregnancy, chronic stress, and a prior history of mental health conditions can also raise the risk of developing STPD.
• Coexisting conditions: Research suggests that about two-thirds of people with STPD are diagnosed with at least one additional personality disorder, especially borderline personality disorder (BPD). Other mental health conditions that often occur alongside STPD include autism spectrum disorder, social anxiety disorder, and attention-deficit hyperactivity disorder (ADHD).

Other factors may influence the risk of schizotypal personality disorder, including sex, racial background, and socioeconomic factors. For instance, STPD appears to occur more in males, those from low-income communities, and Black people. Why these groups are more affected is unclear, but studies believe that high stress levels and limited resources to manage life’s stressors may play a role.

Unlike physical health conditions that may require an imaging scan or a blood test, there is no one specific test for diagnosing schizotypal personality disorder. Instead, mental healthcare providers often use a psychological evaluation to ask questions about your family and medical history, symptoms, lifestyle habits, and behaviors.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person should have five or more of these symptoms to receive a diagnosis for STPD:

• Excess social anxiety that may be associated with paranoid fears
• Odd beliefs and thoughts
• Eccentric behavior or appearance
• The belief that random and unrelated events in the world directly relate to oneself
• Unusual perceptual experiences
• No close friends
• Suspiciousness
• Expressing emotions inappropriately

To further meet the criteria for diagnosing STPD, a mental healthcare provider will also need to rule out other related conditions, such as autism spectrum disorder (ASD). They also need to ensure that symptoms do not occur exclusively during the course of an episode of psychosis.

Schizotypal personality disorder is a lifelong condition and, just like other personality disorders, has no cure at this time. But this doesn’t mean there aren’t any treatments available. Several treatment options exist to improve functioning and reduce the severity of symptoms. Generally, the treatment plan for STPD may include medications, supplements, therapy, and social skills training.

Medications

The United States Food and Drug Administration (FDA) has not approved any medications for specifically treating personality disorders like STPD. However, healthcare providers use certain medications off-label (meaning not for their intended use) to treat this condition. Your healthcare provider may recommend:

• Antidepressants: Includes medications like Navane (thiothixene) and Prozac (fluoxetine), which commonly treat conditions like schizophrenia, panic disorder, obsessive-compulsive disorder (OCD), and major depressive disorder (MDD).
• Antipsychotic medications: Involves the use of medications like Risperdal (risperidone) and Zyprexa (olanzapine), which can help reduce symptoms like depression and paranoia in people with STPD.

If STPD is causing cognitive difficulties, providers may recommend stimulant drugs. For anxiety caused by STPD, benzodiazepines can help alleviate symptoms.

Supplements

Taking certain supplements that help improve brain functioning can sometimes help improve STPD symptoms. For instance, a study funded by the National Institutes of Health (NIH) suggested that omega-3 fatty acid supplements in childhood may reduce STPD symptoms and prevent more severe symptoms from developing by adolescence.

It’s important to check in with a healthcare provider to learn if supplements are safe for you (or your child) before starting them.

Therapy

Therapy options like cognitive-behavioral therapy (CBT) and supportive therapy are useful strategies for treating STPD. The goals of therapy are to identify challenging patterns and behaviors, restructure harmful thoughts, learn adaptability and social skills, and offer encouragement and self-efficacy.

Social Skills Training

Since people with STPD typically experience extreme social anxiety and find it difficult to navigate social situations, social skills training (SST) may be beneficial. SST offers lessons on how to improve communication, socialize better, and reduce anxiety and stress in social settings.

Researchers are not exactly sure why some people develop STPD—and unfortunately, there is no surefire way to prevent this personality disorder. However, some strategies may help reduce the risk of developing more severe symptoms of STPD. These methods include:

• Eating a balanced diet that consists of whole grains, lean proteins, healthy fats, fruits, and vegetables
• Regularly getting physical activity
• Getting enough sleep at night
• Taking omega-3 supplements 

Schizotypal personality disorder shares some similar symptoms with other mental health conditions. These include:

• Schizoid personality disorder: Another cluster A personality disorder that causes symptoms like a lack of desire to have close friendships, wanting solitude, and being emotionally cold to others
• Paranoid personality disorder (PPD): Contributes to similar symptoms like suspiciousness and lack of interest in or trust in others, but also causes an extreme fear of intimacy or closeness to others and a tendency to experience extreme bouts of anger
• Avoidant personality disorder: Shares a similar tendency of social isolation as people with STPD, but also contributes to a fear of rejection and low self-worth
• Autism spectrum disorder (ASD): A developmental disorder that affects how people communicate, interact, learn, and behave

Getting a diagnosis for a personality disorder can be overwhelming—and living with the condition can be just as challenging. That’s because personality disorders can affect different aspects of your life, including work, school, relationships, and mental health. However, understanding that you may need support and seeking proper treatment can help reduce symptoms and improve your quality of life.

Working with a mental healthcare provider can help you learn how to build stronger connections with others, communicate better, deal with stress, and reduce the severity of your symptoms. Asking for support from your loved ones during your treatment journey and meeting with a support group of others who live with a personality disorder can also encourage you to invest in your growth and healing.