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Schizotypal Personality Disorder

DSM-IV Diagnostic Criteria

A pervasive pattern of discomfort with and reduced capacity for close relationships as well as perceptual distortions and eccentricities of behavior, beginning by early adulthood. At least five of the following should be present:

Ideas of reference: Interpreting unrelated events as having direct reference to the patient (eg, a television program is really about him even though the patient is never named).

Odd beliefs or magical thinking inconsistent with cultural norms (eg, superstitiousness, belief in clairvoyance, telepathy or a "sixth sense").

Unusual perceptual experiences, including bodily illusions.

Odd thinking and speech (eg, circumstantial, metaphorical, or stereotyped thinking)

Suspiciousness or paranoid ideation.

Inappropriate or constricted affect.

Behavior or appearance that is odd, eccentric or peculiar.

Lack of close friends other than first-degree relatives.

Excessive social anxiety that does not diminish with schizotipal.

Clinical Features

These patients often display peculiarities in thinking, behavior and communication.

Discomfort in social situations, and inappropriate behavior may occur.

Magical thinking, belief in Aextra sensory perception@, illusions and derealization are common.

Repeated exposure will not decrease social anxiety since it is based on paranoid concerns and not on self-consciousness.

The patient may have a vivid fantasy life with imaginary relationships.

Speech may be idiosyncratic, such as the use of unusual terminology.

These patients may seek treatment for anxiety or depression.


This disorder is more common in relatives of schizophrenics compared to the general population.

Schizotypal personality disorder may be a pre-morbid condition in schizophrenia.

The prevalence is approximately 3% in the general population.

Differential Diagnosis of Schizotypal Personality Disorder

Schizoid and Avoidant Personality Disorder. Schizoid and avoidant patients will not display the oddities of behavior, perception, and communication of schizotypal patients.

Schizophrenia. No formal thought disorder is present in personality disorders. When psychosis is present in patients, it is of brief duration.

Patients with paranoid personality disorder will not display the oddities of behavior, perception and communication patients. Unlike schizotypals, paranoid patients can be very verbally aggressive and do not avoid conflict.

Personality Change Due to a General Medical Condition and Substance-Related Disorder. Acute symptoms are temporally related to a medication, drugs or a medical condition. The long standing patterns of behavior required for a personality disorder are not present.


Psychotherapy is the treatment of choice.