How to Recognize Schizotypal Personality Disorder

Co-authored by Padam Bhatia, MD

Last Updated: August 8, 2022 References

Identifying Symptoms

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Understanding Personality Disorders

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Professional Help

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Expert Q&A

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Tips

Schizotypal personality disorder is characterized by odd perceptions and thoughts, interpersonal problems, and eccentricity in speech and behavior.^{[1]
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PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source} Personality disorders are pervasive and long-term, meaning that the symptoms do not occur in episodes and tend to be enduring patterns. Look out for specific signs and symptoms and know how to distinguish schizotypal personality disorder from schizophrenia. The best way to identify schizotypal personality disorder is through an evaluation given by a mental health professional.

Part 1

Part 1 of 3:

Identifying Symptoms

1
Notice unusual preoccupations or excessive social anxiety. Someone with schizotypal personality disorder may express unusual or odd thoughts or excessive social anxiety that tends to be associated with paranoid fears. For example, someone might believe they are being monitored by the government or that grand conspiracies exist in which they have privy information.^{[2]
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Cleveland Clinic
Educational website from one of the world's leading hospitals
Go to source} When you try to provide evidence against their claims, they might rigorously defend their viewpoint, whether they have evidence or not.
- This person may believe they have special powers or magical abilities, such as mind reading or telepathy.
- This person may be overly superstitious and go out of their way to avoid superstitious places or events.
2
Identify odd, eccentric, or peculiar behaviors. Outside of having strange ideas or beliefs, people with schizotypal personality disorder may behave in eccentric or odd ways. This person’s odd or unusual thoughts may lead to odd or unusual behavior.^{[3]
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PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source} For example, they might act out their suspicions or paranoia.
- The person may have an odd or eccentric appearance or social presence. They may be disheveled or make unusual outfit choices.
- The person may claim to experience unusual bodily experiences, like saying that little beings live inside them or that aliens have implanted something into their body.^{[4]
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3
Tune into their odd thinking and speech. People with schizotypal personality disorder tend to have elaborate odd thinking and speech. For example, they may speak in a vague or circumstantial way. They may also talk almost exclusively in metaphors or in an overly elaborate manner. Their speech may seem stereotyped or as if it is parroted.^{[5]
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- While you may not be able to put your finger on it, you may notice this person’s speech and way of talking seems odd or a bit off.
- For example, they might make overly-generalized statements such as, “Everybody knows that aliens live underneath the Earth. The government has been hiding it from us but everybody knows it.”
4
Look at their expression. Often, people with schizotypal personality disorder have a strange way of showing their feelings. They may not show a range of normal emotions such as happy, sad, complacent, or excited. Or, their expression of feelings may sway heavily in one direction inappropriately, such as being overly upset or preoccupied. Socially, the person may not know how to communicate the way they feel or may be inappropriate in their expressions.^{[6]
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MedlinePlus
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- They may inappropriately show affection or feelings toward people, animals, and situations.
- Patients with Schizotypal Personality Disorder tend to have an affect or expression that is unusual, while their affect can be inappropriate or constricted.
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Recognize a lack of close friendships. People with schizotypal personality disorder tend to have significant difficulty with relationships. They may have great difficulty in making and maintaining friendships. Emotional intimacy and relationships may make the person feel incredibly uncomfortable. This person may be unwilling or disinterested in connecting with others in a meaningful way.^{[7]
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- Someone with this disorder may lack close friends outside of first-degree relatives, due to a lack of socialization. You might consider this person a loner or socially isolated.
- The person may appear to be intensely socially anxious, yet the anxiety appears to come from paranoia and not from negative judgments about the self.

Part 2

Part 2 of 3:

Understanding Personality Disorders

1
Know what qualifies a personality disorder. A personality disorder is a long-term pattern of behavior that differs significantly from what is socially acceptable. Often, people with personality disorders don’t realize they have a problem.^{[8]
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MedlinePlus
Collection of medical information sourced from the US National Library of Medicine
Go to source} The person’s thoughts may be inflexible. This type of behavior is often observed in the person’s thoughts, mood/disposition, and social relationships.
- A personality disorder affects a person’s ability to approach employment, day-to-day life, and social relationships, often resulting in problems in these areas and emotional distress.^{[9]
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  Research source} Personality disorders do not occur in episodes and are pervasive in the person’s day-to-day life.
2
Differentiate from schizophrenia. It can be difficult to differentiate suspicious and paranoid ideation from schizophrenia. With schizophrenia, people tend to lose contact with reality and enter into a state of psychosis. Usually, if psychotic symptoms are present then it is schizophrenia. Someone with schizotypal personality disorder may experience delusions and/or hallucinations, however, these episodes are not as frequent, intense, or prolonged as those of a schizophrenic episode. Schizotypal is considered a less severe diagnosis than schizophrenia.^{[10]
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Cleveland Clinic
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- People with schizophrenia truly believe their reality is correct and those with schizotypal personality disorder may be receptive to feedback that their reality is distorted.
3
Differentiate from autism. Autistic people can also be very eccentric, have few friends, and be nervous in social situations (usually due to bad experiences). However, they experience developmental delays and do not develop paranoia or delusions unless another disorder is present.
- Autistic people can usually carry on a logical conversation, and although they can be easily fooled, they are able to distinguish between fantasy and reality.
- Autistic people are likely to display passionate and intense interests, sensory over- or under-sensitivities, developmental delays and quirks, disorganization, difficulty understanding social skills, and stimming. People with schizotypal PD typically do not.
4
Note the presence of other disorders. Many people with schizotypal personality disorder experience intense social anxiety. Social relationships with others may be difficult or impossible due to paranoid fears such as being spied on or being followed.^{[11]
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PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source} Even once familiar with a new person, someone with schizotypal personality disorder may continue to experience extreme anxiety. People with schizotypal personality disorder are also at an increased risk for depression, anxiety, other personality disorders (such as paranoid personality disorder), suicide, and problems with drugs or alcohol.^{[12]
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- Those with schizotypal personality disorder may be at a higher risk for a psychotic episode, typically in response to stress.
5
Look at family history. While little is known about the causes of schizotypal personality disorder, it does appear to have a genetic link. People with schizotypal personality disorder are more likely to have a relative with schizophrenia.^{[13]
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MedlinePlus
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- Generally, personality disorders are diagnosed in adulthood. Because personality is constantly changing during development, children and teens do not typically receive this diagnosis.^{[14]
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- Some early warning signs include having poor social skills and few interpersonal relationships. These patterns may begin to emerge in childhood.

Part 3

Part 3 of 3:

Professional Help

1
Encourage a loved one to seek help. If you suspect someone you know may have schizotypal personality disorder, suggest that they seek treatment. Most people do not seek treatment until the symptoms begin to significantly impact their lives. In some cases, people seek treatment for concurrent disorders such as paranoid personality disorder or anxiety before obtaining a diagnosis of schizotypal personality disorder.^{[15]
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Expert Source

Padam Bhatia, MD
Board Certified Psychiatrist
Expert Interview. 3 April 2020.}
- If you are concerned about your loved one, encourage them to speak with a treating professional such as a psychologist, social worker, or psychiatrist.
2
Get a psychological evaluation. A psychologist can provide a diagnosis by conducting an interview and performing a psychological evaluation, usually through cognitive behavioral therapy.^{[16]
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MedlinePlus
Collection of medical information sourced from the US National Library of Medicine
Go to source} The evaluation may include self-report questionnaires, and a thorough understanding of mental health history, family history, and social history.^{[17]
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Padam Bhatia, MD
Board Certified Psychiatrist
Expert Interview. 3 April 2020.}
- It’s important to get a diagnosis in order to better understand the diagnosis and to receive treatment.
3
Obtain treatment. Most treatment for schizotypal personality disorder involves therapy and social skills training.^{[18]
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MedlinePlus
Collection of medical information sourced from the US National Library of Medicine
Go to source} This can include individual therapy as well as group therapy. Social skills training can help someone to cope more effectively with social situations and reduce social anxiety. Hospitalization or residential care may be necessary if symptoms are severe.
- Medications can be helpful to treat severe symptoms, but these must be prescribed by a clinical psychiatrist.^{[19]
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  Research source} Patients should see a therapist or psychologist for cognitive behavioral therapy while being treated with ongoing medication.^{[20]
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  Expert Source
  
  Padam Bhatia, MD
  Board Certified Psychiatrist
  Expert Interview. 3 April 2020.}

Expert Q&A

Question

How can I talk to my therapist if I think I may be schizotypal?

Padam Bhatia, MD
Board Certified Psychiatrist
Dr. Padam Bhatia is a board certified Psychiatrist who runs Elevate Psychiatry, based in Miami, Florida. He specializes in treating patients with a combination of traditional medicine and evidence-based holistic therapies. He also specializes in electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), compassionate use, and complementary and alternative medicine (CAM). Dr. Bhatia is a diplomat of the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association (FAPA). He received an MD from Sidney Kimmel Medical College and has served as the chief resident in adult psychiatry at Zucker Hillside Hospital in New York.

Padam Bhatia, MD

Board Certified Psychiatrist

Expert Answer

Just be open and honest with your therapist about what you're experiencing and feeling. Describe your symptoms and explain your concerns. A lot of people shy away from talking about mental health because there's a lot of stigma out there, but you really don't have anything to worry about. Therapists talk about mental health all the time and they're going to listen and be sympathetic if you open up to them.