Schizotypal personality disorder
Encyclopedia
Schizotypal personality disorder, or simply schizotypal disorder, is a personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...

 that is characterized by a need for social isolation
Social isolation
Social isolation refers to a lack of contact with society for members of social species. There may be many causes and individuals in numerous generally social species are isolated at times, it need not be a pathological condition. In human society, in those cases where it is viewed as a pathology,...

, anxiety in social situations, odd behavior and thinking, and often unconventional beliefs.

Genetic

Although listed in the DSM-IV-TR on Axis II, schizotypal personality disorder is widely understood to be a "schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

 spectrum" disorder. Rates of schizotypal PD are much higher in relatives of individuals with schizophrenia than in the relatives of people with other mental illnesses or in people without mentally ill relatives. Technically speaking, schizotypal PD is an "extended phenotype" that helps geneticists track the familial or genetic transmission of the genes that are implicated in schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

.

There are dozens of studies showing that individuals with schizotypal PD score similar to individuals with schizophrenia on a very wide range of neuropsychological tests. Cognitive deficit
Cognitive deficit
Cognitive deficit, also known as cognitive impairment is an inclusive term to describe any characteristic that acts as a barrier to cognitive performance...

s in patients with schizotypal PD are very similar to, but somewhat milder than, those for patients with schizophrenia.

Social and environmental

People with schizotypal PD, like patients with schizophrenia, may be quite sensitive to interpersonal criticism and hostility, and there is now evidence to suggest that parenting styles, early separation and early childhood neglect can lead to the development of schizotypal traits.

World Health Organization

The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

's ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

 lists schizotypal personality disorder as Schizotypal disorder. (Note that in ICD-10, Schizotypal disorder is classified as a mental disorder associated with schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

 rather than a personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...

 as with DSM-IV. The DSM-IV designation of schizotypal as a personality disorder is controversial.
)

It is characterized as:
A disorder characterized by eccentric behavior and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies have occurred at any stage. There is no dominant or typical disturbance, but any of the following may be present:

  • Inappropriate or constricted affect
    Affect (psychology)
    Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...

     (the individual appears cold and aloof);
  • Behavior or appearance that is odd, eccentric or peculiar;
  • Poor rapport with others and a tendency to social withdrawal;
  • Odd beliefs or magical thinking
    Magical thinking
    Magical thinking is causal reasoning that looks for correlation between acts or utterances and certain events. In religion, folk religion, and superstition, the correlation posited is between religious ritual, such as prayer, sacrifice, or the observance of a taboo, and an expected benefit or...

    , influencing behavior and inconsistent with subcultural norms;
  • Suspiciousness or paranoid ideas;
  • Obsessive rumination
    Rumination (psychology)
    Rumination is a way of responding to distress that involves repetitively focusing on the symptoms of distress, and on its possible causes and consequences. Rumination is more common in people who are pessimistic, neurotic, and who have negative attributional styles. The tendency to ruminate is a...

    s without inner resistance, often with dysmorphophobic
    Body dysmorphic disorder
    Body Dysmorphic Disorder is a type of mental illness, a somatoform disorder, wherein the affected person is exclusively concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features...

    , sexual or aggressive contents;
  • Unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization
    Depersonalization
    Depersonalization is an anomaly of the mechanism by which an individual has self-awareness. It is a feeling of watching oneself act, while having no control over a situation. Sufferers feel they have changed, and the world has become less real, vague, dreamlike, or lacking in significance...

     or derealization
    Derealization
    Derealization is an alteration in the perception or experience of the external world so that it seems unreal. Other symptoms include feeling as though one's environment is lacking in spontaneity, emotional coloring and depth. It is a dissociative symptom of many conditions, such as psychiatric and...

    ;
  • Vague, circumstantial, metaphorical, over-elaborate or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence;
  • Occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations and delusion-like ideas, usually occurring without external provocation.

The disorder runs a chronic course with fluctuations of intensity. Occasionally it evolves into overt schizophrenia. There is no definite onset and its evolution and course are usually those of a personality disorder. It is more common in individuals related to people with schizophrenia and is believed to be part of the genetic "spectrum" of schizophrenia.

Diagnostic Guidelines

This diagnostic rubric is not recommended for general use because it is not clearly demarcated either from simple schizophrenia or from schizoid or paranoid personality disorders. If the term is used, three or four of the typical features listed above should have been present, continuously or episodically, for at least 2 years. The individual must never have met criteria for schizophrenia itself. A history of schizophrenia in a first-degree relative gives additional weight to the diagnosis but is not a prerequisite.

includes

  • borderline schizophrenia
  • latent schizophrenia
    Sluggishly progressing schizophrenia
    Sluggishly progressing schizophrenia or sluggish schizophrenia was a category of schizophrenia diagnosed by psychiatrists in the Soviet Union...

  • latent schizophrenic reaction
  • prepsychotic schizophrenia
  • prodromal schizophrenia
  • pseudoneurotic schizophrenia
  • pseudopsychopathic schizophrenia
  • schizotypal personality disorder

Millon's subtypes

Theodore Millon
Theodore Millon
Theodore Millon is an American psychologist known for his work on personality disorders.-Biography:Millon was born in 1928, the only child of immigrant Jewish parents from Lithuania and Poland. His 19th-century ancestors came from the town of Valozhyn, then a part of the Russian Empire...

 identified two subtypes of schizotypal
. Any individual schizotypal may exhibit none or one of the following:
  • insipid schizotypal - a structural exaggeration of the passive-detached pattern. They include schizoid
    Schizoid personality disorder
    Schizoid personality disorder is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and sometimes apathy, with a simultaneous rich, elaborate, and exclusively internal fantasy world...

    , depressive
    Depressive personality disorder
    Depressive Personality Disorder is a controversial psychiatric diagnosis that denotes a personality disorder with depressive features....

    , dependent
    Dependent personality disorder
    Dependent personality disorder , formerly known as asthenic personality disorder, is a personality disorder that is characterized by a pervasive psychological dependence on other people...

     features.

  • timorous schizotypal - a structural exaggeration of the active-detached pattern. They include avoidant
    Avoidant personality disorder
    Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...

    , negativistic (passive-aggressive) features.

Differential diagnosis

There is a high rate of comorbidity
Comorbidity
In medicine, comorbidity is either the presence of one or more disorders in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.- In medicine :...

 with other personality disorders. McGlashan et al. (2000) stated that this may be due to overlapping criteria with other personality disorders, such as avoidant personality disorder
Avoidant personality disorder
Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...

, paranoid personality disorder
Paranoid personality disorder
Paranoid personality disorder is a psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others....

 and borderline personality disorder
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...

.

There are many similarities between the schizotypal and schizoid personalities. Most notable of the similarities is the inability to initiate or maintain relationships (both friendly and romantic).
The difference between the two seems to be that those labeled as schizotypal avoid social interaction because of a deep-seated fear of people. The schizoid individuals simply feel no desire to form relationships, because they see no point in sharing their time with others.

Prevalence (epidemiology)

Schizotypal personality disorder occurs in 3% of the general population and occurs slightly more commonly in males.

History

The specific term schizotype was coined by Sandor Rado
Sandor Rado
Sándor Radó was a distinguished Hungarian psychoanalyst of the second generation, who moved to United States of America in the thirties....

 in 1956 as an abbreviation of schizophrenic phenotype.

See also

  • DSM-IV codes (personality disorders)
  • ICD-10 codes (personality disorders)
  • Paranoid personality disorder
    Paranoid personality disorder
    Paranoid personality disorder is a psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others....

  • Schizoid personality disorder
    Schizoid personality disorder
    Schizoid personality disorder is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and sometimes apathy, with a simultaneous rich, elaborate, and exclusively internal fantasy world...

  • Schizophrenia
    Schizophrenia
    Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

  • Schizotypy
    Schizotypy
    Schizotypy is a psychological concept which describes a continuum of personality characteristics and experiences ranging from normal dissociative, imaginative states to more extreme states related to psychosis and in particular, schizophrenia...


External links

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