Patients who suffer from this type of personality are aloof, distant and eccentric. They express peculiar thinking and odd or bizarre beliefs related to topics like clairvoyance (the supposed ability to see events that cannot be perceived by the senses), supernatural powers or mystical, metaphysical issues. Speech may be circumstantial, tangential or stilted. Under great stress, transient delusions (false beliefs despite evidence of the contrary) may appear.

Schizotypal personality disorder is one of the three cluster A personalities (personalities that are odd and bizarre) described in the DSM IV TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision). It is defined as a pervasive pattern of social and interpersonal deficits marked by a reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities beginning by early adulthood. Some characteristic symptoms are ideas of reference (patients believe that things completely disconnected from them are influencing them directly); odd beliefs or magical thinking inconsistent with subcultural norms (e.g., superstitiousness,  telepathy); unusual perceptual experiences; odd thinking and speech (e.g., vague, metaphorical, stereotyped); suspiciousness or paranoid ideation; inappropriate affect; eccentric or peculiar behavior or appearance; lack of close friends or confidants other than first-degree relatives; excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears.

Schizotypal personality is a chronic disorder that has a lifetime prevalence of 3% and is more common in males than in females. Marriage, friendship or cooperative work with others is often impossible. The prevalence of schizotypal personality disorder is increased in the biologic relatives of patients with schizophrenia. Schizoid personality is differentiated by the absence of peculiarities in thought and speech. Schizophrenia is distinguished by the presence of chronic delusions and other symptoms like hallucinations and loosening of associations.

As with most personality disorders, schizotypal personality disorder is best treated with some form of psychotherapy (talk therapy). Social skills training can help some people cope with social situations. Antipsychotic medications may alleviate some of the peculiarities. Antidepressant medications are prescribed for associated depressive symptoms. The outcome varies based on the severity of the disorder and the compliance with the recommended treatment plan.

By Ana C Posada-Diaz, MD

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