Schizotypal Personality Disorder and Schizophrenia

Simone Hoermann, Ph.D. Updated: Aug 29th 2009

images of brain scan People with Schizotypal Personality Disorder (SPD) tend to be very uncomfortable with other people and therefore often only have a few close relationships. Based on the definition in DSM IV-TR, they can come across as reserved and distant, as well as odd and eccentric. People with SPD frequently experience unusual perceptions, for instance, noticing flashes of light or seeing objects or shadows in the corner of their eyes and then realizing that nothing is there. They often have a hard time trusting other people, even when they get to know them or are close to them. People with Schizotypal Personality Disorder often dress, talk, or behave in ways that are unusual- for instance, talking in metaphors, or wearing a winter coat in the middle of the summer. They may have spiritual or religious beliefs that do not fit into their culture and that would be considered extreme by people in their environment, for instance, about telepathy, superstitions, or a sixth sense.

Schizotypal Personality Disorder can look somewhat similar to Schizophrenia, a severe mental illness that has to do with perceiving reality in a way that is extremely different from other people. Symptoms of schizophrenia include hallucinations, for instance, seeing or hearing things that are not actually there, as well as delusions, which means having beliefs that are irrational or not true. Examples of delusions would be the belief that the television is sending special messages, or that someone is controlling one’s thoughts. The expression of emotions can be impacted, too, in that often people with schizophrenia can appear like they are withdrawn and emotionally expressionless. Moreover, the way someone who has schizophrenia thinks and speaks can be affected. Thoughts can come and go rapidly, attention and concentration can be affected, and the thoughts can come out on a way of speaking that can be disorganized and jumbled. Depending upon the specific combination of these symptoms, someone with schizophrenia can present as withdrawn, lacking in motivation, and disengaged, or, alternatively, as agitated and preoccupied.

Emil Cocarro and Larry Siever, who have done a lot of research on schizotypal personality disorder and its genetic and biological underpinnings, quote studies on families with schizophrenia showing that relatives of people with schizophrenia are at increased risk of having Schizotypal Personality Disorder. There is some indication that there is a strong genetic relation between the two disorders, since some of the symptoms and abnormal patterns in brain chemistry, brain structure, and brain functioning found in people with schizophrenia can also be found in people with Schizotypal Personality Disorder. Some experts argue that schizotypal personality disorder might be a mild form of schizophrenia, whereas other researchers suggest that there is evidence that schizotypal personality disorder shares some characteristics with schizophrenia and that there are similar deficits in certain areas, but that there are also important differences in other brain functions that prevent people with schizotypal personality disorders from developing schizophrenia.

It is difficult to estimate how common Schizotypal Personality Disorder is, because people with SPD tend to be socially withdrawn, which is why they may not seek help as frequently as other people, so we may not see people with SPD in our practices and clinics, and they may be less likely to participate in research studies than other people. Estimates of how prevalent SPD is in the community range from 1% to 3% of the population.

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

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Me and my disorder - Chris - Nov 19th 2009

I have been diagnosed with Epilipsy, M.S., Bipolar 1 and paranoid schizophrenia. Many years I have been hallucinations since I was a kid, and I have assoasiated this with normal. I am a very intelligent person with a state test IQ of 137. I see these things you say are dellusions, but they dont bother me, I believe they are not reality. Can intelligence mask my hallucinations and create a logical world around it. I still see things and I believe I see auras after years of research even though I don't believe that science. I am an extrovert and I have many friends can multiple personality disorders mutate a normal diagnosis. Please send me your advice or just your opinion.

image - Kashya - Nov 4th 2009

Can StPD be seen on MRI or other ways on the brain? Or only from the behavior?

I'm really worried... - Rose - Oct 29th 2009

I'm really worried because lately I've been suspecting that I may have Schizotypal Personality Disorder. After reading this article, I am sure of it. I am only 15 years old, but I have always been extremely shy (used to be thought of as Selective Mutism) and I do dress and talk strangely, or so others say. Lately, I've been having minor hallucinations (occasional flash of light, but I know it's not really there, or occasional "buzz" of light that looks slightly Tinkerbellish that I also knew immediately afterwards was not ever really there.) I do have some strange beliefs, though I really think they are true, but like I said, they are very strange (the thought is that my family is supernatural). I do not have such a trust problem, but I have a very hard time talking to people. I do have ADD/ADHD, diagnosed at 3. I also have had thoughts that I may perhaps have telepathy and not know it, but I'm not so sure anymore. What should I do? I'm really afraid. Does anyone know if Schizotypal Personality Disorder can turn into Schizophrenia? Schizophrenia does run in my family, so I'm really scared. What should I do?

What the difference? - Arczap - Oct 26th 2009

I have schizophrenia or perhaps schizoaffective disorder or maybe schizotypal personality disorder. But my shrink just says Schizophrenia and I agree. Reading this article, I think, really, you doctors are confusing yourselves. I think it should be easy as; ‘one who hears voices’ and ‘ones who do not’. Everything else – delusions, being withdrawn, anti- social behaviour, disorganisation, personal hygiene etc etc is pretty much the same across the board. Now “SPD”?, really, stop picking out bits of the main disorder (schizophrenia), schizophrenics behaviour differ a bit but very much have the same thing. Instead: improve medications, and provide strategies for recovery and prevention in young adults. Make the links in disorders in children. Stop the behaviour identification process and start making SOLUTIONS!!!!!

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