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Schizotypal Personality Disorder

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What is schizotypal personality disorder?

Schizotypal personality disorder (STPD) is a mental health condition marked by a consistent pattern of intense discomfort
with close relationships and social interactions. People with STPD have distorted views of reality, superstitions and unusual
behaviors. Their relationships are usually hindered by their symptoms.

Schizotypal personality disorder is one of a group of conditions called “Cluster A” personality disorders, which involve unusual
and eccentric thinking or behaviors. Personality disorders are chronic (long-term) dysfunctional behavior patterns that are
inflexible, prevalent and lead to social issues and distress.

People with schizotypal personality disorder typically display unusual behavior, odd speech and magical beliefs. They often
don’t realize their behavior is unusual or problematic.

Some people with schizotypal personality disorder later develop schizophrenia.

What is the difference among schizoid and schizotypal personality disorders and schizophrenia?

Schizoid personality disorder (ScPD) is a mental health condition marked by a consistent pattern of detachment from and
general disinterest in social relationships. This is distinct from schizotypal personality disorder (STPD) because people with
STPD have an intense discomfort with personal relationships, not a lack of interest in them.

People with STPD also have peculiar thoughts and behaviors, such as magical thinking, whereas people with ScPD generally
don’t.

Many researchers consider schizotypal personality disorder to be one of the schizophrenia spectrum disorders, which also
includes brief psychotic disorder, schizophreniform disorder, schizoaffective disorder and delusional disorder.

However, schizotypal personality disorder is distinct from schizophrenia because people with STPD don’t have psychotic
symptoms, such as hallucinations and delusions, which are hallmarks of schizophrenia.

Schizophrenia negatively impacts someone’s day-to-day function much more than schizotypal personality disorder.

Who does schizotypal personality disorder affect?

Most personality disorders, including schizotypal personality disorder (STPD), begin in the teen years when personality
further develops and matures.

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STPD affects people assigned male at birth (AMAB) slightly more than people assigned female at birth (AFAB).

How common is schizotypal personality disorder?

Schizotypal personality disorder is relatively rare. It affects approximately 3% to 5% of people in the United States.

Symptoms and Causes

What are the signs and symptoms of schizotypal personality disorder?

People with schizotypal personality disorder experience intense discomfort and distress in social situations. They have a lot of
difficulties forming close relationships and maintaining them, partially due to a distorted interpretation of social interactions,
as well as odd social behavior.

A person with schizotypal personality disorder may:

Have intense social anxiety and poor social relationships.

Not have close friends or confidants, except for first-degree relatives.
Have peculiar behaviors and mannerisms.
Have odd thoughts and speech, such as using excessively abstract or concrete phrases or using phrases or words in
unusual ways.
Have unusual perceptive experiences and magical beliefs, such as thinking they have special paranormal powers.
Incorrectly interpret ordinary situations or happenings as having special meaning for them (idea of reference).
Be paranoid and suspicious of others’ intentions.
Have difficulty with responding appropriately to social cues, such as maintaining eye contact.
Have a lack of motivation and underachieve in educational and work settings.

A person with STPD generally lacks awareness about how their thoughts and behaviors impact others.

What causes schizotypal personality disorder?

Personality disorders, including schizotypal personality disorder, are among the least understood mental health conditions.
Researchers are still trying to figure out the exact cause of them, but believe they develop due to several factors.

Researchers think the cause of schizotypal personality disorder (STPD) is mainly biological and genetic because it shares
many of the brain changes characteristic of schizophrenia. STPD is also more common among biological relatives of people
with schizophrenia or Cluster A personality disorders, which suggests a genetic link.
Diagnosis and Tests

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How is schizotypal personality disorder diagnosed?

Personality continues to evolve throughout childhood, adolescence and early adulthood. Because of this, healthcare providers
don’t typically diagnose someone with schizotypal personality disorder until after the age of 18.

Personality disorders, including schizotypal personality disorder, can be difficult to diagnose since most people with a
personality disorder don’t think there’s a problem with their behavior or way of thinking and don’t think they need to change
their behavior.

When they do seek help, it’s often due to co-existing conditions, such as anxiety or depression, not the disorder itself. Rates of
these two mental health conditions are particularly high among people with schizotypal personality disorder.

When a mental health professional, such as a psychologist or psychiatrist, suspects someone might have schizotypal
personality disorder, they often ask questions that’ll shed light on:

Childhood history.
Relationships.
Work history.
Reality testing.

Because a person suspected of having schizotypal personality disorder may lack insight into their behaviors, mental health
professionals often work with the person’s family and friends to collect more details about their behaviors and history.

Mental health providers base a diagnosis of schizotypal personality disorder on the criteria for the condition in the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Management and Treatment

How is schizotypal personality disorder treated?

Psychotherapy (talk therapy) and low-dose antipsychotic (neuroleptic) medication are the main treatment options for
schizotypal personality disorder.

Antipsychotic medication for schizotypal personality disorder

Healthcare providers sometimes prescribe low-dose antipsychotic (neuroleptic) medications for people with schizotypal
personality disorder to treat the following symptoms:

Cognitive peculiarities.
 Odd speech.
Depression.

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Anxiety.
Impulsivity.

Antipsychotic medications are particularly useful for people with moderately severe schizotypal symptoms and those
experiencing mild, transient psychotic symptoms.

Psychotherapy for schizotypal personality disorder

Psychotherapy (talk therapy) is a term for a variety of treatment techniques that aim to help people identify and change
troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist,
can provide support, education and guidance to the person and their loved ones.

Types of psychotherapy that may benefit people with schizotypal personality disorder include:

Group therapy: This is a type of psychotherapy in which a group of people meets to describe and discuss their problems
together under the supervision of a therapist or psychologist. Group therapy may help someone with schizotypal
personality disorder develop social skills because it addresses social anxiety and awkwardness. However, people with
more severe symptoms may be disruptive in group therapy, especially if they have prominent paranoid thinking and
behaviors.
Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A therapist or psychologist helps
someone take a closer look at their thoughts and emotions to understand how their thoughts affect their actions. For
someone with schizotypal personality disorder, a therapist may focus on reality testing and attention to interpersonal
boundaries. They may also help the person recognize distorted thinking patterns, such as referential, paranoid or magical
thinking.

Prevention

Can schizotypal personality disorder be prevented?

While schizotypal personality disorder generally can’t be prevented, treatment can allow a person who’s prone to this
condition to learn more productive ways of altering unhelpful behaviors and thoughts.

Outlook / Prognosis

What is the prognosis (outlook) for schizotypal personality disorder?

Schizotypal personality disorder is a chronic condition that requires lifelong treatment.

If left untreated, the prognosis (outlook) for schizotypal personality disorder (STPD) is generally poor. It’s very common for
people with STPD to have other mental health conditions, including:

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Social anxiety disorder.
Depression.
Obsessive-compulsive disorder.
Substance use disorder.

About 30% to 50% of people have major depressive disorder when they’re diagnosed with STPD.

It’s essential that people with STPD receive treatment for these conditions.

A note from Cleveland Clinic

It’s important to remember that schizotypal personality disorder (STPD) is a mental health condition. As with all mental
health conditions, seeking help as soon as symptoms appear can help decrease the disruptions in a person’s life. Mental health
professionals can offer treatment plans that can help manage thoughts and behaviors.

The family members of people with STPD often experience stress, depression and isolation. It’s important to take care of your
mental health and seek help if you’re experiencing these symptoms.

References:

American Addiction Centers. How to Treat Schizotypal Personality Disorder and Co-Occurring Drug Use. (https://america
naddictioncenters.org/personality-disorders/schizotypal) Accessed 5/15/2022.
Merck Manual: Professional Version. Schizotypal Personality Disorder (STPD). (https://www.merckmanuals.com/professiona
l/psychiatric-disorders/personality-disorders/schizotypal-personality-disorder-stpd?query=schizotypal%20personality) Accessed
5/15/2022.
National Institutes of Health, National Library of Medicine. Schizotypal Personality Disorder. (https://medlineplus.gov/ency/
article/001525.htm) Accessed 5/15/2022.
Kirchner SK, Roah A, Nolden J, Hasan A. Diagnosis and Treatment of Schizotypal Personality Disorder: Evidence from a
Systemic Review. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170383/) NPJ Schizophr. 2018; 4:20. Accessed
5/15/2022.
Weissman SH. Personality Disorders. In: Ebert MH, Leckman JF, Petrakis IL. eds. Current Diagnosis & Treatment: Psychiatry,
3e. McGraw Hill; 2019. Accessed 5/15/2022.

Terms Linked In This Article:

personality disorders (https://my.clevelandclinic.org/health/diseases/9636-personality-disorders-overview)

schizophrenia (https://my.clevelandclinic.org/health/diseases/4568-schizophrenia)
schizophreniform disorder (https://my.clevelandclinic.org/health/diseases/9571-schizophreniform-disorder)
schizoaffective disorder (https://my.clevelandclinic.org/health/diseases/21544-schizoaffective-disorder)
social anxiety (https://my.clevelandclinic.org/health/diseases/22709-social-anxiety)
 anxiety (https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders)
depression (https://my.clevelandclinic.org/health/diseases/9290-depression)

9500 Euclid Avenue, Cleveland, Ohio 44195 | 800.223.2273 | © 2023 Cleveland Clinic. All Rights Reserved.
psychologist (https://my.clevelandclinic.org/health/articles/22679-psychologist)
psychiatrist (https://my.clevelandclinic.org/health/articles/22702-psychiatrist)
Cognitive behavioral therapy (CBT) (https://my.clevelandclinic.org/health/treatments/21208-cognitive-behavioral-therapy-cb
t)
Obsessive-compulsive disorder (https://my.clevelandclinic.org/health/diseases/9490-obsessive-compulsive-disorder)

Last reviewed by a Cleveland Clinic medical professional on 05/15/2022.

O R I G I N A L A RT I C L E | https://my.clevelandclinic.org/health/diseases/23061-schizotypal-personality-disorder
DAT E P U B L I S H E D | May 25, 2022
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