December 21, 2021

Schizotypal Vs. Schizophrenia

Although the two may share similar names, schizotypal personality disorder and schizophrenia are entirely different mental health conditions. Understanding the risk factors, symptoms, and treatment options can be beneficial for supporting you or your loved ones.

What Is Schizotypal Personality Disorder?

Schizotypal personality disorder is within the Cluster A personality disorders. These personality disorders are most noted in having odd or eccentric behavior.

Someone with schizotypal personality disorder tends to prefer being alone. They may not have many friends. If they do have relationships, they tend to be shallow and superficial. It is challenging for them to trust others or feel vulnerable in interpersonal settings. (Source: Harvard Health Publishing)

Furthermore, they usually exhibit strange speech or behavioral patterns. For instance, they may ramble about certain topics or present as overly vague. They might also wear strange clothing, engage in odd mannerisms, or collect unusual things.

Common Signs of Schizotypal Personality Disorder 

The eccentric behavior is usually the most telling sign of schizotypal personality disorder. Of course, everyone has quirks and oddities. But someone with schizotypal personality disorder may deeply believe in superstitions or different types of magical thinking. They may also have paranoid thoughts that make it difficult to trust others or the world around them.

Relationship problems are the next key sign. People with schizotypal personality disorder do not form close, intimate relationships. Instead, they generally feel comfortable around others and prefer solitude when possible. 

Other symptoms include:

  • Heightened social anxiety associated with paranoia.
  • Continuous mistrust about someone else’s loyalty. 
  • Believing that benign events are personal.
  • Failing to engage in appropriate grooming or hygiene.
  • Speaking in ways that are culturally or generally inappropriate.
  • Showing flat or restricted affect in most situations.

Risk Factors

In general, there is not much research about schizotypal personality disorder. It tends to be rare, with some studies suggesting it has a lifetime prevalence of 4%, with more men experiencing the condition than women. That said, many people do not receive diagnoses or treatment, which can undoubtedly affect those statistics.

It appears that people with other mental illnesses, like major depression, bipolar disorder, and post-traumatic stress disorder, are at an elevated risk for schizotypal personality disorder. In addition, it appears to be comorbid with other personality disorders, such as borderline and narcissistic personality disorder.

There are likely some genetic components to consider. For instance, people with schizotypal personality disorder are more likely to have a first-degree relative with the same condition. 

Finally, one’s environment likely plays a role. Specific experiences, particularly those rooted in childhood trauma, neglect, and abuse, may increase the likelihood of someone developing schizotypal personality disorder.

Treatment 

Schizotypal personality disorder, like all personality disorders, is chronic and lifelong. There is no cure. However, proper treatment can reduce symptoms and help people live meaningful, fulfilling lives.

Unfortunately, there is limited research on the various treatment options recommended for schizotypal personality disorder. Like with most personality disorders, many clients do not receive the treatment they need. That’s because they may not recognize that they have a problem. 

Furthermore, someone with this condition may be especially distrusting of mental health professionals, such as therapists or psychiatrists. As a result, they may be wary or completely against seeking treatment.

Psychiatric Medication

The FDA has not approved any specific medications for schizotypal personality disorder. However, a doctor or psychiatrist may prescribe second-generation antipsychotics, including olanzapine and risperidone. These medications can reduce the intensity of bizarre thoughts or paranoid beliefs. 

They may also prescribe antidepressants, such as Zoloft, Celexa, Paxil, or Prozac. These medications help balance serotonin levels in the brain. Therefore, antidepressants may reduce some of the apathy or depression people feel.

Psychotherapy

Talk therapy can also be helpful, although it may take some time to build rapport and trust. Social skills training, in particular, can benefit clients in learning how to understand and react appropriately to various social situations.

Cognitive-behavioral therapy (CBT) offers support in reframing negative thoughts into more realistic or positive ones. It also introduces healthy coping skills for managing distress. In addition, CBT can help people recognize paranoid patterns and identify alternative solutions for handling them.

Individual therapy tends to yield the best outcomes. A therapist may recommend family therapy in some cases, especially if the individual lives with their family. Group therapy is not typically advised. 

What Is Schizophrenia?

Schizophrenia is a chronic mental health condition that includes patterns of delusions, hallucinations, odd thinking patterns, and disorganized speech. Schizophrenia symptoms can range in severity, but severe cases can be debilitating for individuals and their loved ones.

People with schizophrenia often experience delusions, which refer to false beliefs not rooted in reality. For example, they may believe they have magic powers or that a certain person is intentionally trying to harm them. These delusions tend to result in suspicion, paranoia, and bizarre behaviors.

They are also likely to experience hallucinations. Hallucinations refer to seeing, hearing, feeling, or sensing things not physically there. For example, someone with schizophrenia may believe they can hear God or see a dead relative. While hallucinations can occur within any of the five senses, hearing voices tends to be the most typical.

Common Signs of Schizophrenia

Hallucinations and delusions are the hallmark symptoms of schizophrenia. Some people display these symptoms outwardly, making them obvious to other people. Others are more covert, and these signs are not as easily recognizable.

Other common symptoms include:

  • Disorganized, strange, or generally incoherent speech.
  • Disorganized, inappropriate behavior (acting very childish, showing resistance to basic instructions, not responding at all, engaging in odd behaviors).
  • Neglecting personal grooming or hygiene.
  • Avoiding eye contact with others.
  • Speaking in a flat tone and/or having an entirely flat affect.
  • Appearing to have no interest in everyday activities.
  • Difficulties with interpersonal relationships and social settings.

Risk Factors

In men, schizophrenia symptoms tend to first emerge in the early to mid-20s. In women, the onset is later- most women first experience symptoms in their mid-to-late 20s. However, some people will exhibit initial symptoms during adolescence. Overall, the lifetime prevalence of developing schizophrenia is about 1%. 

Researchers do not exactly know what causes schizophrenia. Instead, the condition is likely due to a combination of brain chemistry, environmental factors, and genetics.

That said, there appears to be a link between schizophrenia and family history. In other words, someone with schizophrenia is likely to have a close relative with the same condition. When this is the case, the risk of an individual developing schizophrenia increases to 10%. 

Similarly, some studies have shown links between low birth weight, premature labor, and oxygen problems during birth. This means prenatal and postnatal factors may play a role.

It should also be noted that there tends to be higher rates of schizophrenia in lower-income, urban areas. Therefore, when examining prevalence from a cultural framework, there may be inequalities within the treatment and diagnosing itself. 

Finally, neuroimaging studies show structural differences in the brains of people with schizophrenia. For example, their central nervous systems physically look different, and they tend to have less gray matter, which is associated with understanding risk, reward, and consequences. Longer episodes of psychosis are connected with high levels of gray matter loss.

Treatment

Most people are first diagnosed with schizophrenia after experiencing a psychotic episode. However, some people may be diagnosed with other conditions, like depression, bipolar disorder, or a substance use disorder beforehand. 

Schizophrenia is a lifelong, chronic condition. There is no cure- if someone does not get help, they risk their condition progressing and worsening. Unfortunately, this can lead to difficulties functioning in most areas of life. Therefore, ongoing treatment is essential for symptom management. 

Psychiatric Medication

Medication tends to be the first line of defense when treating schizophrenia. First-generation or second-generation antipsychotic medication helps reduce or eliminate psychotic symptoms, like hallucinations or delusions. These drugs balance serotonin and dopamine levels. 

Some of the standard antipsychotics include:

  • Thorazine
  • Haldol
  • Navane
  • Prolixin
  • Abilify
  • Latuda
  • Zyprexa
  • Risperdal
  • Seroquel
  • Geodon

Antipsychotics come in tablet pills or as twice or once-monthly injectables. An injectable may be recommended for people who struggle to take medication on time. It may also be recommended for people who frequently stop taking medication once they start feeling better. 

As of recently, Clozapine was the only FDA-approved medication currently recommended for treating schizophrenia in people resistant to other treatments. However, in late 2019, the FDA approved a new drug, Caplyta, for treatment. This drug can improve how nerve cells communicate, thus reducing psychotic episodes.

Some doctors will also prescribe mood stabilizers in addition to antipsychotics. Mood stabilizers support emotional regulation, which can help with other symptoms associated with schizophrenia. Lithium, Depakote, and Lamictal are commonly-prescribed.

Finally, they may also recommend an antidepressant, like Celexa, Prozac, Zoloft, or Lexapro. Antidepressants can help reduce or eliminate the lack of motivation, lethargy, or persistent feelings of sadness that may coincide with schizophrenia.

Psychotherapy

Along with medication, many people also benefit from engaging in talk therapy for treating schizophrenia. That said, talk therapy can be challenging. Some individuals may be scared or resistant to meet with a mental health professional. They may be wary of judgment or shaming, and those fears are entirely valid.

CBT is one of the most widely-studied talk therapies for schizophrenia. This therapy can help clients understand their psychotic symptoms and reframe their associated thoughts. It also teaches appropriate relaxation and coping skills for coping with stressful triggers.

Some people benefit from creative expression or art therapy in treating their schizophrenia. These treatments often focus on helping clients understand and extrapolate their feelings. It can be especially helpful in understanding both trauma and psychosis, and it offers language for people who may struggle with identifying their specific emotions.

What Is the Main Difference Between Schizotypal Personality Disorder and  Schizophrenia?

Both conditions share some symptoms overlapping. For instance, people with both conditions may struggle in social situations or have difficulties with hygiene and grooming. Likewise, there is a similarity between paranoid thinking and odd behavior.

That said, people with schizophrenia experience hallucinations and delusions. This is not necessarily true with schizotypal personality disorder. If they do have hallucinations or delusions, they are not as frequent, intense, or longstanding. 

Likewise, people with schizotypal personality disorder tend to be more receptive to the notion that their perceptions may be faulty. Those with schizophrenia often believe their realities are the true reality. 

At the same time, people with schizophrenia may be more likely to receive treatment. That’s because their symptoms typically present as more prominent and concerning to others. They may also be mandated therapy due to various legal issues arising from their condition (such as being in jail for a substance problem or being admitted into a hospital after a suicide attempt).

Can You Have Both Conditions Simultaneously?

No, you cannot meet the criteria for both conditions at the same time. However, as mentioned, the two conditions look similar. Some professionals even consider schizotypal personality disorder to be on the same spectrum as schizophrenia, although they often perceive the personality disorder as milder. 

A trained mental health professional will conduct a thorough assessment to screen various symptoms for a proper diagnosis. In addition, they will ask relevant background questions about certain mental health issues, family history, and other medical concerns. For this reason, it is essential to try to be as honest as possible. 

It may be helpful to write down some of your symptoms (along with their intensity and frequency) ahead of time. You can also write down any other areas where you may be struggling. 

Even if it feels scary or shameful, telling the truth allows qualified people to help you. Moreover, getting an accurate diagnosis starts you on the right path towards recovery. 

Final Thoughts 

If you suspect you or a loved one may be struggling with schizotypal personality disorder or schizophrenia, treatment is available. No matter your circumstances, you don’t have to struggle alone. Reaching out for professional support can make an invaluable difference in improving how you feel. 

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Disclaimer: This information is not specific medical advice and does not replace information you receive from your healthcare provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or lifestyle choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

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