What Is… Schizoid & Schizotypal Personality Disorders

In this series, I dig a little deeper into the meaning of psychology-related terms. This week we’re doing a 2-for-1 looking at schizoid and schizotypal personality disorder.

Both schizoid and schizotypal personality disorders fall within the DSM-5‘s cluster A, which is the odd/eccentric cluster. Despite the similarities in names (it took me a long time to get straight in my head which was which), there are considerable differences.

Schizoid personality disorder

While the name sounds like schizophrenia, schizoid PD is more along the lines of an asocial personality disorder (not that such a thing exists), with asociality taken to extremes. Still, a family history of schizophrenia is a risk factor for schizoid PD, so there is some link there, although no clear genetic links have been identified. Emotionally cold, neglectful, or detached parents can also increase the risk.

Symptoms

Schizoid personality disorder symptoms can include:

• feeling detached from and completely disinterested in social relationships, including sexual relationships
• lack of emotional expression during interpersonal interactions
• no interest in or pleasure from social relationships, including family or romantic relationships
• strong preference for solitary activities
• lack of enjoyment in activities
• lack of close social relationships
• appear indifferent to what others think of them (not in the sense of feeling confident without others’ validation; rather, it’s a matter of total disinterest in other people)
• emotional coldness or detachment, lack of strong emotions

Like any personality disorder, symptoms begin early and are well established by adulthood, and cause significant functional impairment and/or distress. The disorder is consistent over time, even more so than other personality disorders. It occurs in less than 5% of the population, with no difference in prevalence between males and females.

About half of people with schizoid PD also experience major depressive disorder. It’s common to have other co-occurring personality disorders, such as schizotypal, paranoid, borderline, or avoidant.

Differentiating between schizoid PD and the autism spectrum

There is some overlap between traits observed in schizoid personality disorder and autism spectrum disorder. While autism is most often diagnosed in childhood, schizoid PD is rarely diagnosed in childhood. A key difference when it comes to social difficulties appears to be that people on the autism spectrum have difficulties with skills needed to form social relationships, while people with schizoid PD lack the desire or motivation to form such relationships.

Treatment

Lack of interest in having anything to do with other people means that people with this disorder lack motivation to participate in treatment. Little research has been done on treating schizoid PD, but cognitive behavioural therapy (CBT) focused on social skills training may be helpful. Even with therapy, people are unlikely to find social engagement pleasurable.

Schizotypal personality disorder

Schizotypal PD is sort of like schizophrenia lite. It’s thought to be quite biologically based, and it’s more common when there is a family history of some form of psychotic disorder. Trauma may contribute to the development of the disorder in people who have a genetic vulnerability. A number of genes have been identified that may play a role, including the COMT Val158Met polymorphism, which encodes for an enzyme involved in the metabolism of neurotransmitters like dopamine.

Schizoid PD has been associated with reduced volume in the brain’s temporal lobes. These changes are more localized and stable over time compared to differences that are observed in people with schizophrenia.

Symptoms

Schizotypal personality disorder symptoms can include:

• decreased ability to function in social relationships, with intense discomfort and lack of understanding of social cues
• distorted thoughts /perceptions and behavioural eccentricities
• belief that things in the environment around them are specifically directed at them, known as ideas of reference, but not to the intensity level of delusions
• odd beliefs (e.g. in the paranormal) or magical thinking (the belief that thinking something can make it happen)
• odd perceptual experiences, such as hearing whispering
• suspicious/paranoid (but not to the intensity of delusions)
• odd/eccentric behaviours or appearance
• don’t have close social relationships
• social anxiety (related to paranoia)

Some of the symptom criteria (like suspiciousness and lack of close relationships) overlap with other personality disorders, but the ideas of reference, odd beliefs, and odd perceptions are more specific to schizotypal PD.

As a personality disorder, this begins when younger and is well established by adulthood. It occurs in about 4% of the population, and it’s slightly more common in males. Over half of people with this disorder have co-occurring major depressive disorder, and a co-occurring substance use disorder is also common.

Treatment

Limited research has been done investigating treatment options. Antipsychotics and antidepressants are sometimes used, and there’s some research to support the use of the antipsychotic risperidone. Cognitive behavioural therapy (CBT) is another treatment option that may be used, but as with medications, limited research has been done on psychotherapeutic interventions.

Thoughts

In my mental health nursing career, I didn’t tend to come across either of these disorders, which probably has a lot to do with the types of settings I worked in. I’m pretty darn asocial, but schizoid PD is an entirely different thing from my strong introvert leanings. Schizotypal sounds like a very difficult disorder to live with. The symptoms might not be as severe as schizophrenia, but they’re very persistent, and I would imagine that quality of life is probably rather low.

Were you familiar with either of these disorders, or do you know people that experience them?

References

• Cook, M. L., Zhang, Y., & Constantino, J. N. (2020). On the continuity between autistic and schizoid personality disorder trait burden: A prospective study in adolescence. The Journal of Nervous and Mental Disease, 208(2), 94.
• Fariba, K.A., & Gupta, V. (2022). Schizoid personality disorder. StatPearls.
• Kirchner, S. K., Roeh, A., Nolden, J., & Hasan, A. (2018). Diagnosis and treatment of schizotypal personality disorder: Evidence from a systematic review. NPJ Schizophrenia, 4(1), 1-18.
• Rosell, D. R., Futterman, S. E., McMaster, A., & Siever, L. J. (2014). Schizotypal personality disorder: a current review. Current Psychiatry Reports, 16(7), 1-12.
• Zimmerman, M. (2021). Schizoid personality disorder. Merck Manual Professional Version.
• Zimmerman, M. (2021). Schizotypal personality disorder. Merck Manual Professional Version.