This article will provide an in-depth and nuanced exploration of schizoid and schizotypal personality disorders. It will highlight their differences and complexities and offer insights into diagnosis, treatment, and living with these conditions.
Understanding Personality Disorders
Personality disorders apply to ten specific mental health disorders defined by an enduring pattern of individual experiences and behaviors that are very different from cultural norms and expectations.
Personality disorders tend to begin in adolescence or early adulthood, and they come with inflexible and pervasive behaviors and thoughts that can cause significant impairment in daily life and severe distress to the individual.
Personality disorders are divided into three categories based on their key characteristics. These are referred to as:
- Cluster A includes paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Cluster A disorders are characterized by odd or eccentric behavior.
- Cluster B refers to borderline personality disorder, narcissistic personality disorder, antisocial personality disorder, and histrionic personality disorder. Cluster B disorders are characterized by emotional, dramatic, or erratic behavior.
- Cluster C includes obsessive-compulsive personality disorder, dependent personality disorder, and avoidant personality disorder. Cluster C disorders are characterized by anxiety and fear.
It is important to differentiate between disorders within a given cluster, which can be difficult because they share similar traits and comorbidities. With the help of a trained professional and personal education, you can learn to identify some of the key symptoms that differentiate between the two and find the right type of treatment if diagnosed.
This article will review the symptoms and behaviors of schizoid vs schizotypal, the overlapping features of schizoid or schizotypal, and the diagnosis and treatment approaches for both.
Schizoid Personality Disorder
Schizoid personality disorder is a condition where individuals have consistent patterns of disinterest and detachment, particularly where social connections and relationships are concerned. It’s not uncommon for someone struggling with schizoid personality disorder to find no enjoyment in close relationships, even with their families. They are often emotionally detached and avoid social activities or interactions.
Diagnostic criteria: schizotypal vs schizoid
To receive a diagnosis of schizoid personality disorder, an individual must demonstrate the following criteria:
- They must exhibit a pervasive pattern of detachment from social relationships, with limited emotional expression in social settings, both of which start in childhood or adolescence and present with at least four of the following:
- Does not desire or enjoy close relationships, including those with family
- Selects solitary activities almost always
- Has little interest in any sexual experiences with anyone else
- Finds pleasure in few, if any, activities
- Has no close friends or confidants beyond their first-degree blood relatives
- Is indifferent to the criticism or praise of others
- Has detachment and emotional coldness
- They must not have the features above because of schizophrenia, bipolar disorder, or depressive disorder
Key features of schizoid personality disorder
Someone with schizoid personality disorder has a pervasive pattern of detached social relationships with limited emotional expression when it comes to interpersonal settings.
Someone with schizoid personality disorder, for example, won’t have any desire for intimacy, and they won’t care about developing close relationships or getting much satisfaction out of being part of a social group or even their family. They will even have limited interest in any sexual experiences and take very little pleasure in any activities.
For example:
Christian doesn’t derive pleasure from interpersonal experiences like walking on the beach at sunset, nor does he have any feelings of pleasure from bodily or sensory experiences like having sex.
It’s not uncommon for people with SPD to be considered loners because they prefer to be by themselves and remain socially isolated. The hobbies and activities they perform often exclude interaction with other people intentionally.
Similarly, they will prefer abstract tasks like mathematical games.
Individuals who have schizoid personality disorders are often indifferent to criticism or approval from other people. They tend to be oblivious to the subtleties of social interactions like spoken or unspoken social cues, body language, or even facial expressions. They’ll also demonstrate limited visible emotional reactions and fail to reciprocate basic facial expressions like nods or smiles to other people.
Schizotypal Personality Disorder
Schizotypal personality disorder brings about similar discomfort when it comes to social interactions and relationships with individuals often described as eccentric or odd. However, people who struggle with schizotypal personality disorder usually have unusual behaviors, thoughts, or speech patterns that interfere with their ability to not only form relationships but maintain them, whether with friends or family.
Diagnostic criteria: schizotypal vs schizoid
To receive a diagnosis of schizotypal personality disorder, an individual must demonstrate the following criteria:
- They have a pervasive pattern of interpersonal and social deficits where they experience great discomfort with close relationships and limited capacity for them. They also have cognitive or perceptual distortions and eccentric behavior, all of which manifest in childhood or adolescence and present with at least five of the following:
- Ideas of reference
- Odd beliefs or magical thoughts that influence either behavior and are not considered normal, such as a belief in clairvoyance, bizarre preoccupations, belief in telepathy, superstitiousness
- Unusual perceptual experiences
- Odd thinking and communication like circumstantial, stereotyped, vague, metaphorical, or overelaborate thinking/speech
- Paranoid or suspicious ideas
- Inappropriate or constricted affectations
- Accentric, peculiar, or odd appearances or behaviors
- A lack of confidence or close friends other than their first-degree biological relatives
- Excessive social anxiety that does not go away no matter how familiar they become with someone which tends to be associated with paranoid fears, not fear about being judged by others
- They must not have the features above because of schizophrenia, bipolar disorder, or depressive disorder
Key features of schizotypal personality disorder
Someone with schizotypal personality disorder has a regular pattern of interpersonal and social deficits. They are usually acutely uncomfortable with the idea of close and personal relationships, even with their families.
Someone with schizotypal personality disorder will also struggle with things like incorrect interpretations of incidents or viewing external events as having particular meaning just for them. It’s not uncommon for someone with schizotypal personality disorder to be superstitious or otherwise preoccupied with paranormal activity that is not considered normal.
Someone with STPD might believe they have special powers, like the ability to read someone else’s thoughts or sense events before they happen. They might believe that they have magical powers over others.
For example:
John believes that his wife taking the dog for a walk is a direct result of him having thought about her walking the dog 1 hour before.
They might also believe that they can make people comply with magical rituals.
For example:
Sarah believes that walking past the African vase she has in her living room three times will help her avoid getting into car accidents.
STPD can manifest with perceptual alterations, such as an individual believing that someone else is present or hearing a voice. It’s not uncommon for individuals with this disorder to be suspicious and paranoid.
For example:
Margaret believes that all of the colleagues at work are trying to undermine her reputation with their manager.
Those with schizotypal personality disorder usually have odd or eccentric behaviors, mannerisms, and ways of dressing, like wearing clothes that don’t fit correctly and are covered in ink stains, avoiding eye contact in social settings, or being unable to communicate with normal workplace banter.
Schizoid vs Schizotypal: Key Differences
Schizoid personality disorder vs schizotypal sex/gender issues
One difference between schizoid personality disorder vs. schizotypal personality disorder is the prevalence within different genders.
SPD
Research suggests there is no difference in prevalence based on gender for schizoid personality disorder.
STPD
Some research suggests that schizotypal personality disorder is slightly more common in men than it is in women.
Cultural issues with schizotypal vs schizoid
When comparing schizotypal vs. schizoid personality disorder, some culturally related issues have to be taken into account before a diagnosis can be provided, as these cultural issues might explain the behaviors and diagnostic manifestations.
SPD
Certain cultural backgrounds exhibit interpersonal styles as well as defensive behaviors that can be mislabeled as schizoid personality disorder.
For example:
A child or adolescent who moves from a rural community to a major city might experience what is referred to as emotional freezing, where they cut themselves off emotionally for several months, restricting their communication with others and engaging in solitary activities.
Immigrants who come from other countries might be mistaken as cold or indifferent, mislabeled as having schizotypal personality disorder when, in reality, their emotional isolation and limited social interaction is a response to social ostracism.
STPD
Cognitive distortions associated with schizotypal personality disorder have to be viewed in the context of culture. Certain cultures that practice supernatural or religious beliefs might seem to exhibit schizotypal diagnostic criteria when, in reality, those criteria have more to do with religious beliefs or practices. Some examples include:
- Speaking in tongues
- Believing in life beyond death
- Having magical beliefs about health
- The sixth sense
- Mind reading
- Voodoo
- Shamanism
- The evil eye
Overlapping Features and Commonalities
There are many areas where schizoid and schizotypal personality disorders have overlapping features and commonalities, such as their prevalence, developmental manifestations, risks, and cultural issues.
Prevalence of schizoid personality disorder vs schizotypal
Neither schizoid personality disorder nor schizotypal personality disorder are common in the United States, a shared similarity between the two.
SPD
Schizoid personality disorder is very uncommon, with a prevalence across the United States of around 1.3%.
STPD
Schizotypal personality disorder is even less common than schizoid personality disorder, with an average across the United States of 06%.
Developmental difference between schizoid and schizotypal
Some of the similarities between schizotypal personality disorder and schizoid personality disorder have to do with their development. When symptoms first manifest, they do so at the same time frame, and they share three key symptoms: poor peer relationships, solitary behavior, and underachievement in school. However, that is the extent of the developmental features of SPD, while STPD has several more.
SPD
Schizoid personality disorder manifests in childhood and adolescence with features like:
- Poor peer relationships
- Solitary behavior
- Underachievement in school
With schizoid personality disorder, the early manifestations tend to mark the individual as different from everyone else, and that often results in a lot of teasing and bullying from their peers.
STPD
Schizotypal personality disorder manifests in childhood or adolescence with characteristics like:
- Solitary behavior
- Poor peer relationships
- Hypersensitivity
- Social anxiety
- Underachievement in school
- Peculiar thoughts or language
- Bizarre fantasies
It is not uncommon for children with schizotypal personality disorder to seem odd or eccentric and to be teased or bullied by their peers.
Risks for schizoid and schizotypal
One similarity between schizoid and schizotypal personality disorders is the risk factor. Both share common genetic and physiological risks.
SPD
Causes are still being researched, but there are genetic components such that individuals who have a family member with schizophrenia or schizotypal personality disorder are more likely to struggle with schizoid personality disorder.
STPD
Schizotypal personality disorder tends to appear in individuals who have first-degree biological relatives who also have schizophrenia or other psychotic disorders.
Certain studies have found that rare environmental factors can also increase the risk among those who already have a genetic predisposition.
Comorbidity for schizoid or schizotypal
There are common mental health conditions known to coexist for those with schizoid or schizotypal personality disorders.
SPD
Individuals with schizoid personality disorder might experience brief psychotic episodes that last anywhere from a few minutes to a few hours in response to severe stress. It is also common for individuals to sometimes develop major depressive disorder, which can be diagnosed and treated with the help of a professional.
STPD
Individuals with schizotypal personality disorder can experience transient psychotic episodes in response to severe stress, but they are often insufficient in terms of how long they last to Warrant any type of additional diagnosis.
Similarly, those with schizotypal personality are at risk for developing co-occurring schizoid, paranoid, avoidance, or borderline personality disorders.
Differential diagnosis: What other mental health issues share symptoms
It can be very difficult to get a correct diagnosis because there are several mental health issues that have shared symptoms, not to mention the overlapping traits between schizoid personality disorder and schizotypal personality disorder. For that reason, it’s essential to work with a professional psychiatrist to get an accurate diagnosis, which can take several sessions, and the right type of treatment.
SPD
Schizoid personality disorder shares traits with things like delusional disorder, schizophrenia, and depressive or bipolar disorders because of the periods of persistent delusions or hallucinations.
However, with a schizoid personality disorder, symptoms must be present before any psychotic symptoms, and they have to continue long after hallucinations or delusions have ended.
There can be problems differentiating between schizoid personality disorder and autism spectrum disorder, but autism spectrum disorder has unique stereotyped interests and behaviors that are not associated with schizoid personality disorder.
Schizoid personality disorder might share symptoms brought about by medical conditions that have to be ruled out by a professional when receiving a diagnosis.
Other personality disorders are more easily confused with schizoid because of the commonality of features.
STPD
Schizotypal personality disorder, much like schizoid personality disorder, shares traits with things like delusional disorder, schizophrenia, depressive disorder, and bipolar disorder in that it has similar periods of persistent psychotic symptoms, namely hallucinations and delusions.
In order to differentiate between schizotypal personality disorder and other disorders, the symptoms of the personality disorder must have been present before any psychotic symptoms began and, much the same as SPD must continue after the delusions and hallucinations come to an end.
There can be challenges differentiating between schizotypal personality disorder and neurodevelopmental disorders among children, particularly children whose behaviors are characterized by social isolation, peculiarity of language, and eccentricity.
These types of communication disorders and neurodevelopmental disorders can be differentiated based on the severity of the language disorder and whether or not there’s any impairment in a language assessment. For example, autism spectrum disorders have an even greater lack of emotional reciprocity and social awareness compared to schizotypal personality disorder.
Schizotypal personality disorder symptoms could manifest as the result of other medical conditions that have to be ruled out by a psychologist.
Other personality disorders can be easily confused with STPD because of the overlapping features. With schizotypal personality disorder and avoidant personality disorder, close relationships are very limited, but with an avoidant personality disorder, the individual desires relationships but they don’t have them because they’re afraid of rejection, whereas schizotypal personality disorder doesn’t want the relationships and deals with persistent detachment.
Tangentially, individuals with narcissistic personality disorder might have the same type of social isolation and alienation, but those aspects derive from fears of flaws or imperfections.
Borderline personality disorder has similar transient symptoms, but those are related to shifts in stress and are often dissociative. Those with schizotypal personality disorder might have psychotic symptoms, but they get worse under stress.
There is a high rate of co-occurrence between borderline personality disorder and schizotypal personality disorder, so it is best to work with a professional therapist to get a diagnosis.
Can you have both schizoid and schizotypal personality disorder?
If you have personality features that meet the diagnostic criteria for more than one personality disorder, including schizoid personality disorder and schizotypal, you can be diagnosed with both.
However, schizoid personality disorder is usually distinguished from schizotypal by a lack of perceptual or cognitive distortions and social isolation that is intentional rather than attributed to a fear of rejection. Schizoid personality disorder has a much more pervasive level of detachment and desires to avoid social intimacy.
Diagnosis and Treatment Approaches
Given the many shared diagnostic features and other patterns, it’s important that you work with a therapist or psychiatrist to get a proper diagnosis if you feel that you exhibit some of these symptoms.
Diagnostic processes for schizoid and schizotypal personality disorder
When you work with a therapist or psychiatrist, the diagnostic processes for schizotypal vs. schizoid will include individual therapy sessions where:
- A doctor conducts a physical exam to rule out potential medical conditions responsible for the symptoms.
- You get a referral for a mental health screening.
- A therapist asks you about your symptoms and goes through several questions to rule out which other conditions, if any, might coexist or better explain how you feel.
A therapist will work with the DSM-5 as their metric for reviewing whether or not your symptoms meet the diagnostic criteria when your symptoms have begun and whether other conditions explain any other symptoms.
Overview of treatment options
With schizoid personality disorder and schizotypal personality disorder, it can be difficult to reach out to a mental health care professional, especially given that you may not be emotionally close to anyone and you might not be sure that you want to change.
Nonetheless, overcoming the complete lack of desire for emotional connections or social closeness can help you get the treatment you need to improve certain areas of your life. Treatment often includes:
- Individual therapy
- Group therapy
- Medication for specific symptoms
Talk Therapy
One of the primary forms of treatment is talk therapy or psychotherapy. Psychotherapy usually takes place individually, so you work with a single therapist, limiting the amount of social interaction you have.
During your individual sessions, which usually last around 1 hour and take place once per week, your therapist gets to explore aspects of your relationships and your communication, and after listening to you, they can help you set goals for yourself and work toward achieving them.
Cognitive behavioral therapy is another option for schizoid personality disorder or schizotypal personality disorder, which focuses on helping to acquire the social skills you need to make changes like recognizing social cues that you might not pick up on, such as the following:
- Facial expressions
- Body language
- Spoken cues
Medication
There are no current medications for schizotypal personality disorder or schizoid personality disorder; however, there are medications that can be prescribed to help with specific symptoms or issues like depression or anxiety if those manifest for you. Similarly, if you have co-occurring disorders, you can find medication and additional treatment for the second or third disorder symptoms, which might help reduce the schizotypal or schizoid symptoms.
Group Therapy
Group therapy can provide additional support when it comes to learning how to interact with others and practice social skills. If one of your goals is to improve your social interactions, group therapy can help complement the information learned in individual talk therapy.
Summing Up
With schizoid vs. schizotypal personality disorder, there are several overlapping features and common traits. Can you have both schizoid and schizotypal personality disorders? Yes. Understanding the difference between schizoid and schizotypal in terms of diagnostic criteria and key features can make it easier to understand what it is you or someone close to you might be struggling with.
However, given that there are many features that overlap and many other conditions that have shared features and manifestations, it’s important to work with a professional to get a proper diagnosis and to find the right treatment plan.