Schizotypal Personality Disorder DSM-5 301 (F21)
DSM-5 Category: Personality Disorders
Introduction
Schizotypal personality disorder (SPD), one of six distinct types of personality disorders identified under the DSM-5, is a social disorder characterized by odd thinking or behavior (American Psychiatric Association, 2013);Those inflicted have marked social deficits, and consequently live solitary lives and show a lack of interest in social situations, and may live in a fantasy world. They are often emotionless, show apathy and have difficulties expressing their emotions. Depression and psychosis may also be experienced. As a result of their tendency toward withdrawal, they may have problems developing personal relationships and showing emotional intimacy in relationships. Although schizotypal disorder shares some characteristics with schizophrenia and is more common in families with schizophrenia, they are separate disorders.
Individuals with schizotypal disorder may mask their introverted personality with an engaging and interested manner while remaining detached. They may even have many acquaintances but will develop few meaningful relationships. They have a tendency toward secrecy and may share less with family members and others within their social circle. Those with a schizotypical disorder may demonstrate interpersonality problems.
The disorder is characterized by differential effect. Positive effect may involve paranoid characteristics and delusions. Those with negative effect show deficits in social skills and the expression of emotions. The positive effect group has a high rate of suicide. SPD is comorbid with a number of psychological disorders, including depression, anxiety disorders, and narcissistic and borderline personality disorder(Lentz, Robinson and Bolton, 2010).
Impact of Language Disorders on Daily Life
Individuals with SPD may experience mild-to-severe impairments in functioning in daily life. The impairments in social skills affect vocational functioning, although schizotypal personality disorder has a weaker link with employment history than other personality disorders such as schizophrenia and paranoid personality disorder. SPD has, however, been shown to impact social contact at work (McGurk et al., 2013), which could affect performance. Dissociative characteristics are associated with interpersonal problems. Thus, he/she will prove inept at small talk with colleagues and more comfortable in an impersonal analytical role.
In personal relationships, individuals with SPD are likely to remain distant, and may develop superficial attachments. They may pick a partner for whom they have a strong connection such as sharing the same profession (doctor, lawyer), activities (interests) or background (religion). He/she will not be as responsive in processing emotional information. They will choose to be in relationships in which they have control, and are regulated more by rules than emotions and feelings.
Individuals with SPD report more life stressors and a greater degree of stress associated with stressful events. A study of teenagers concluded that stressful life events may be a factor in the onset of SPD. Social anxiety and lack of emotion are associated with a lower level of daily positive affect. A correlation is shown between negative affect and quality of life.
Schizotypal Disorder Therapies
Given the effect of SPD symptoms on QOL, therapy should be pursued. Like many personality disorders, psychotics are sometimes unnecessarily or over-subscribed. Schizotypal types respond well to psychotherapy. Psychotherapists seek to address fantasies and delusional thoughts while avoiding directly questioning their authenticity. Dream therapy and Jungian psychoanalysis have been explored as a way of helping the patient connect delusional thoughts and anxieties with the realities of their everyday lives. Since the schizotypal patient will be more withdrawn and less in touch with his/her emotions, creative therapy approaches should be considered.
Psychotherapy can explore the type and root causes of the avoidant behavior. It may, for example, be related to child abuse. Treatment will be influenced by whether the patient avoids social contact through indifference or anxiety. Behavioural training can help develop social interaction and relationship skills. Learning new patterns of thinking and behavior can improve social anxiety and social maladjustment.
Group therapy and self-help groups provide an opportunity to develop social skills within a therapy session. A noteworthy finding is that social anxieties have not affected the participation or dropout rate of group therapy of those with SPD (Dorrepaal et al, 2013) ;indicating a strong desire to overcome their insecurities and fears. Role playing is an effective technique to prepare for social situations, such as job interviews, dates, and so on.
Cognitive behavioural therapy (CBT) has shown to be more effective than many other therapies in helping those with social disorders face social situations and improve interaction with others. Through CBT, those afflicted can learn to adapt their behaviours and thought patterns to social situations. Early treatment with CBT has shown to reduce the risk of developing psychosis, (van der Gaag,2013);as well as reduce its severity, (Byrne and Morrison,2013)
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Lentz, V., Robinson, J., & Bolton, J. M. (2010). Childhood adversity, mental disorder comorbidity, and suicidal behavior in schizotypal personality disorder. The Journal of nervous and mental disease, 198(11), 795-801.
McGurk, S. R., Mueser, K. T., Mischel, R., Adams, R., Harvey, P. D., McClure, M. M., ... & Siever, L. J. (2013). Vocational functioning in schizotypal and paranoid personality disorders. Psychiatry research, 210(2), 498-504.
Dorrepaal, E., Thomaes, K., Smit, J. H., Veltman, D. J., Hoogendoorn, A. W., van Balkom, A. J., & Draijer, N. (2013). Treatment compliance and effectiveness in complex PTSD patients with co-morbid personality disorder undergoing stabilizing cognitive behavioral group treatment: a preliminary study. European journal of psychotraumatology, 4.
van der Gaag, M., Smit, F., Bechdolf, A., French, P., Linszen, D. H., Yung, A. R., ... & Cuijpers, P. (2013). Preventing a first episode of psychosis: Meta-analysis of randomized controlled prevention trials of 12month and longer-term follow-ups. Schizophrenia research, 149(1), 56-62.Byrne, R. E., & Morrison, A. P. (2013). Young people at risk of psychosis: Their subjective experiences of monitoring and cognitive behaviour therapy in the early detection and intervention evaluation 2 trial. Psychology and Psychotherapy: Theory, Research and Practice.
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