Schizotypal personality disorder

Understanding schizotypal personality disorder

Schizotypal personality disorder (STPD) is a ‘Cluster A’ personality disorder, which includes paranoid and schizoid personality disorder. Cluster A personality disorders are characterised by distorted and/or eccentric thinking and behaviours, and social discomfort.

Those with schizotypal personality disorder often believe they have extrasensory abilities, or a ‘sixth sense’, can see into the future and can read other people's minds. They also describe supernatural experiences, such as out-of-body experiences and recurrent coincidences, commonly known as déjá-vu. 

Those with schizotypal personality disorder often have difficulties forming relationships. They also tend to feel extreme anxiety in social situations and may act inappropriately, or not react at all, during conversations.

People with STPD can be suspicious of other people’s intentions. Therefore, those with the disorder tend to trust few people and view the world as an isolated place. Individuals typically behave in ways that many people would describe as ‘eccentric.’ Their speech can also be elaborate and difficult to follow.

Signs of schizotypal personality disorder

• odd beliefs, behaviour and fantasies
• eccentric appearance and mannerisms 
• odd speech, often difficult to follow
• unusual perceptual experiences
• excessive social anxiety
• difficulty forming relationships 
• suspicion and paranoia
• difficulty responding to social cues 
• may seem emotionally distant 

Who is more likely to be diagnosed with STPD? 

People with schizotypal personality disorder are more likely to be diagnosed in early adulthood. There are a number of factors that might influence the likelihood of someone being diagnosed with schizotypal personality disorder. These can include:

• Genetics. Schizotypal personality disorder can run in families. Therefore, individuals are more likely to be diagnosed if they have relatives with schizophrenia, STPD or other personality disorders. 
• Environmental factors. Adverse childhood experiences such as abuse, neglect or trauma may mean someone is more likely to have schizotypal personality disorder. 

Treatment for schizotypal personality disorder

Personality disorder diagnosis can be considered controversial because some believe that it is unhelpful to call someone’s personality a ‘disorder,’ particularly if the person believes that their behaviours are reasonable and are out of their control. Additionally, for people with schizotypal personality disorder who experience paranoia surrounding social interactions, it may be especially hard for them to receive treatment. 

For some people, however, receiving a diagnosis can help them better understand their experiences and seek treatment and support. The National Institute for Health and Care Excellence (NICE) recommends psychological therapies for personality disorders. 

Commonly, talking therapies are used alongside other treatments, such as medication.  Reality is typically more distorted with STPD than with schizoid personality disorder. Medication may be used for more acute phases of the disorder, which commonly occur during stressful situations that the individual cannot cope with adequately.

More research is needed to be done into the use of talking therapies to support people with personality disorders, however, some of the most used include dialectical behavioural therapy, cognitive behavioural therapy and group therapy. 

Group therapy

Given that many people who are diagnosed with STPD have difficulty trusting others, a group therapy setting can be beneficial as it can help individuals feel more supported by others with similar conditions. Not only can group therapy help improve social skills, but it can also address social discomfort that is typically experienced by people with STPD. 

Dialectical behavioural therapy (DBT) 

DBT helps people manage difficult emotions and was originally created to support people with borderline personality disorder. It helps people to accept their emotions and make positive changes to their behaviour. Dialectical behavioural therapy focuses on the person’s strengths and can help people with STPD  manage their emotions and communication skills. 

Cognitive behavioural therapy (CBT)

CBT is the most popular form of psychotherapy for schizotypal personality disorder. Similarly to DBT, CBT helps individuals understand their distorted thoughts and change their thinking. It can be an especially useful approach to help individuals better communicate and understand healthy relationship behaviours. CBT can also support people with STPD to manage their social anxiety. 

It’s important to remember that our personalities are unique to us and make us individual. However, if you recognise any of the above symptoms in yourself (or someone you know) and it’s having an impact on your daily life, including your ability to form close relationships, you may wish to seek some support. 

Talking to a doctor, particularly if you recognise other symptoms of mental health conditions like anxiety or depression, is a brave step towards recovery. Your doctor may then refer you to a psychologist or psychiatrist who will be able to establish a diagnosis if you feel this would benefit you. For people with schizotypal personality disorder, discomfort in social situations can perpetuate social isolation. Seeking support early on is an effective way to prevent this and assist long-term change. 

Further help

• Personality disorders