Schizotypal Personality Disorder: Diagnostic Criteria And Tr ✓ Solved

Schizotypal Personality Disorder: Diagnostic Criteria and Treatment

Schizotypal personality disorder is characterized by magical thinking, peculiar notations, ideas of reference, illusions, and derealization. Three percent of the population have this disorder, and its prevalence increases in families of schizophrenic probands and women with fragile X syndrome (Sadock et al., 2017). This disorder shows deficits in social and interpersonal realms with reduced capacity for close relationships and cognitive or perceptual distortions, as well as eccentricities of behavior beginning in early adulthood. To be diagnosed, individuals must present with five or more of the following traits: 1) ideas of reference; 2) odd beliefs or magical thinking that influences behavior and is inconsistent with cultural norms (clairvoyance, telepathy, etc.); 3) unusual perceptual experiences, including bodily illusions; 4) odd thinking and speech; 5) suspiciousness or paranoid ideation; 6) inappropriate or constricted affect; 7) odd behavior or peculiar appearance; 8) lack of close friends; 9) excessive social anxiety that does not diminish with familiarity and is often associated with paranoid fears rather than negative judgments about themselves.

These patterns do not occur during the course of schizophrenia, bipolar, or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder (American Psychiatric Association, 2013). Diagnostically, these patients can resemble those with autism spectrum disorder (ASD). A distinction to remember is that individuals with schizotypal personality disorder (SPD) usually demonstrate no sense of humor, related to the way they perceive the world. Furthermore, SPD patients often experience more ego-boundary issues and discontinuity regarding time and personal identity (Stone, 1985).

Psychotherapy and Treatment for Schizotypal Personality Disorder

Long-term psychodynamically-informed psychotherapy is typically indicated for individuals with SPD. Poorly functioning patients may benefit from supportive therapy, while higher-functioning patients may respond better to more exploratory psychotherapy (Stone, 1985; Wheeler, 2014). Although no trials directly compare different psychotherapeutic approaches for SPD, the therapist can function as a "reality organ" for the patient, helping in grounding their perceptions (Stone, 1985).

Low-dose antipsychotics can assist those experiencing perceptual symptoms or significant discomfort due to thoughts considered highly ego-dystonic (McClure et al., 2009). While selective serotonin reuptake inhibitors (SSRIs) are usually the first-line treatment for social anxiety, they tend to be ineffective for individuals with schizotypal personality disorder. Alternatives like low-dose daily clonazepam and gabapentin have shown some potential effectiveness. Additionally, stimulants may benefit those facing cognitive challenges (Siegel et al., 1996).

Case Example

A notable case involved a 27-year-old inpatient who believed she was "Sparkle Pony" from the My Little Pony universe. She needed to have glitter on her to calm her anxiety and feared that people sitting too close would steal her sparkle. This patient worked from home as a call center technician and had a few online friends from the My Little Pony fandom but no friends in real life. Her admission was prompted by a 911 call made in hysteria after her scheduled delivery of glitter was delayed due to COVID-19. Upon evaluation, she met the criteria for SPD based on her bizarre beliefs, perceptual disturbances, odd behavior, lack of close friends, and significant social anxiety. She was admitted to rule out psychosis but was discharged shortly after evaluation.

Upon further examination, it was revealed that she had survived severe childhood sexual abuse, which may have contributed to her development of schizotypal personality disorder as a coping mechanism. Upon discharge, she was referred to a female therapist who had autism spectrum disorder and shared an interest in anime and My Little Pony, which was hoped to create a supportive therapeutic relationship.

Conclusion

Schizotypal personality disorder is a complex condition with unique diagnostic criteria and treatment options. Its characteristics can often lead to social isolation and significant distress in affected individuals. By employing a combination of psychotherapeutic interventions and, when appropriate, pharmacological treatments, patients can work toward better functioning and improved quality of life. Awareness and understanding of SPD are essential for clinicians to provide effective support and treatment.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
• McClure, M. M., Koenigsberg, H. W., Reynolds, D., Goodman, M., New, A., Trestman, R., Silverman, J., Harvey, P. D., & Siever, L. J. (2009). The effects of risperidone on the cognitive performance of individuals with schizotypal personality disorder. Journal of Clinical Psychopharmacology, 29(4), 396–398.
• Siegel, B. V., Jr., Trestman, R. L., O'Flaithbheartaigh, S., Mitropoulou, V., Amin, F., Kirrane, R., Silverman, J., Schmeidler, J., Keefe, R. S., & Siever, L. J. (1996). D-amphetamine challenge effects on Wisconsin Card Sort Test. Performance in schizotypal personality disorder. Schizophrenia Research, 29–32.
• Stone M. (1985). Schizotypal personality: psychotherapeutic aspects. Schizophrenia Bulletin, 11(4), 576–589.
• Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock’s Synopsis of Psychiatry (11th ed.). Wolters Kluwer.
• Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.