i love sessions like this because as gray as mental health is any opportunity to make it
a little more black and white just for ease of understanding really helps me
and we're about to do that with the nine traits of schizotypal personality disorder why don't we
start with trait number one the first one is called what we call ideas of reference
now that is what we don't see in this schizotypal personality are delusions
of reference delusions of reference we'd see in a psychotic disorder like schizophrenia a delusion
is an is an alteration in belief it's a false belief um and not based in reality an idea of
reference is this this sense that people are talking about you and things are about you
and it's not out of left field but you are making too many things about you there's
like a tinge of paranoia to it without it being fully paranoid so it's a it's it's
it's almost an egocentricity this is about me and this is about me and this is about me right
so there's something very primitive thinking all these things are about you but they become very
self-referential they think people are looking at them and you may be looking at them but they'll
perceive a menace in that you see what i'm saying that's what an idea of references okay what about
the second one the second one is that people with schizotypal personality will often engage and have
or often have odd beliefs or engage in magical thinking if i think this then this thing will
happen or you know on on this particular date you know something will happen it's like it's very
it's a little bit worse than having like a lucky rabbit's foot but it's like a certain date will
mean something so they might go to great pains on that day to avoid a bad consequence from that but
their beliefs are strange i mean almost um they're they may even be at the level of like really
believing in like psychic stuff but in a way that seems beyond the pale for other people millions of
people believe inside beyond that that's what i'm saying it's very it would really be that
something that's not it's not just consistent with cultural norms it's really something that is um
it's more unusual than that and like i said where do you draw that line a lot of it has to do with
the culture one is embedded in i think somebody might take umbrage for example if somebody was
i don't know the head of a major hospital and if that person said i'm using numerology to decide
how we're going to make major spending decisions but then a person who's ahead of a major hospital
likely wouldn't have schizotypal personality either but it is odd beliefs it's magical
thinking it's drawing lines together on beliefs that you know it's like believing that on the
night of a lunar eclipse that some terrible fate is going to befall people and then doing things
to prevent that terrible fate that's what i mean by that okay all right what about the third one
um people the third one entails unusual perceptual experiences so these are people who might
report see this is where it gets tricky with the type of personality
these are not hallucinations they are not seeing things that are not there but they will say i feel
a vision there's a vision like there's a vision i feel it right now there are these people in the
room i can feel their energy that's very different than george washington is sitting on that sofa
i feel like i've heard people say that all the time in los angeles like you walk in the room
and they go oh i feel the energy there must be somebody here that isn't happy and someone like
me would probably turn to my dining companion and say this person might be okay all right but it
really is this sense of they feel they will report feeling energy and hearing certain frequencies and
seeing certain frequencies and you know and and but and they'll describe it and they'll endorse
it like they're having it but it's not like i said they'll say i feel the energy of these people in
the room and now that this energy is here we can i don't know we can make love now or something
like okay it's an interesting line but it's not like saying jesus is on the sofa right
they're not making it's not a specifically identified individual they're not giving them
presents because they're not hallucinating they're not hallucinating they're not hallucinating all
right let's go to the next one okay and the next one is that they will express odd thinking and
odd ways of speaking or odd speech and so their thinking or their speech may be vague it may be
what we call circumstantial meaning that they're talking in circles they're not really talking
about something but they're talking about it in these almost tangential ways so they'll
be saying things but they won't be saying things so they will they'll be talking about
energy or they'll be talking about a phenomenon they'll be talking about a conspiracy it's not
unusual for people schizotypal personality styles to be conspiracy theorists so they the the events
they some of these events are talking about may really happen but they try to draw a line across
them so as they talk about it and as they think about it their thinking doesn't hang together in a
good linear logical way so again in schizophrenia we would talk about somebody having a thought
disorder so they're literally the way they're thinking about things there's no logical sense to
it people with schizotypal personality don't have a full-on thought disorder but the way they talk
doesn't really make sense it can be very vague it can be very impressionistic they're not really
making a point it's like they're talking around the point but they never get to it understood
let's go to trait number five the fifth quality of schizotypal personality disorder relates to their
suspiciousness they are very suspicious of other people of their motives they're very mistrustful
and they can look frankly paranoid but not be fully paranoid again it's that line between
i truly believe you're out to get me and i'm defending myself against you it's rather like why
are you looking at me what do you want what do you see do you know like it'll almost be to the point
where they'll get into a very suspicious conflict with someone and what that does is it makes them
strange in their behavior they'll be hoarding all their stuff they'll be worried that someone's
going to take their things they will um again it'll feel suspicious to the point of paranoid and
so as a result they often have very antagonistic interactions with people because they perceive
malevolent intent from other people even when it's not there even when it's not that even
when somebody's not even looking at them they may literally be looking over there but the
person's kind of on the way to there so they think that they're looking at them but it is in a more
menacing way it's not that it's not that kind of antagonistic narcissistic psychopathic you looking
at me kind of thing it's really like what are you looking at you know it's that it's quite different
understood okay trait number six with trait number six we see a pattern around their
emotional presentation or something we call their affect and specifically it's called inappropriate
affect or constricted affect inappropriate affect is when a person just starts laughing
to themselves loudly by themselves to nothing in particular or they um they seem to be getting
angry and there's no one there to be angry at their their emotional reactions don't make sense
given what's being talked about or what's going on in their environment that's inappropriate affect
the behavioral manifestation of the emotion and what appears to be the actual manifest the actual
emotion i should say don't match up yeah but sometimes haven't we all been in a meeting where
you're thinking about something funny and then you it really gets you going and you're trying
to laugh even though it's inappropriate or trying not to laugh yes because it's inappropriate that's
one time yeah now imagine though you i'm again i'm going to give you the example of somebody
who might be on the street and screaming at you get away from my stuff get away from my stuff
you come near me get ominate you know get so mad at you and then they start laughing like a madman
you see what i'm saying it doesn't add up the manifestation the demonstration of the emotion
at that point doesn't connect or they can have what we call constricted affect constricted affect
is when there's very very little emotional manifestation it's it's they're almost very
monotone and they don't make eye contact and they don't show joy and they don't show anger they
just sort of it's like that there's no emotion so it's either inappropriate and disconnected or it's
very constricted all right let's move on to trait number seven this is gets it with their appearance
and their behavior and it's usually behavior that looks odd eccentric or really peculiar this
goes back to your original point how eccentric is eccentric enough so this could be manifest in the
way they're walking the things they're carrying the vocalizations they're uttering as they walk by
the way they're dressed um they're costuming the things they're carrying you know all of those
things that would be odd or peculiar or downright eccentric and it's that what you might be thinking
well there's parts of town where people do that to get attention sure but then they shouldn't
have again you need five of nine of the things on this list so that's the only thing they're
doing that might even be more of a histrionic presentation where they're trying to get attention
here we're talking about people who almost don't get that this isn't okay like this is not this
is not consistent with the cultural norm of a particular situation so there's a delusion there
not a delusion i would say a a distorted perception and so what's the difference between
delusion and distorted perception a delusion is you you actually really believe this thing is true
and do you really believe you're mickey mouse yes not just wearing the mickey mouse costume or
you believe you're walt disney or you believe your walt disney okay let's go on to trait number eight
number eight gets to the fact that people with schizotypal personality don't do well with close
relationships and what we see is that they have no close friends no close relationships and maybe the
only relationships they have are close relatives and in that way they're not even close to them
but they may have a mother or a father or brother or an aunt that they'll have contact with but
otherwise they do not have any close relationships and that's a real signature quality because the
absence of close relationships is something we take notice of another place we've seen this
and something we've talked about is antisocial personality disorder now they don't have trusted
or trusting or reciprocal close relationships but they have people they have sex with they
have people that they domineer over they have people they work with they may even be married
it would be incredibly rare to see a person with schizotypal personality disorder be married or be
a parent or any of that okay and the final trait the final trait relates to social anxiety people
with schizotypal personality incredible social anxiety they do not have to know
how to engage with other people they don't know how to interact with other people
they don't do well with appropriate social interactions and if somebody approaches them
and expects to have an appropriate back and forth the social anxiety is paralyzing for individuals
it's a type of personality disorder and it can come off as them being unusual or peculiar or
bizarre but more than anything you're really overwhelmed by social anxiety social anxiety is
something we see in many psychotic disorders yeah well that rundown was very helpful and in our next
session we'll talk about the diagnostic process and the treatment options for those with stpd