- Hi, I'm Dr. Tracey Marks
and I make mental health education videos.
Today I'm answering a viewer request
to talk about schizotypal personality disorder.
Schizotypal personality is unique
because it's not only considered a personality disorder
but in the Diagnostic and Statistical Manual
of Mental Disorders, fifth edition
it's listed as a schizophrenia spectrum illness.
And this is because some consider it
to be a prodrome of schizophrenia.
Meaning that it precedes the diagnosis of schizophrenia.
But not all people with schizotypal personality disorder
develop schizophrenia.
It's term schizotypal personality disorder
in the diagnostic manual.
But the original term came from
a psychological construct of schizotypy.
Schizotypy, originally defined
by the British psychologist
Dr. Gordon Claridge
can be just thought of as proneness to psychosis.
Here's how schizotypal personality disorder
is defined by the Diagnostic
and Statistical Manual of Mental Disorders, fifth edition.
A pervasive pattern of social and interpersonal deficits
marked by acute discomfort with
and reduced capacity for, close relationships
as well as cognitive and perceptual distortions
and eccentricities of behavior,
beginning in early adulthood
and present in a variety of contexts
as indicated by five or more of the following.
Here's a translation of that.
A key characteristic of schizotypal personality
that differentiates it from the other personalities
is that the person is very uncomfortable
with close relationships
and their overall demeanor is odd and eccentric.
Like other personality disorders,
this way of thinking, behaving and relating
shows up in different contexts.
It's not just something that happens
when you're around certain groups of people.
It's the way you are in most contexts.
I emphasize this point of various contexts
because I often get the question,
what if I only have one or two of the traits?
Anyone can have aspects
of the various personalities
without manifesting it as a personality disorder.
There may be contexts where you exhibit behaviors
that are consistent with histrionic personality,
as an example.
But those behaviors don't interfere
with your overall functioning and relationships.
Also, those behaviors don't cause you distress.
It's just the way you act in certain circumstances.
Another aspect of a personality disorder
is how rigidly you hold to certain beliefs and perspectives.
Without the personality disorder,
you can do some of these things,
but if you see that they aren't working for you
because they cause you trouble
or interfere with your relationships,
you change the way you think.
But with a personality disorder,
you persist with this way of thinking, behaving
or relating even in the face of negative consequences.
So that's just some of the differences
between having a personality disorder
versus having some traits of a personality disorder.
So back to the criteria.
For the diagnosis of schizotypal
you need five of the nine.
The first is ideas of reference.
This is when you incorrectly assume
random or casual events
are directly related to you.
An example of this is being in a group of people
and believing that everyone is talking about you.
An odder example of this
is watching a speaker on television
and believing that when the speaker's mouth twitched
that was a signal for you to quit your job.
This is a good example
of a trait that anyone can have at anytime.
Like if you have insecurities,
you can always think
that the things that you do or don't do
have more of an effect on people than they really do.
The difference with schizotypal personality
is that it's not a one-off thing.
It's a predominant way of thinking
and usually has an odd unrealistic aspect to it,
like the example with the television speaker.
Number two is odd beliefs or magical thinking
that influences your behavior
and is inconsistent with subcultural norms.
Examples of this is being preoccupied
with superstitions and paranormal activities
like telepathy and clairvoyance.
Telepathy is when you believe
that you can communicate with people
without using any of your senses.
Clairvoyance is sensing things supernaturally
without any obvious data
on, on which to base that conclusion.
Fortune telling is an example of clairvoyance.
And example of magical thinking
is believing that your friend
brought you the newspaper
because you wished for it a few hours before.
Next is unusual perceptual experiences
including bodily illusions.
This can look like,
sensing another person's presence in a room.
One example of this is having a seance.
A seance is a meeting where people connect with the dead.
They can do this by using a person
as the medium of communication
or ouija board
that has letters and numbers on it to spell out messages.
Another trait is odd thinking and speech.
With this kind of speech pattern
you may notice that something's not quite right,
or it just doesn't seem to make sense.
Here's an example.
And this is a comment from an anonymous viewer.
"Alienation has a way of reaching
to where you'd be tempted to see its relativity
with some other dilemma,
like being slapped with a heavy years-long
and life-altering public demerit."
This sounds very intellectual,
and it takes a lot of thought
to work through the words
to understand the meaning.
When I first read this person's comments,
and this person comments a lot.
So I was getting used to looking at these kinds of comments.
I asked the person if they were using Google
to translate from another language.
Because it sounds like
words are artificially inserted into the sentence.
The person told me no,
they spoke native English
and they realized that not everyone understands them.
Now, I'm not saying this viewer has this disorder.
I'm just using this as an example of a metaphorical
and over-elaborate speech pattern
that we can see with schizotypal disorder
and other disorders.
But can you see how this could be alienating
and make relating to others difficult?
This illustrates how someone
with schizotypal personality disorder
can feel anxious and uncomfortable around people,
when they have this kind of trouble communicating.
Number five is suspiciousness or paranoid thinking.
Six is inappropriate or constricted affect.
With this, the person doesn't seem
to respond appropriately to cues.
They may have trouble reading body language,
or facial expressions, or they may not be able
to express themselves in a way that fits the situation.
To the observer,
the person may have appeared stiff and unnatural.
Number seven, is having an odd eccentric
or peculiar behavior or appearance.
The person may have unusual mannerisms.
An example would be not making eye contact
or like looking just below the eyeline
when they're talking.
So if you're on the receiving end of that
you may feel like you wanna go.
Number eight is lack of close friends or confidants
other than first-degree relatives.
People with this disorder
feel uncomfortable in relationships
and they feel they don't connect with people.
So, they desire close relationships though.
And this is a key difference
from schizoid personality
where the person doesn't desire closeness
and is fine being disconnected from people.
The disconnectedness of schizotypal personality
is a sore spot and a source of distress.
I did a video talking about
The Indifference of Schizoid Personality Disorder
in this video.
The last trait is excessive social anxiety
that does not diminish with familiarity
and tends to be associated with paranoid fears
rather than negative judgements about themselves.
There's a couple of things
that play into the anxiety here.
You can have the feeling
that you don't fit in with people.
You draw that conclusion
when you see other people's reactions
to the way you talk, your mannerisms and your responses
that don't seem to match the circumstances.
But then also,
the undercurrent of paranoid thinking
makes your anxiety persist
when you become more familiar with the person.
So in other words
getting to know people doesn't make you feel more at ease.
Instead, the time spent gives you more information
to support your suspicions
that other people are judging you
or have malevolent intentions.
For the diagnosis of the personality disorder,
you need at least five of those.
The prevalence of schizotypal personality disorder
is about 3% of the general population.
That's about the same prevalence as bipolar disorder.
But for some reason, it's not talked about
as much, even in the psychiatric community.
It may be because
people with schizotypal personality disorder
like the other personality disorders
don't come to treatment because of their beliefs.
They come to treatment because they develop something else
like depression or anxiety.
I mentioned earlier that a certain percentage
of people can go on to develop schizophrenia.
A 2013 study,
looked at a group of men
with schizotypal personality.
They scanned their brains
and found them to have reduced gray matter
in certain areas of the brain.
Gray matter refers to the nerve cell bodies.
So these people had reduced nerve cells in the brain.
These findings are very similar
to the brain changes seen in schizophrenia.
But in schizophrenia,
the reduction in gray matter is more pronounced.
So it's believed that the reduced gray matter
is responsible for the negative symptoms we see.
Negative symptoms refer to things like
decreased emotional expression, apathy,
trouble communicating, and social withdrawal.
And we do see these negative symptoms in schizophrenia.
So it looks like these two disorders
share some similarities
which is why schizotypal is considered
a schizophrenia spectrum illness.
People with schizotypal personality
don't have the overt hallucinations
and delusions that you see with schizophrenia though.
The significance of this connection
is that there has been research
in the area of using computerized
social cognitive training with auditory training
to improve the negative symptoms of schizophrenia.
The anti-psychotic medications treat positive symptoms
like hallucinations and delusions,
but they don't help as much
with the negative symptoms and cognitive deficits,
like slowed processing and memory problems.
Given the similarities
between schizotypal personality disorder
and schizophrenia,
it's possible this could be
a non-medication approach
to treating this personality disorder.
It's still an experimental approach
and we don't have a standard protocol for it yet,
but it's promising.
For more on schizophrenia,
watch this video.
See you next time.