The Big Difference Between Schizophrenia and Schizotypal Personality Disorder

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MAGICAL BELIEFS, ODD SPEECH, and strange behavior are all characteristics that people with schizotypal personality disorder (STPD) might display. But they often don’t realize that these behaviors are unusual, even though they can interfere with someone’s ability to develop relationships.

“People with schizotypal personality disorder are often described as odd or eccentric,” says Meghan Marcum, Psy.D., chief psychologist at AMFM Healthcare. “They may be overly suspicious of other people and have difficulty trusting people. They sometimes have magical thinking wherein they believe special powers or unique qualities are possible.”

Feeling uncomfortable with social interactions and relationships is another sign of STPD, which is a clinically diagnosable personality disorder.

While people with schizoid personality disorder (ScPD) also struggle with relationships, the two conditions aren’t the same. The main difference: People with ScPD generally have no interest in relationships or socializing, while those with STPD are interested in relationships, but are uncomfortable forming them.

“People with STPD can experience social anxiety and distress,” says Frank Ghinassi, Ph.D., ABPP, president and CEO of Rutgers University Behavioral Health Care and senior vice president of RWJBarnabas Health’s Behavioral Health and Addictions Services.

STPD is considered a cluster A personality disorder, which features unusual thinking or behaviors. It’s a chronic condition that can affect someone’s work and home lives, but the symptoms can improve with treatment, Marcum says.

But, she adds, people with personality disorders often don’t seek treatment on their own. Instead, they usually have to be motivated by a family member or because they have another condition, such as anxiety or depression.

What Is Schizotypal Personality Disorder?

A strong discomfort with relationships defines STPD, says Melissa Dowd, LMFT, therapy lead at PlushCare. People with the disorder might be interested in relationships, but usually don’t have close friends outside immediate family members.

They might not understand how relationships work or how their behavior affects others, and misinterpret others’ behaviors and mistrust people, according to Mayo Clinic. This can lead to anxiety in social situations.

People with STPD also often have incorrect or eccentric explanations for things going on in their lives, Ghinassi says. They might be paranoid and interpret situations as having a special meaning aimed specifically at them. (See how it differs from paranoid personality disorder here.)

“While not quite a delusion, they believe they have special powers, such as the ability to understand superstitions and what may feel like magical thinking,” he says.

The exact cause of STPD isn’t known, but it’s likely based on genetic or biological factors. And some people with the condition later develop schizophrenia, a brain disorder that causes delusions, hallucinations, and disorganized thoughts and speech, according to the Cleveland Clinic.

Signs of Schizotypal Personality Disorder

STPD is a chronic, lifelong illness, Dowd says, and treatment should be ongoing. Trouble forming relationships and displaying odd behavior are central characteristics of the condition.

To be diagnosed with STPD, someone usually needs to display at least five of these symptoms, according to Mayo Clinic:

  • Lacking close friends, other than immediate family

  • Being a loner

  • Having flat, limited, or inappropriate emotional responses

  • Displaying social anxiety that’s persistent and excessive

  • Interpreting events incorrectly—like feeling something harmless has a direct personal meaning

  • Displaying peculiar, eccentric, or unusual beliefs, thinking, or mannerisms

  • Having paranoid thoughts or doubting or being suspicious about others’ loyalty

  • Believing in special powers, like telepathy or superstitions

  • Experiencing unusual perspectives, like illusions

  • Dressing peculiarly—such as wearing mismatched or unkempt clothing

  • Speaking peculiarly—like using vague language, usual speech patterns, or rambling oddly

How Does Schizotypal Personality Disorder Differ from ScPD and Schizophrenia?

Both schizotypal and schizoid personality disorders fall into cluster A, explains Chase Cassine, LCSW, a therapist in New Orleans. “But schizotypal personality disorder displays more cognitive and perceptual disturbances, such as exhibiting odd beliefs, paranoia, distorted thinking, and eccentric speech.”

People with both disorders may shy away from relationships, but for the different reasons stated earlier, Dowd says. (With STPD, someone feels intense discomfort and anxiety with a close relationship, rather than the lack of interest that comes with ScPD.)

People with STPD might sometimes experience temporary psychotic episodes when they’re under extreme stress, Ghinassi says. For example, their paranoia can become exaggerated, and they may experience a delusion that they're being persecuted.

“Once the extreme stress subsides and the episode is over, they can return to more baseline behaviors,” he says.

STPD doesn't have the extreme, ongoing hallucinations and delusions of schizophrenia. And STPD usually doesn't affect someone's ability function day-to-day, unlike schizophrenia.

Can Schizotypal Personality Disorder Be Treated?

Therapy and medication can help someone with STPD manage their symptoms, Dowd says. “Commitment to ongoing, lifelong treatment can improve one’s ability to learn more productive ways of managing unhelpful behaviors and thoughts.”

Yet people may need a nudge to seek therapy. Someone is more likely to visit a psychotherapist if they’ve been encouraged by a family member or someone else in their life, Cassine says. They might also want treatment for other conditions, like depression.

Psychotherapy and a low dose of antipsychotic medication are the most common treatment options for STPD, Cassine says. “Group therapy can possibly help someone with schizotypal personality disorder learn social skills to process social anxiety and receive support from others with common issues.”

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