Schizotypal Personality Disorder

The Disease Perspective

Proposed Revision | APA DSM-5 New! The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994, pg. 645) describes Schizotypal Personality Disorder 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 and present in a variety of contexts, as indicated by five (or more) of the following:

ideas of reference (excluding delusions of reference); odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (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 thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped); suspiciousness or paranoid ideation; inappropriate or constricted affect; behavior or appearance that is odd, eccentric, or peculiar; lack of close friends or confidants other than first-degree relatives; excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

The disorder does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.

The Dimensional Perspective

Here is a hypothetical profile, in terms of the five-factor model of personality, for Schizotypal Personality Disorder (speculatively constructed from McCrae, 1994, pg. 306):

High Neuroticism Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making. Low Extraversion

Social isolation, interpersonal detachment, and lack of support networks; flattened affect; lack of joy and zest for life; reluctance to assert self or assume leadership roles, even when qualified; social inhibition and shyness. High Openness Preoccupation with fantasy and daydreaming; lack of practicality; eccentric thinking (e.g., belief in ghosts, reincarnation, UFOs); diffuse identity and changing goals: for example, joining religious cult; susceptibility to nightmares and states of altered consciousness; social rebelliousness and nonconformity that can interfere with social or vocational advancement. Low Agreeableness Cynicism and paranoid thinking; inability to trust even friends or family; quarrelsomeness; too ready to pick fights; exploitive and manipulative; lying; rude and inconsiderate manner alienates friends, limits social support; lack of respect for social conventions can lead to troubles with the law; inflated and grandiose sense of self; arrogance. High Conscientiousness Overachievement: workaholic absorption in job or cause to the exclusion of family, social, and personal interests; compulsiveness, including excessive cleanliness, tidiness, and attention to detail; rigid self-discipline and an inability to set tasks aside and relax; lack of spontaneity; overscrupulousness in moral behavior.

Specific Affects
Social anxiety, phobic anxiety, anhedonia, feelings of humiliation, paranoia (Stone, pp. 2719, 2220, 2724, 2726).

Character Weaknesses and Vices*

referentiality* social anxiety* illusions* magical thinking* no close friends* odd speech* inappropriate affect* eccentric suspicious

Know Your Major Weaknesses

* Derived from Michael Stone's (pg. 22) list of the "personality traits" of DSM-III-R Schizotypal Personality
Disorder. Descriptors marked with an asterisk, he says, are not true personality traits.

The Behavior Perspective

Motivations
Want to avoid being influenced by anyone.

Behaviors
Aloofness, odd communication, isolation; Ego-boundary problems, "ego-diffusion," merging phenomena and other severe distortions of the self, mirroring, narcissistic disturbances, faulty sense of identity; difficulty sensing what other people are all about or else at knowing how to best respond when their perceptions of interpersonal situations happen to be accurate; marked peculiarities of speech, dress, and habit; sensitivity to criticism, avoidance of intimacy; insensitivity to the feelings of spouse, oversensitivity to spouse's behavior; extreme loneliness and need for human relatedness, inability to "connect" meaningfully and pleasurably with other people (Stone, pp. 2719, 2221-2726). Odd speech: vague, circumstantial, metaphorical, overelaborate, or stereotyped speech; idiosyncratic phrasing, unusual use of words, overly concrete or abstract responses to questions; odd, eccentric, or peculiar mannerisms or dress; excessive social anxiety associated with paranoid fears about the motivations of others, rather than with negative judgments about themselves; difficulty responding to interpersonal cuing and expressing a full range of affects; difficulty in developing rapport or engaging in casual and meaningful conversations; an inappropriate, stiff, or constricted manner (Gunderson and Philips, pg. 1437).

Associated Disorders
Symptoms of anxiety, depression, or other dysphoric affects; transient psychotic episodes; Brief Psychotic Disorder, Schizophreniform Disorder, Delusional Disorder, Schizophrenia; Major Depressive Disorder (American Psychiatric Association, 2000, pg. 698-699). Hypochondriasis, transient psychotic experiences; "psychoticism," obsessive-compulsive symptoms (Stone, pp. 2723-2726).

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The Life Story Perspective

Childhood
Physical, sexual, and emotional trauma. Common Character Disorder Compensatory Narcissistic

Stoic explanation
Schizotypal personality disorder is a typological representation of bad character, of a vicious disposition formed by habitual passion. Passions are, or are the results of, erroneous value-judgments. The objects of passion listed below (derived mostly from Oldham, pp. 252-66) are external, indifferent things that the Schizotypal personality incorrectly judges to be good or bad. (Evolutionary Psychology and Behavior Genetics provide adequate scientific explanations of the origins of these impulses.) The cure of Schizotypal personality disorder will require correcting these habitual, erroneous value-judgments by making proper use of impressions.

Niebuhrian / Horneyan explanation

Schizotypal character disorder is a type of "solution" to the problem of anxiety; that is, it is a strategy to alleviate anxiety. The objects of desire and pleasure listed below (derived mostly from Oldham, pp. 252-66) are limited goods pridefully turned to for security when we fail to trust God. They are analogous to Karen Horney's "neurotic needs." Karen Horney: Intrapsychic Strategies of Defense The Resignation Solution "Even when we deeply value ourselves, the anxiety built into finitude will tempt us to find our source of security in some strategy rather than a trust in God" (Cooper, pg. 163).

False Value-Judgments False Goods

False Bads

non-conformity dreaming the spirit visions

conformity convention tradition close relationships

mysticism eccentricity freethinking idiosyncratic feelings and belief systems, worldview, and approach to life odd habits self-direction independence the occult the extrasensory the supernatural abstract and speculative thinking being inner-directed observing others new experiences and feelings rapture freedom from rules

how other people react to them that others think them strange old belief systems joining affiliation adapting accepting or espousing anyone else's principles and beliefs standard explanations ridicule doubt uncertainty disillusionment the "regular" world narrow-minded people normal behavior standards others' expectations accepting authority

Cognitive Effects
Basic Belief: I need to consider only my own views; I must not be influenced by anyone. Strategy: Eccentric thinking. Suspiciousness, ideas of reference, illusions; "cognitive slippage," a disturbing sense of discontinuity with respect to time and person; tendency to misinterpret: reacts to symbols, to possible meanings, rather than facts; poor at generalizing from one situation to another analogous one; concreteness, and humorlessness; conviction of unlikeablity (Stone, pp. 2719, 2221, 2725, 2726). Parataxic thinking. The "idealized self is made up of beliefs about how we should feel, think, or act" (Tamney, pg. 32). Compulsive beliefs and attitudes are idols, too. In Cognitive Therapy of Personality Disorders, Aaron T. Beck and Arthur Freeman (1990) list typical beliefs associated with each specific personality disorder. According to my view, the beliefs and attitudes rationalize and reinforce the idealized image and the compulsive attachments and aversions. They are analogous to Karen Horney's "shoulds" and "neurotic claims." Here are some of the typical attitudes and assumptions that they have listed (pg. 140) for Schizotypal Personality Disorder:

I feel like an alien in a frightening environment. Since the world is dangerous, you have to watch out for yourself at all times.

There are reasons for everything. Things don't happen by chance. Sometimes my inner feelings are an indication of what is going to happen. Relationships are threatening. I am defective.