The field of psychiatry addresses the needs of patients with various mental disorders, who often have individual symptoms and do not respond to traditional treatment procedures. One of the mental health issues is schizotypal personality disorder, a problem characterized by altered cognitive perceptions that directly affect behavioral functions. This issue is characterized by hallucinations, manic states, and other related problems that create difficulties not only for patients but also for their loved ones. In addition, schizotypal personality disorder can lead to the development of other dangerous states, such as anxiety disorders. The available clinical information indicates that the problem develops significantly more often in adulthood, although cases of the illness in children and adolescents do occur. This paper aims to review the features of the manifestation of schizotypal personality disorder, its key symptoms, and available treatment options. Along with medical interventions, appropriate therapeutic programs are utilized, namely group, family, cognitive-behavioral, and supportive therapies. The use of a credible academic base makes it possible to identify the most effective interventions that can be combined to achieve the most positive effect on the patient’s psyche.
Schizotypal Personality Disorder: An Inventive Review in Psychology
Schizotypal personality disorder is a mental illness that has peculiar features and manifests itself distinctively. According to the American Psychiatric Association (2013), schizotypal personality disorder (SPD) is characterized by interpersonal deficits, such as suspiciousness and difficulty establishing and maintaining close relationships. This condition may also be associated with cognitive or perceptual distortions and eccentric behavior, all of which are pervasive throughout much of an individual’s lifetime (American Psychiatric Association, 2013). Individuals with SPD are not psychotic (out of touch with reality), although others typically perceive them as odd or strange. They often harbor strange ideas, such as magical thinking, which is the belief that merely thinking about an event, for instance, a loved one’s death, can trigger that event. SPD typically begins in early adulthood and is present in about 3% to 5% of the general population (Cook et al., 2020, p. 94). Thus, the disorder rarely affects children, although there are precedents.
It is not uncommon for patients with the diagnosed disorder to exhibit eccentricity in behavior, which is the reason for their lack of a large social circle of interaction. As a rule, they do not have a precise idea of how close relationships are built. The inability to adequately interpret the behavior and actions of others complicates communication, and distrust of society is often a characteristic feature in such patients. These concomitant problems can lead to severe anxiety and a tendency to avoid social situations because the person with the disorder tends to hold peculiar beliefs and may have difficulty responding appropriately to social cues. Schizotypal personality disorder is usually diagnosed in adulthood and may continue across the lifespan, although some treatment options, such as medications and therapy, can improve symptoms.
Overview of SPD
Schizotypal personality disorder (SPD) first appeared in the American Psychiatric Association (1980) diagnostic nosology in 1980, although its roots go back more than 100 years, which were under such labels as borderline, ambulatory, and latent schizophrenia. SPD is unique that has been conceptualized both as stable personality pathology and a milder manifestation of schizophrenia-spectrum psychopathology. SPD has remained largely unchanged for the last 40 years, with emphasis on interpersonal deficits, cognitive and perceptual distortions, and odd and eccentric behaviors (Kwapil & Barrantes-Vidal, 2012). An alternative model for personality disorders (AMPD) retained many aspects of SPD while offering a hybrid model that included both disturbances in personality functioning and specific pathological personality traits. The present perspective was examined based on the empirical literature on the success of the AMPD model when capturing SPD (Kwapil & Barrantes-Vidal, 2015). Although research is limited, there is still evidence that the six trait facets proposed for the AMPD have provided good coverage of SPD and are closely monitored to criterion counts from the categorical SPD diagnosis.
SPD vs. Schizophrenia
Schizotypal personality disorder is often confused with schizophrenia, another mental illness that is accompanied by psychosis, that is, the loss of an adequate perception of reality. Despite the fact that the disorder in question is also sometimes accompanied by psychosis, its dynamics and duration are not as pronounced as in schizophrenia (“Schizotypal personality disorder,” 2022). As another difference, one may note distinctive perceptions of reality. Patients with schizotypal personality disorder can usually recognize that their visions are hallucinations, while those with schizophrenia find it difficult to prove that his or her beliefs about a particular phenomenon are false. While speaking of similarities between the two diagnoses, similar treatment practices apply for both disorders (“Schizotypal personality disorder,” 2022). However, when comparing the severity of the courses of such diseases, schizophrenia is considered a more severe mental health problem.
Symptoms of SPD
With regard to symptoms of disorders, people may think it is a couple, but for SPD, their number is larger. The disorder typically includes five or more signs and symptoms (Zimmermann et al., 2019). People with SPD usually do not have close friends, except for immediate family, and they are uncomfortable relating to others. These people are reluctant to communicate with others because they do not feel attached to society. Life phenomena that are familiar and understandable to an ordinary person often cause anxiety in SPD patients who perceive reality incorrectly or inadequately (Zimmerman, 2022). It is not uncommon for people with this diagnosis to be convinced of their superiority over others, being confident that they have superpowers, for instance, telepathy. The presence of so-called magical abilities is a way for them to manipulate, and they are confident that they can force others to obey (Zimmermann et al., 2014). Their speech may be odd, for example, filled with abstract or incoherent phrases that only they understand.
Mannerism and odd dressing habits are common features of people with SPD. They may ignore ordinary social conventions and social cues and may interact with others inappropriately or stiffly (Zimmermann et al., 2014). Suspicion is another characteristic feature of such a diagnosis. In the case of the disorder in adolescence, teenagers show high levels of anxiety, which manifests itself in social withdrawal and solitude (See et al., 2021). A child may be an underperformer in school or appear socially out whack with peers, which may result in teasing or bullying.
In schizotypal personality disorder, cognitive experiences reflect a more florid departure from reality, for instance, ideas of reference, paranoid ideas, bodily illusions, or magical thinking. Moreover, during this condition, greater disorganization of thought and speech occurs than in other personality disorders (American Psychiatric Association, 2000). The reported prevalence of schizotypal personality disorder varies, but the estimated prevalence is about 3.9% of the general US population, and the disorder may be slightly more common among men than women (Bachetti et al., 2020, p. 194). Over half of the patients with schizotypal personality disorder have more than one episode of major depressive disorder, and 30 to 50% of them have major depressive disorder when schizotypal personality disorder is diagnosed (Bachetti et al., 2020, p. 197). These patients also often have a substance use disorder (Zimmerman, 2022). As a result, a large number of related health problems make the disorder in question dangerous and deserving close attention and adequate treatment.
Treatment Options: Psychotherapy and Low-Dose Antipsychotic
The disorder under consideration may be treated differently depending on the severity of the patient’s condition. Psychotherapy (talk therapy) and low-dose antipsychotic (neuroleptic) medications may be considered the main treatment options for SPD (Savero et al., 2022). Healthcare providers sometimes tend to prescribe low-dose antipsychotic medications for people with SPD to treat some cognitive impairments, odd speech, depression, anxiety, and impulsivity. Antipsychotic medications are useful for most people with moderately severe schizotypal symptoms and those that experience mild, transient psychotic symptoms (Gilleen et al., 2020). As for psychotherapy (talk therapy), it is a term utilized to describe a large number of intervention techniques that allow for addressing patients’ unique emotions, thoughts, and behaviors. When working with a mental healthcare professional, such as a psychologist or psychiatrist, patients or their loved ones can count on support, education, and guidance.
Types of Psychotherapy
Treatment for schizotypal personality disorder often includes a combination of psychotherapy and medication. Many people can be helped by work and social activities that are a fit for their personality styles. Psychotherapy may help people with SPD begin to trust others and learn coping skills by building a trusting relationship with a therapist. The types of psychotherapy that may benefit people more with schizotypal personality disorder include group therapy, cognitive behavioral therapy (CBT), supportive psychotherapy, and family therapy.
Group Therapy
Group therapy is a type of intervention when a group of people with the same diagnosis meets each other and discuss their problems together under the supervision of a medical specialist, as a rule, a therapist or psychologist. This form of therapy tends to help people with schizotypal personality disorder by developing social skills because social anxiety and awkwardness are addressed (Attademo et al., 2021). Nevertheless, people whose SPD are manifested severely may be reluctant to participate in group sessions because their behavior may provoke others, especially if they have a prominent paranoia when thinking and with their behaviors.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is an intervention characterized by a structured and goal-oriented interaction process. In this instance, a therapist or psychologist helps patients take a closer look at their thoughts and emotions to understand how their inner feelings affect their actions. For instance, when interacting with a person with SPD, a therapist may focus more on reality testing and attention to interpersonal boundaries (Perris et al., 2019). In addition, a qualified medical professional can identify personal manifestations of the problem, such as paranoid behavior patterns, and help the patient deal with them successfully.
Supportive Therapy
Supportive psychotherapy can also be useful by offering encouragement and fostering adaptive skills. The goal is to establish an emotional, encouraging, and supportive relationship with the patient and then help them develop healthy defense mechanisms, especially in interpersonal relationships. Supportive practices allow for creating a clear acceptance of the problem in the patient, thereby stimulating the desire for recovery (Grover & Avasthi, 2019). Since SPD often manifests itself in the form of poor communication with others, supportive therapy is an opportunity to help people with this problem socialize and feel safe in being around other people. Feeling supported, it is easier for patients to adapt to normal living conditions. As a result, by developing confidence in the patient’s ability to overcome a problem, therapists help develop healthy social relationships.
Family Therapy
Patients with SPD find it difficult to get along with other people, including those close to them. For family members, the neighborhood with such a person is also stressful, and frequent quarrels can be the result of high emotional stress. In such conditions, it is difficult to form an environment of trust. Therefore, when speaking about the manifestations of SPD, one should note that the problem affects not only patients themselves but also their families, who need the right behavioral guidelines (Law et al., 2021). Involving the patient’s loved ones in education sessions may help improve communication, trust, and the ability to work together to assist the person in reducing the symptoms of SPD.
Discussion
The analysis of the aforementioned therapeutic interventions can help identify the optimal type of therapy for patients with SPD. When evaluating the treatment options presented, one may notice that family therapy is a convenient form of interaction with the individual and his or her loved ones, allowing for a potentially effective recovery environment. As Law et al. (2021) argue, combining individual interaction strategies with family interventions creates optimal conditions for the most effective impact on the patient’s psyche. Slotema et al. (2019) confirm this thesis and state that, regardless of the severity of the disorder and concomitant factors, educational work with patients’ relatives should be part of any therapeutic program. These nuances speak in favor of family therapy as one of the most important and effective strategies for helping targeted patients.
Since the mental disorder in question is characterized by individual symptoms and manifests itself differently in each patient, cognitive behavioral therapy is another effective intervention. Perris et al. (2019) note that this therapeutic mechanism is the basic and first choice of treatment for the patient, and based on the conclusions of the medical specialist, additional and auxiliary programs are prescribed. The evaluation of personal anxieties, fears, hallucinations, and other manifestations of SPD allows for identifying the patient’s individual views on one’s problem, which is more difficult to achieve, for instance, through group therapy. In collaborative sessions, the patient opens up when seeing the interest of others and feeling feedback (Attademo et al., 2021). However, this format does not allow for addressing the problems of each session participant comprehensively, which indicates greater effectiveness of personal than group interventions, especially given the atypical manifestations of the disorder.
When speaking of supportive care, one might notice that this type of intervention has a number of advantages, but its effectiveness in the absence of other supportive procedures is lower than with other therapeutic programs. This is especially true for patients with severe manifestations of the disorder, and in these cases, additional interventions should complement supportive care (Kedare & Syeda, 2020). Thus, family and cognitive behavioral therapy sessions are the most effective programs for helping patients with SPD.
Conclusion
Schizotypal personality disorder is a common personality disorder that manifests itself most often in adulthood and is often characterized by eccentric and odd behavior. Once diagnosed, full recovery is unpredictable, but appropriate therapeutic interventions, supplemented by medical treatment as needed, can alleviate symptoms and help patients socialize. The disorder can manifest itself in many ways and include both typical symptoms, such as manic behavioral patterns, and personality peculiarities, such as hallucinations, sleep problems, and other health issues. Not only is STPD a chronic condition, but it also requires lifelong treatment. If left untreated, the prognosis for schizotypal personality disorder is generally poor. It is common for individuals to have other mental health conditions that can include social anxiety disorder.
Among the therapeutic options available for addressing SPD, several alternative programs are commonly used. Among them, it is customary to single out group, cognitive-behavioral, supportive, and family therapy. Based on the evaluation of all these types of interventions, one may notice that family and cognitive behavioral therapies are the most effective. In the first case, patients and their relatives receive the necessary education and guidelines, which allows the person with SPD to better socialize and count on the help of family members. Cognitive behavioral therapy is designed to address the individual problems of the patient, which is an effective method of interaction and contributes to the effective addressing of personal symptoms. Group therapy provides an opportunity to get feedback from other patients and learn more about the problems of others, but it, like a supportive type of intervention, is best combined with other practices. Medication treatment is also possible, and antipsychotic drugs may be prescribed as directed by the medical specialist. Seeking professional help in a timely manner can help identify the disorder at an early stage, making it more effective to manage.
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