What is schizotypal personality disorder (STPD)?

Schizotypal personality disorder (STPD) is characterized by a pattern of unusual thoughts, behaviors, and appearance and difficulty forming and maintaining interpersonal relationships. While there’s limited data on the prevalence of STPD, some research shows that it may affect approximately 4% of people worldwide. STPD appears to disproportionately affect people experiencing housing instability.

Signs and symptoms of STPD

To be diagnosed with STPD, a person must display chronic, intense discomfort in social situations and difficulty forming close relationships. They must also experience eccentric behavior or thinking. 

Some of the most common signs of STPD include:

• Having unusual or odd beliefs, fantasies, preoccupations, or behaviors (like believing they have special abilities or can communicate with supernatural entities)
• Having unusual or odd appearance, speech, or mannerisms
• Experiencing paranoia or suspiciousness (like thinking they’re being surveilled without evidence)
• Living with co-occurring mental health conditions, like depression, anxiety, borderline personality disorder (BPD), or substance use disorder (SUD)
• Having few friends or close relationships
• Expressing feelings in inappropriate or constricted ways
• Feeling extreme discomfort in social situations

Keep in mind that almost anyone can have these experiences. For example, you might like to dress in unique ways, have a narrow set of interests, or have trouble making friends. This doesn’t necessarily mean you have a mental health condition. 

To be diagnosed with STPD, on top of the symptoms mentioned above, a person must experience at least five of the following symptoms by early adulthood:

• Believing that everyday occurrences have special personal significance (sometimes referred to as having ideas of reference)
• Thinking they have special abilities or magical powers 
• Reporting unusual and unfounded experiences (like hearing voices or unexplained sounds)
• Speaking in strange, overly elaborate, or metaphorical language
• Experiencing frequent suspiciousness or paranoia
• Having few close friends or acquaintances outside of immediate family 
• Showing limited or unusual facial expressions
• Experiencing significant social anxiety linked to paranoia rather (than self-judgment)
• Having strange, eccentric, or odd appearance and/or behaviors

Can STPD symptoms overlap with other conditions?

Sometimes, STPD symptoms can overlap with symptoms of other mental health conditions. For example, schizophrenia, delusional disorder, and mood disorders with psychotic features can all involve hallucinations (seeing or hearing things that aren’t there) and delusions (believing things that are qualitatively false). 

On the surface, these symptoms can look similar to the odd or eccentric beliefs that accompany STPD. However, there’s an important distinction between STPD and these conditions: People with STPD have ideas of reference. This means they interpret real events as having special meaning for them. However, they don’t typically experience delusions or hallucinations that aren’t based in reality.

In addition, STPD can be mistaken for autism spectrum disorder (ASD). This is because both conditions can create interpersonal difficulties, communication challenges, unusual behaviors, and problems with self-regulation. However, symptoms like magical thinking and ideas of reference are more common with STPD than with ASD. 

What causes schizotypal personality disorder?

STPD is a complex condition that hasn’t been studied as frequently as other personality disorders. While the exact cause of STPD isn’t known, it likely has to do with a combination of the following:

• Genetics: Having a first-degree relative with STPD or related conditions, like schizophrenia, may make you more likely to develop the condition.
• Environment: Experiencing abuse, neglect, or other adverse childhood experiences may increase your risk of STPD.
• Psychology: Your individual personality style and the way you respond to stress and manage relationships could contribute to the onset of STPD.

How severe is schizotypal personality disorder?

Left untreated, STPD can negatively affect many aspects of a person’s life, including education, employment, and relationships. In rare cases, it can progress to schizophrenia or other psychotic disorders, although the majority of individuals with STPD do not develop these conditions. 

People with STPD are often unable to achieve their educational goals and maintain steady employment without support. And given the interpersonal difficulties STPD can cause, people with this condition may struggle to form a strong social network or close, long-term relationships.

What treatment options are there for STPD?

Most people with STPD need ongoing care to manage their mental health and overall well-being. This usually involves a combination of medication and therapy. While there are no medications approved to treat STPD specifically, there are medications that can increase mental stability or address symptoms of co-occurring conditions, like depression. It’s important to work with your provider to determine if medication is right for your unique needs.

Similarly, there aren’t any STPD-specific talk therapies. But research shows that approaches like cognitive behavioral therapy (CBT) can be helpful for people living with personality disorders. In the case of STPD, CBT can help people improve social skills and learn to form meaningful connections when delivered within the context of a safe and supportive therapeutic relationship. 

Find care with Rula

STPD is a serious mental health condition that causes unusual thought and behavior patterns. It can also lead to an odd or eccentric appearance and an inability to form close relationships. Without treatment, people with STPD may have trouble attending school, holding a job, and caring for themselves. However, while there’s no cure for STPD, it can be managed with the right support. 

If you or someone you care about is living with STPD or another mental health condition, know that help is just a few clicks away. At Rula, we partner with over 10,000 mental health professionals who can offer the specialized care you deserve. In just a few clicks, you can use our platform to find a therapist who takes your insurance and schedule your first live video session for as soon as tomorrow.

Get started with Rula today