Schizoid vs. Schizotypal Personality Disorders

A comprehensive look at two commonly confused conditions

Medically reviewed by Steven Gans, MD

Most people have heard of narcissistic personality disorder and borderline personality disorder, but there are actually a wide range—and three different types—of personality disorders as described by the DSM-5-TR (the most recent version of the Diagnostic and Statistical Manual of Mental Disorders).

Two of those personality disorders—belonging to “Cluster A” disorders—are schizoid personality disorder and schizotypal personality disorder. Read on to learn more about these personality disorders and how to recognize them.

Definition of Schizoid and Schizotypal Personality Disorders

“Cluster A” personality disorders include paranoid, schizoid, and schizotypal personality disorders.

Takeaway

These disorders are characterized by difficulty forming close personal relationships and odd or eccentric behavior.

Schizoid and schizotypal have, at first glance, some overlapping signs and symptoms, but they are in fact very different.

Schizoid Personality Disorder

Someone with schizoid personality disorder is not interested in and may be unable to form close relationships with others, either romantic or friendship-based, although they may possess a rich internal fantasy world. It’s also very difficult for people with schizoid personality to exhibit a wide array of emotions. Their affect—the way they express emotions—is blunted and can cause them to come off as aloof, disengaged, and distant.

Takeaway

One easy way to remember the difference between schizoid and schizotypal is that “schizoid” rhymes with “devoid”—as in, devoid of emotion.

This lack of expression makes it appear as though people with schizoid personality disorder do not care about other people or about what is happening to them and around them.

While schizoid personality disorder can sometimes mimic what are known as “negative symptoms” in schizophrenia—specifically, a blunted affect and difficulty connecting with others—people with this disorder do not experience hallucinations or delusions.

They are able to express their thoughts to others in a clear and cogent way, as opposed to experiencing the disorganized thought process that is common with psychotic disorders.

Schizotypal Personality Disorder

While those with schizotypal personality disorder also experience social difficulties, schizotypal is characterized by a pattern of extreme discomfort with social interactions and close relationships, rather than the disinterested inability to form them.

People with schizotypal personality disorder also consistently hold distorted views of reality, tend to be extremely superstitious, and display unusual behaviors related to delusional thinking such as magical beliefs (think: never stepping on a sidewalk crack because you are absolutely convinced that it will actually break your mother’s back).

Takeaway

These superstitions and behaviors are often expressed with what most people would consider odd speech, making those with schizotypal personality disorder appear affected and strange to people who aren’t familiar with the condition.

One of the defining aspects of schizotypal personality disorder is that the person experiencing it might not realize that their behavior, speech, or beliefs are unusual, and often cannot recognize when their actions may be problematic.

Comparing the Symptoms

Although there are some overlapping qualities between schizoid and schizotypal personality disorders, they are in fact quite different.

Both disorders are characterized by issues with relationships. However, while people with schizoid personality disorder display a chronic disinterest in forming and maintaining relationships, those with schizotypal personality disorder are intensely uncomfortable with relationships.

Takeaway

The relationship with reality is also vastly different between these two disorders.

While those with schizoid personality disorder experience no overt psychotic symptoms such as distorted thinking, delusions, or paranoia, schizotypal is characterized by superstition, suspiciousness, odd thinking, and unusual behavior.

As far as these disorders’ connections to schizophrenia go, they are both different here as well. Schizoid personality disorder is not related to and does not lead to schizophrenia. The development of schizotypal personality disorder, on the other hand, might lead to full-blown schizophrenia (both conditions usually appear in early adulthood).

Takeaway

Schizotypal personality disorder is actually considered by some to be on the “schizophrenia spectrum” —as in, it is a milder version of schizophrenia.

However, there are notable differences between schizophrenia and schizotypal personality disorder. Those with the latter might experience odd distorted thinking, the former is characterized by more persistent hallucinations and delusions.

Schizoid Personality Disorder

• No interest in relationships

• Indifferent to praise or criticism

• Lack of affect/range of emotions

• No psychotic symptoms

Schizotypal Personality Disorder

• Acute discomfort with and reduced capacity for relationships

• Affect/emotions might be restricted or inappropriate

• Unusual behavior, odd thinking, superstition

• Suspiciousness or paranoia may be present

Diagnostic Criteria for Both Disorders

According to the DSM-5, the following factors must be present to be diagnosed with schizoid personality disorder:

• Disinterest and detachment from social connections and relationships

• Limited and restricted range of expression in interpersonal or social situations

• Symptoms that appear by early adulthood

• Four or more of the following factors:

• Does not desire or enjoy close relationships, including family relationships

• Almost always chooses solitary activities

• No or very little interest in sexual activities or experiences

• Has no close friends other than immediate family

• Appears indifferent to others’ responses to them, including criticism or praise

• Shows emotional coldness, detachment, or flattened affectivity

With schizotypal personality disorder, the following factors must be present:

• Acute discomfort with and reduced capacity for close relationships

• Cognitive or perceptual distortions

• Odd behavior that can’t be explained by cultural norms (as in, the behavior can’t be attributed to cultural practices)

• Five or more of the following factors:

• Ideas of reference (interpretation of random or irrelevant situations or occurrences in the world relate directly to one as an individual)

• Excessive social anxiety that is not resolved with familiarity and tends to be based on paranoia rather than negative self-judgment

• Odd or unusual thought processes (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense;” in children and adolescents bizarre fantasies or preoccupations)

• Unusual perceptual experiences, including bodily illusions

• Odd or eccentric behavior or appearance

• Lack of close friends or confidants

• Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)

• Inappropriate or constricted affect (the expression of emotions that is not appropriate for the situation or the inability to experience the full range of human emotions)

• Suspiciousness or paranoia

For both conditions, these symptoms cannot be attributed to another medical condition, and these symptoms cannot occur in the setting or context of schizophrenia, bipolar disorder, depressive disorder with psychotic features, another psychotic disorder or an autism spectrum disorder.

Prevalence and Causes

Both schizoid personality disorder and schizotypal personality disorder are relatively uncommon. By some estimates the prevalence of schizoid personality disorder (how many people are living with this condition) is 3.1%. whereas being slightly more prominent in men, whereas the prevalence of schizotypal personality disorder in some studies is about 3.9%.

Takeaway

The causes of both schizoid and schizotypal personality disorders are unknown, but it is generally felt that hereditary and genetics play a significant role along with environmental factors. Some researchers believe there might be a connection between schizoid personality disorder and autism spectrum disorder.

With schizotypal personality disorder, changes in brain function during development, environmental factors (such as where you grew up and with whom and other early exposures), and learned behaviors might play a part.

In addition, the risk of developing schizotypal personality disorder might be higher if you have a relative with a psychotic disorder like schizophrenia.

Treatment Options

People with schizoid or schizotypal personality disorder might only seek treatment at the behest of friends or family; or, they might seek treatment for a co-occurring condition, such as depression or anxiety, rather than for the personality disorder itself. In these cases, they might be prescribed antidepressants, antipsychotics or other medication to treat their symptoms.

Takeaway

There are no medications with a specific indication for schizoid or schizotypal personality disorder.

Those with schizoid personality disorder can benefit from talk therapy in both individual and group settings. Talk therapy modalities like cognitive behavioral therapy and psychodynamic psychotherapy can help those with schizoid examine their emotional responses and approach to relationships, while group therapy can help them learn and practice social skills.

People with schizotypal personality disorder may benefit from some of the same treatment approaches as those for schizophrenia—talk therapy and antipsychotic medication. How effective medication may be can vary and should be considered and prescribed on a case-by-case basis.

If you or a loved one are dealing either schizoid or schizotypal personality disorder, talk to a doctor to find out which treatment options may be worth exploring.

Read the original article on Verywell Mind.