Schizotypal personality disorder

People with schizotypal personality disorder are often described as odd or eccentric, and they usually have few, if any, close relationships. They generally don't know how relationships form or how their behavior affects others. They also tend to misinterpret others' motivations and behaviors and greatly distrust others.

These problems may lead to severe anxiety and a tendency to stay away from social situations. That's because people with schizotypal personality disorder tend to hold odd beliefs and may find it hard to respond correctly to social cues.

Schizotypal personality disorder usually is diagnosed in early adulthood, although some features of this condition may show up during childhood and the teen years. It's likely to be a lifelong condition. Treatments, such as medicines and therapy, can make symptoms better.

Schizotypal personality disorder usually includes five or more of these symptoms. The person may:

• Be a loner and lack close friends and other relationships outside of the immediate family.
• Have flat emotions or have emotional responses that are limited or not proper socially.
• Have too much social anxiety, which is ongoing.
• Incorrectly interpret events, such as feeling that something harmless or not offensive has a direct personal meaning.
• Have strange or unusual thinking, beliefs or mannerisms.
• Have suspicious or paranoid thoughts and constant doubts about the loyalty of others.
• Believe in special powers, such as mental telepathy or superstitions.
• Have unusual thoughts, such as sensing an absent person's presence, or having illusions.
• Dress in odd ways, such as appearing messy or wearing oddly matched clothes.
• Speak in an odd way, such as vague or unusual patterns of speaking, or ramble oddly while speaking.

Symptoms of schizotypal personality disorder, such as more interest in activities done alone or a high level of social anxiety, may be seen in the teen years. The child may not do well in school or appear socially out of step with peers. This may lead to teasing or bullying.

Schizotypal personality disorder vs. schizophrenia

It's easy to confuse schizotypal personality disorder with schizophrenia, which is a severe mental health condition where people struggle with interpreting and managing reality. This is known as psychosis. People with schizotypal personality disorder may have brief psychotic bouts with delusions or hallucinations. But the bouts aren't as often, as long or as intense as with schizophrenia.

Another key difference is that people with schizotypal personality disorder usually can be made aware of how their distorted ideas differ from reality. Those with schizophrenia generally can't be swayed away from their delusions.

Despite the differences, people with schizotypal personality disorder can benefit from treatments like those used for schizophrenia. Sometimes schizotypal personality disorder is thought to be on a spectrum with schizophrenia, with schizotypal personality disorder viewed as less severe.

When to see a doctor

People with schizotypal personality disorder are likely to seek help only at the urging of friends or family members. Or people with schizotypal personality disorder may seek help for another problem such as depression, anxiety or substance misuse. If you think that a friend or family member may have the condition, consider gently suggesting that the person seek the help of a healthcare professional or mental health professional.

If you need immediate help

If you're concerned that you might harm yourself or someone else, go to an emergency department or call 911 in the U.S. or your local emergency number right away. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).

It's not known what causes schizotypal personality disorder. But it's likely that changes in the way the brain functions, genetics, environmental influences and learned behaviors play a role.

You may be more at risk of schizotypal personality disorder if a relative has schizophrenia or another psychotic disorder.

People with schizotypal personality disorder are more at risk of:

• Depression.
• Anxiety.
• Other personality disorders.
• Schizophrenia.
• Temporary psychotic bouts, usually in response to stress.
• Misuse of alcohol or drugs.
• Suicide attempts.
• Problems with work, school and other social relationships.

People with schizotypal personality disorder may seek help from a healthcare professional because of other symptoms, such as anxiety, depression or problems coping with social situations, or for treatment of substance misuse.

After a physical exam to rule out other medical conditions, your healthcare professional may refer you to a mental health professional for more help to figure out the diagnosis.

Diagnosis of schizotypal personality disorder usually is based on:

• A thorough discussion about your symptoms and any hard times you're having.
• Your personal and medical history, including treatments that you've had.

Treatment for schizotypal personality disorder often includes talk therapy and medicine. Many people can be helped by work and social activities that are a fit for their personality styles.

Talk therapy

Talk therapy, also called psychotherapy, may help people with schizotypal personality disorder begin to trust others and learn coping skills, especially how to manage social relationships and situations. This is done by building a trusting relationship with a therapist.

Psychotherapy may include:

• Cognitive behavioral therapy — Uncovering and challenging negative thought patterns, learning specific social skills, and changing problem behaviors.
• Supportive therapy — Offering encouragement and promoting adaptive skills.
• Family therapy — Involving family members, which may make communication and trust better and make people better able to work together with others in the home.

Medicines

The Food and Drug Administration has not approved any medicines specifically to treat schizotypal personality disorder. But healthcare professionals may prescribe an antidepressant medicine to help ease certain symptoms, such as depression or anxiety. Periodically, some people may need to be prescribed an antipsychotic medicine to address hallucinations or delusions. Some medicines may help people think about things in a new way or more than one way, known as flexible thinking.

Schizotypal personality disorder is a lifelong condition. Some symptoms may get better over time through experiences that promote positive coping skills. This can raise self-confidence, help get over things that are hard and improve ability to manage social situations.

Factors most likely to make some symptoms of this condition better include:

• Getting along well with friends and family and in other social situations, such as doing tasks that bring you in contact with others.
• Maintaining healthy daily routines, including having a schedule, following a good sleep routine, exercising and regularly taking prescribed medicines at the same time.
• Having a sense of achievement at school or work, and in other interests or hobbies.

You're likely to start by seeing your healthcare professional. But when you call to set up an appointment, you may be referred to a mental health professional such as a psychiatrist or psychologist.

Take a family member or friend along, if possible. With your permission, someone who has known you for a long time may be able to help answer questions or share information with the mental health professional that you don't think to bring up.

Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you or your family noticed, and for how long. Ask friends or family members if they've felt concerned about your behavior and what they've noticed.
• Important personal information, including distressing events in your past and any current, major stressors. Find out about your family's medical history, including any history of mental illness.
• Your medical information, including other physical or mental health conditions that you've been diagnosed with.
• All medicines you take, including the names and doses of any medicines, herbs, vitamins or other supplements you take.
• Substances that you use, including what you smoke or drink, as well as any prescribed or recreational drugs you use.
• Questions to ask your healthcare professional to make the most of your appointment.

Some basic questions to ask include:

• What is likely causing my symptoms?
• What are other possible causes for my symptoms?
• What treatments are most likely to help me?
• How much can I expect my symptoms to get better with treatment?
• How often will I need talk therapy, and for how long?
• Are there medicines that can help?
• Is there a generic alternative to the medicine you're prescribing?
• If you're recommending medicines, what are the possible side effects?
• I have other health conditions. How can I best manage them together?
• Are there any brochures or other printed material I can take? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you several questions, such as:

• What are your symptoms?
• When did you or your family first notice these symptoms?
• How are your symptoms affecting your life?
• Have your family members or friends expressed concern about your behavior?
• Do you feel comfortable in social situations? Why or why not?
• Do you have any close relationships?
• If you're not satisfied with work, school or how well you get along with others, what do you think is causing your problems?
• Have you ever thought about harming yourself or others? Have you ever done so?
• Have you ever felt that other people can control your thoughts or that you could influence other people and events through your thoughts?
• Have any of your close relatives been diagnosed with or treated for a mental health condition?

Your healthcare professional or mental health professional might ask more questions based on your responses, symptoms and needs. Preparing for these questions will help you make the most of your appointment time.