Schizotypal Personality Disorder

Learning Objectives

  • Describe the characteristics and diagnosis of schizotypal personality disorder

We have learned about paranoid personality disorder and schizoid personality disorder, now let’s take a look at another Cluster A disorder: schizotypal personality disorder. Persons with schizotypal personality disorder usually have few, if any, close relationships and exhibit eccentric behaviors.

Table 1. DSM-5 Personality Disorders
DSM-5 Personality Disorder Description Cluster
Paranoid harbors a pervasive and unjustifiable suspiciousness and mistrust of others; reluctant to confide in or become close to others; reads hidden, demeaning, or threatening meaning into benign remarks or events; takes offense easily and bears grudges; not due to schizophrenia or other psychotic disorders A
Schizoid lacks interest and desire to form relationships with others; aloof and shows emotional coldness and detachment; indifferent to approval or criticism of others; lacks close friends or confidants; not due to schizophrenia or other psychotic disorders, not an autism spectrum disorder A
Schizotypal exhibits eccentricities in thought, perception, emotion, speech, and behavior; shows suspiciousness or paranoia; has unusual perceptual experiences; speech is often idiosyncratic; displays inappropriate emotions; lacks friends or confidants; not due to schizophrenia or other psychotic disorder, or to autism spectrum disorder A

Schizotypal Personality Disorder

Schizotypal personality disorder is characterized by severe social anxiety, thought disorder, paranoid ideation, transient psychosis, and often unconventional beliefs. People with this disorder feel extreme discomfort with maintaining close relationships with people and avoid forming them, mainly because the subject thinks their peers harbor negative thoughts towards them. The historical roots of schizotypal personality disorder (STPD) are the non-psychotic personality syndromes within the spectrum of schizophrenia, meaning that its presentation is similar to schizophrenia, but without delusions or hallucinations

signs of schizotypal personality disorder: difficulty making friends, serious social anxiety, social awkwardness, vague, odd speech, eccentric clothing, magical beliefs, paranoia, odd percetions, odd emotions, and ideas of reference.

Figure 1. Common characteristics of schizotypal personality disorder.

In the DSM-5, schizotypal personality disorder (STPD) is defined as a “pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood” (APA, 2010).

At least five of the following symptoms must be present:

  • ideas of reference
  • strange beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitious beliefs; belief in clairvoyance, telepathy, or “sixth sense”; or bizarre fantasies or preoccupations)
  • abnormal perceptual experiences, including bodily illusions
  • strange thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
  • suspiciousness or paranoid ideation
  • inappropriate or constricted affect
  • strange behavior or appearance
  • lack of close friends
  • excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

These symptoms must not occur only during the course of a disorder with similar symptoms (such as schizophrenia or autism spectrum disorder).


There is a high rate of comorbidity with other personality disorders. McGlashan et al. (2000) stated that this high rate may be due to overlapping criteria with other personality disorders, such as avoidant personality disorder, paranoid personality disorder, and borderline personality disorder.

Schizotypal, Schizoid, or Paranoid?

There are many similarities between schizotypal and schizoid personalities. Most notable of the similarities is the inability to initiate or maintain relationships (both friendly and romantic). The difference between the two seems to be that those labeled as schizotypal avoid social interaction because of a deep-seated fear of people. The schizoid individuals simply feel no desire to form relationships because they see no point in sharing their time with others.

Schizotypal personality disorder also differs from paranoid personality disorder in that the main feature of paranoid personality disorder is mistrust or suspicion of others, while schizotypal personality disorder (STPD) is associated with eccentric and socially dysfunctional ways.


Schizotypal personality disorder is widely understood to have a genetic connection with a schizophrenia spectrum disorder, mood disorders, and depression. Rates of schizotypal personality disorder are much higher in relatives of individuals with schizophrenia than in the relatives of people with other mental illnesses.

There is evidence to suggest that parenting styles, early separation, trauma/maltreatment history (especially early childhood neglect) can lead to the development of schizotypal traits.


The reported prevalence of schizotypal personality disorder in community studies ranges from 0.6% in a Norwegian sample to 4.6% in an American sample. A large American study found a lifetime prevalence of 3.9%, with somewhat higher rates among men (4.2%) than women (3.7%).


Schizotypal personality disorder is rarely seen as the primary reason for treatment in a clinical setting, but it often occurs as a comorbid finding with other mental disorders. When patients with STPD are prescribed pharmaceuticals, they are most often prescribed the same antipsychotic drugs used to treat patients suffering from schizophrenia.

According to Theodore Millon, schizotypal personality disorder is one of the easiest personality disorders to identify but one of the most difficult to treat with psychotherapy. Persons with STPD usually consider themselves to be simply eccentric, productive, or nonconformist. As a rule, they underestimate the maladaptiveness of their social isolation and perceptual distortions. It is not so easy to gain rapport with people who suffer from STPD due to the fact that increasing familiarity and intimacy usually increase their level of anxiety and discomfort.

Case StUdy: Schizotypal Personality Disorder

A 37-year-old, unemployed man named Tyrel complained of recurrent irrational thoughts, compulsive behavior, and social isolation. Since childhood, he had always been eccentric, withdrawn, and without real friends. He anxiously feared close relationships and was preoccupied with reading stories about Dracula. He didn’t share his inner thoughts or feeling with anybody, including his parents. He never graduated high school, but maintained worked in factories, often at night. Some years earlier he started doubting if his work was accurate enough. Although he recognized these thoughts as irrational, he started spending a lot of time controlling his work over and over again. Soon these compulsive controls took so much time that he could not finish his work, and started fearing that people could notice his behavior. He started drinking alcohol to control his increasing anxiety. He adopted different peculiar strategies, which ended in new vicious circles of obsessive symptoms and suspicion.

Tyrel is diagnosed with obsessive-compulsive disorder (OCD), alcohol abuse, and schizotypal personality disorder (STPD). He had long-lasting personality difficulties like suspicion, along with odd behavior, and social anxiety prior to the OCD symptoms. STPD is rarely seen as the primary reason for treatment in a clinical setting, but often occurs as a comorbid finding with other mental disorders.

Watch It

Watch this video to learn more details surrounding schizotypal personality disorder.

You can view the transcript for “Schizotypal personality disorder | Mental health | NCLEX-RN | Khan Academy” here (opens in new window).

Key Takeaways: schizotypal personality disorder

Try It


schizotypal personality disorder: characterized by behavior that is often described as odd or eccentric; those with SPD usually have few, if any, close relationships

schizophrenia spectrum: schizoid personality disorder, schizotypal personality disorder, and paranoid personality disorder can be considered schizophrenia-like personality disorders because of their links to the schizophrenia spectrum