Schizotypal personality disorder is a severe mental disorder. In it, affected individuals suffer from significant changes in their emotions and relationships.
What is schizotypal personality disorder?
Schizotypal personality disorder is also known as schizotypal disorder. It should not be confused with schizoid personality disorder. In this mental illness, there are severe behavioral deficits that affect the psychosocial and interpersonal domains. The medical classification of schizotypal personality disorder is not clear-cut. For example, the ICD-10 code does not classify the disorder as a personality disorder, but rather as a delusional or schizophrenic disorder. In contrast, the U.S. DSM-IV classification definitely evaluates the mental disorder as a personality disorder. This makes an exact classification of schizotypal personality disorder difficult. Differentiation from schizoid personality disorder occurred only more recently.
Causes
The exact causes of schizotypal personality disorder have not yet been clearly established. Experts suspect a multicausal origin of the mental disorder. Among other things, genetic factors can be considered as conceivable triggers. For example, the typical schizotypal disorder often appears within families in which schizophrenia has already occurred. Therefore, physicians assume that there is a common genetic disposition for both mental illnesses. Traumatic experiences in early childhood may also play a role. For example, people with schizotypal disorder were often physically abused or sexually abused in childhood. A difficult birth is also considered a traumatic experience. Another possible cause is the neglect of the affected person in early childhood. In this case, the patients did not have a close relationship with their parents during this period. A conceivable reason for this may be a mental illness of the mother, as a result of which she does not fulfill her role to a sufficient extent. Hospitalism has been hypothesized as another cause.
Symptoms, complaints, and signs
In the context of schizotypal personality disorder, affected individuals experience profound interpersonal and social deficits. For example, patients are unable to form close relationships because they cause them discomfort. In addition, they suffer from distortions in thinking and perception. Social contacts are very rarely made by the patients. Because of their deep mistrust of others, their relationships are not long-lasting. Even if they are with a person for a longer period of time, they cannot reduce their mistrust. Most of the time, the opposite is even the case and the feelings of suspicion intensify. It is not uncommon for them to be irritable and aggressive. Furthermore, they appear emotionless, indifferent and inaccessible. In addition, people suffering from schizotypal personality disorder develop behavior that is classified as unconventional. This includes, among other things, an unkempt or whimsical appearance. In addition, patients use peculiar language. This can be awkward, stilted and awkward. Some affected persons succeed in creating extraordinary works of art, which is due to their pronounced sensitivity. In people with high-grade schizophrenia, however, artistic talent is very rare. Instead, their thinking tends to be abstract or technical-functional. Other possible symptoms of schizotypal personality disorder include developing paranoid ideas, relationship ideas or autistic sinking. In addition, sufferers often ruminate compulsively, and it is not uncommon for their thinking to be aggressive or sexually motivated. In severe cases, hallucinations are also possible. Around two-thirds of all patients have other mental disorders. These may include depression, anxiety disorders, addictive disorders, or eating disorders.
Diagnosis and course of the disease
Identifying schizotypal personality disorder is not always easy. For example, patients rarely see a doctor of their own volition.The therapist bases his diagnosis on the patient’s medical history as well as on the typical symptoms of the disorder such as obsessive ruminations, paranoid ideas, eccentric behavior patterns, idiosyncratic appearance, social withdrawal or hallucinations. As a rule, schizotypal personality disorder takes a chronic course. The intensity varies from individual to individual. In some cases, clear schizophrenia may develop. The course of the mental illness mostly corresponds to a conventional personality disorder.
Complications
Schizotypal personalities often live secluded lives with little contact with others. Many of them have poor social skills. This sometimes results in complications for friendships, acquaintances, and family life. Professional careers can also suffer from the social deficits – both in dealing with customers and with colleagues and superiors. Aggressive behavior is possible, but does not affect all people with schizotypal personality disorder. If the affected person suffers from paranoid thoughts, these can also lead to complications. Strong mistrust is an obstacle to treatment in some cases, as the schizotypal personality may not seek help. Sometimes not only psychological help is refused, but also medical help, for example, for an injury or illness. As a result, it is possible for such a physical condition to worsen unnecessarily. Schizotypal personality disorder may be associated with another personality disorder or accompanied by another mental illness. Common comorbidities of personality disorders include anxiety disorders and depression. Some sufferers develop an eating disorder or substance dependence. This arises in part in an attempt to find a “medicine” for the schizotypal symptoms. For example, some sufferers drink alcohol to be more relaxed and less inhibited in social situations. Such attempts can easily lead to the vicious cycle of addiction.
When should you see a doctor?
Behavioral abnormalities or peculiarities of social interaction should always be assessed by a doctor. If there is emotional detachment, an inability to form social bonds, or a strong distrust of other people, it is recommended that the symptoms be clarified. Characteristic for a schizotypal personality disorder is a lack of awareness of the illness. The affected persons experience themselves as normal and see the problems in the people around them. Therefore, it is a challenge to get the affected person to see a doctor. A close and stable relationship is necessary, which, however, is rejected as typical for the disease. In case of emotional distress or discomfort in contact with other people, consultation with a doctor should be sought. If there is an aggressive appearance, emotional injuries or repeated disregard of social rules, a visit to the doctor is advisable. In particularly severe cases, a medical officer should be called. Acts that are self-harming or hurtful are cause for concern. They should be presented to a doctor. In case of hallucinations, delusions, strong fears or a depressive appearance, the affected person needs help. A doctor is needed as soon as the complaints become a burden in everyday life or new symptoms are added. Disorders of eating behavior or tendencies of an addiction are also characteristic of the personality disorder and to be examined.
Treatment and therapy
The treatment of schizotypal personality disorder is similarly difficult as the diagnosis. Thus, quite a few patients resist therapy in the early stages. Only through persuasion or coercion by partners or relatives can cooperation be achieved. Other health problems such as addictions or depression also play a role. Just as with all other personality disorders, the focus in schizotypal personality disorder is not on curing the disease. Rather, the social competence as well as the social environment of the patient should be improved. Psychotherapy and sociotherapy are used for this purpose. At the beginning of treatment, it is considered important to establish a trust-building relationship between patient and therapist.However, this is usually a major challenge for everyone involved. If the establishment of a sustainable relationship is not successful, this ends with the discontinuation of treatment. If the patient suffers from other mental disorders, he is given appropriate medication, such as antidepressants in the case of depression. If, on the other hand, there is an accompanying anxiety disorder, he is often given neuroleptics. Lithium and carbamazepine are also used to ensure stability. Sedatives such as benzodiazepines are suitable for treating panic attacks.
Prevention
Because the causes of schizotypal personality disorder are not well understood, no appropriate preventive measures are available.
Aftercare
Psychotherapeutic follow-up is necessary for schizotypal personality disorder. Duration and intensity (i.e., frequency of therapy sessions) depend on the severity of the disorder. Schizotypal personality disorder is accompanied by behavioral problems. Behavioral aftercare is therefore recommended in parallel with psychotherapy. After a stay in the psychiatric ward, the affected person is accompanied in his return to everyday life. The goal is a largely symptom-free life after treatment has been completed. Mutual trust between the doctor and the patient is a basic prerequisite for successful aftercare. During aftercare, the patient learns to deal consciously with his or her illness. At the same time, his or her self-esteem should be strengthened, since those affected often experience social stigmatization. This can happen at work, among acquaintances or within the family. Overstrained relatives also have the opportunity to turn to the psychotherapist with personal questions. In the case of drug treatment, the therapist monitors the long-term healing progress. The aim is to prevent any resulting dependence on medication. In case of lack of progress or deterioration, the dose is increased, more adequate medicine is administered or the entire therapy approach is modified. As part of follow-up, the specialist arranges for hospitalization if the patient’s condition worsens significantly and/or the patient requests it himself.
Here’s what you can do yourself
Schizotypal personality disorder can progress to schizophrenia. Schizophrenia is essentially characterized by more severe and distinct symptoms than schizotypal personality disorder. However, the nature of the symptoms is similar. Therefore, it makes sense for affected individuals to monitor themselves closely and to inform their treating physician or therapist if symptoms worsen. External living conditions also deserve attention. Not all living conditions can be controlled – a job loss or divorce is usually not wanted. However, sufferers should keep in mind that during such phases of life, the likelihood of relapse or deterioration is particularly high. Good self-care is therefore particularly important at these times. A stable environment helps to stabilize the psyche. People with schizotypal personality disorder may take care in their daily lives to maintain regular social contacts that they find enjoyable. However, one of the characteristics of schizotypal personality disorder is that sufferers have difficulty establishing and maintaining deep relationships. Therefore, psychologists consider targeted social skills training to be useful. If self-help is not sufficient in this regard, behavioral social training, for example, may be considered.
