Schizotypal Personality DisorderSymptoms and Treatment

What is schizotypal personality disorder?

Schizotypal personality disorder (STPD) is a mental health condition that involves eccentric behavior, magical thinking, and distorted perceptions. People with this disorder tend to distrust others, so they have difficulty maintaining close relationships.

STPD is a cluster A personality disorder, which means it involves thinking or behaving in odd ways that affect daily functioning and well-being. For example, if a person has STPD, their paranoia and social anxiety can keep them from speaking up or seeking social interaction at all. Unusual bodily sensations, such as unexplainable tingling, can make it hard for them to focus on work. Their odd mannerisms and strange beliefs may lead to misunderstandings and push others away, resulting in an intensely lonely existence.

If you have a loved one with this personality disorder, you may feel eager to help them find stable, fulfilling connections and escape their anxieties and strange beliefs.

If you’re the one with STPD, you likely feel similarly. You may crave social support, but can’t help but feel misunderstood and alone. No one seems to relate to the way you experience the world. Worse yet, you’re often chastised, belittled, and judged when you try to share your perspective.

As with other personality disorders, schizotypal personality disorder has persistent, complex, and difficult-to-manage symptoms. However, that doesn’t mean a fulfilling life is out of reach. It’s possible to cope with the symptoms and gain a sense of closeness with others. It starts with understanding the symptoms and then learning how to manage them.

Diagnostic criteria from DSM-5

To arrive at a schizotypal personality disorder diagnosis, a medical provider will consider whether your symptoms meet five or more of the following criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the guide used by mental health professionals.

1. Ideas of reference. You believe that ordinary events have a hidden or special meaning, relating to you. If a character on a television show shares your name, for example, you may suspect that whatever happens to that character will also happen to you.
2. Odd beliefs. You tend to hold beliefs that don’t match societal norms. You may believe you can read minds or catch glimpses of the future, for example. Or feel certain that you have to perform daily rituals to ward off bad luck.
3. Unusual perceptions, such as bodily illusions. You may feel like someone is lying next to you, even though you’re alone. Or you might feel as if your limbs are heavier than usual, or experience tingling sensations that have no physical cause. These symptoms can cause confusion and distress.
4. Odd speech. You might talk in metaphors or say things that are either too vague or overly elaborate. Other people likely have a hard time understanding what you mean.
5. Suspiciousness or paranoia. You might fear that other people are plotting to mislead, undermine, or harm you, despite the lack of evidence. People who pass by you on the street seem to secretly be talking about you or recording your every move.
6. Inappropriate affect. This is where your emotional reactions seem inappropriate for the situation. You might force laughter even when a joke isn’t told, for example, or remain unenthused during a celebration. You may also have a hard time expressing your emotions, causing other people to see you as detached.
7. Odd behavior. Others say your actions are eccentric or your way of dressing is unusual. They may remark that the way you move is stiff or erratic.
8. Lack of close connections. You may only have one close friend, or perhaps no confidants at all.
9. Consistent social anxiety. Your anxiety doesn’t seem to go away, even as you spend more time with a person. Paranoia fuels your anxiety, as you remain suspicious of the other person.

Schizotypal personality disorder symptoms

STPD symptoms can be categorized based on whether they show up as cognitive, social, or behavioral issues.

Cognitive symptoms

You might routinely engage in magical thinking, which leads you to consistently find ways to link unrelated phenomena. For example, you might believe that your choice of clothing dictates the weather, or that what you have for breakfast affects how much other people like you. Unusual perceptual experiences, such as hearing whispers in your ear or seeing facial distortions when you look in the mirror, are also possible. These experiences might border on hallucinations.

Some research shows that executive functioning might be impaired in people with STPD. Executive functioning encompasses multiple skills, including the ability to problem solve, make plans, prioritize tasks, and manage emotions. You might struggle to set goals, organize your space, or come up with creative solutions in your daily life.

Similarly, other studies show that people with STPD have moderate problems with memory and attention. Your thoughts might often seem to wander, and sometimes you have a hard time recalling things.

Social symptoms

You might feel deeply uncomfortable in social situations. Anxiety may lead you to avoid being around friends and family members or avoid communicating with coworkers and peers. Your anxiety could possibly be tied to paranoia. You spend your days fearing that people around you have bad intentions or plan to deceive you or swindle you. However, you might frequently feel lonely, unfulfilled, and desiring some form of connection.

When you do socialize, you often have a hard time relating to other people and seem to be constantly misinterpreting social cues. For example, you might have a hard time discerning the meaning behind common facial expressions.

Behavioral symptoms

Maybe you’ve been told that your way of talking is peculiar. You might talk very slowly or always speak in a flat tone that can confuse other people. Or perhaps the way you talk is inappropriate for the situation—talking too loud in a library or sounding detached when accepting a compliment.

Your body language might be unusually stiff, or perhaps other people say you looked disheveled or your clothing is odd. Some of your unusual behavior might be linked to your magical thinking patterns, such as performing strange arm movements to ward off a catastrophe.

Schizotypal personality disorder causes

The exact cause of STPD is unclear. However, a combination of genetic, neurological, and environmental factors likely play a role.

If you have a relative with schizophrenia, you may be more likely to develop schizotypal personality disorder.

It’s possible that STPD involves an issue with the brain’s HPA axis—part of the body’s stress response system—or an imbalance in dopamine, a chemical in the brain. Other studies suggest that differences in gray matter, a type of brain tissue, may play a role in the development of the disorder.

Environmental issues, especially in childhood, seem to be linked to STPD. If you experience emotional neglect, physical abuse, or some other form of childhood trauma, you’re at increased risk of developing STPD. Other research points to a link between malnutrition in childhood and STPD in adulthood.

Who does schizotypal personality disorder affect?

Schizotypal personality disorder occurs in an estimated one to four percent of the population. Unfortunately, the potential for misdiagnosis makes it difficult to know the exact number.

STPD is more commonly diagnosed in men, but can also occur in women. Men seem more likely to show symptoms like difficulty with speech and expressing emotions, while women are more likely to exhibit odd beliefs, suspiciousness, and unusual perceptions.

People with schizotypal personality disorder are less likely to have a college degree or live independently. Teenagers with STPD are less likely to engage in face-to-face interactions and instead opt for online gaming and chat rooms.

STPD commonly co-occurs with disorders such as:

• Mood disorders, such as bipolar disorder.
• Anxiety disorders or obsessive-compulsive disorder (OCD).
• Post-traumatic stress disorder (PTSD).
• Substance use disorders.
• Other personality disorders, such as paranoid, borderline, or avoidant personality disorder.

Schizoid personality disorder vs. schizotypal personality disorder vs. schizophrenia

Schizophrenia is perhaps the most well-known of these disorders. It comes with intrusive and debilitating distortions in perception and thinking, such as hearing voices. Psychotic symptoms make it hard to know what’s real. In addition, a person with schizophrenia might have other symptoms, such as a lack of pleasure, incoherent speech, and impaired judgment, memory, and attention.

Schizotypal personality disorder (STPD). A person with STPD doesn’t experience hallucinations or delusions. However, as a personality disorder, STPD involves persistent traits that can affect a person’s well-being. Schizophrenia, on the other hand, might feature temporary episodes of psychosis, where the person becomes ungrounded from reality.

Research on brains shows that there might be some neurological similarities between the two conditions. It’s also possible for people with STPD to go on to develop schizophrenia. Some researchers even believe the disorders exist on a spectrum, with schizophrenia being on the more severe end.

Schizoid personality disorder involves low motivation to socialize. A person with schizoid personality disorder might seem extremely withdrawn or cold, but they don’t struggle with delusions, magical thinking, or hallucinations.

Another similar term is schizoaffective disorder. This is a disorder that combines schizophrenia symptoms, such as hallucinations and delusions, with symptoms of depression or bipolar disorder.

Schizotypal personality disorder treatment

Evidence is scarce for the effectiveness of STPD treatment options. But potential options do exist. Some combination of psychotherapy or medication may improve the quality of your life.

STPD therapy approaches

A medical provider can help you identify therapy approaches and develop a personalized treatment plan that is effective for you. Some possible therapy approaches include:

Cognitive behavioral therapy (CBT) helps you explore the connection between thoughts, feelings, and behaviors. When it comes to STPD, cognitive behavioral therapy might be useful for co-occurring issues, such as social anxiety or OCD symptoms. For example, you might reflect on how thoughts of paranoia lead to anxiety, and then how anxiety leads you to avoid intimacy.

Metacognitive reflection insight therapy enhances metacognition—the ability to think about your own thinking. It is often used to help people cope with schizophrenia symptoms. If you have STPD, it might help you build self-awareness, reflect on your challenges, such as social issues, and find solutions.

Social skills training can be useful for people with STPD. The training might focus on improving verbal and nonverbal communication skills, such as reading body language, so you feel more comfortable in interactions.

Medication options for STPD

Medication can’t cure a personality disorder. However, certain drugs might be prescribed to address specific symptoms of STPD and co-occurring disorders. Some examples include:

• Olanzapine and risperidone are antipsychotic medications used to treat conditions like schizophrenia and bipolar disorder. They might prove helpful in addressing paranoid thoughts.
• Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), might be prescribed to manage co-occurring conditions like depression and obsessive-compulsive disorder.

Self-help tips for coping with schizotypal personality disorder

Although there’s no cure for schizotypal personality disorder, there are ways to help manage the symptoms. Many of the following steps focus on taming anxiety and building the support you need.

Tip 1: Establish a structured daily routine to minimize stress

Maintaining a daily routine can give your life a sense of structure and predictability. This can minimize stress and help you to better cope with cognitive impairments that might accompany STPD.

Have a plan for your day (or week). This might involve taking a bath or reading a book to wind down before bed. You might have a set eating schedule, or specific time of the day that you like to exercise. Consider setting alarms that let you know when it’s time to move from one activity to another. It’s easier to recover from distractions and disruptions when you have set a course for your day.

Use scheduling tools. Have a go-to way to keep track of appointments, meet-ups with friends, and other events. It could be a physical calendar that you keep on your wall, a pocket-sized planner, or just an app on your phone.

Be realistic and practice self-compassion. Know that you don’t need to plot out every hour of every day. Having even a loose routine can give you the sense of stability you want. Some days you might stray from your schedule, or find yourself easily distracted from a to-do list. Extend yourself some grace, and be willing to try again the next day.

Tip 2: Engage in activities that promote relaxation and emotional well-being

Schizotypal personality disorder can come with increased levels of stress. Social situations, like interacting with strangers, can be particularly stressful for people with STPD. With that in mind, it’s important to have strategies to self-soothe and unwind.

Try out different relaxation practices. Breathing exercises, mindfulness meditation, and yoga are just a few possibilities. You’ll likely find that some relaxation techniques meet your needs or are more effective than others.

Get enough sleep. Sleep deprivation not only increases your stress levels, but it can also reduce executive functioning. Aim for seven to eight hours of sleep each night, and rely on sleep hygiene practices to hit that goal. One study found that ruminating before bedtime seemed to be linked to higher schizotypy, so using a relaxation exercise to rein in those negative thoughts might be helpful.

Exercise. Find an exercise routine that works for you. Maybe you enjoy cycling around your neighborhood in the morning or taking a long leisurely walk in the evening. Physical activity releases stress-reducing chemicals in the brain. You can even combine your exercise routine with your regularly scheduled social meet-up.

Add omega-3s to your diet. Omega-3 fatty acids, which occur naturally in foods like tuna, salmon, walnuts, and beans, may help to reduce anxiety. In addition, some research suggests that omega-3 supplements may reduce schizotypal personality disorder symptoms in children. Start by changing your diet first, focusing on healthy foods that contain these healthy fats. Then, if necessary, consider talking to your physician about trying over-the-counter supplements.

Tip 3: Maintain a strong support network of family and friends

People with STPD tend to report that they lack close connections, and this comes with feelings of loneliness. It’s possible you push people away because you feel suspicious of them, or perhaps you simply feel like they can’t understand your perspective of the world.

Persistent loneliness and social isolation can affect your well-being in all sorts of ways, including exacerbating the symptoms of your personality disorder. So, even if it comes with some initial discomfort, the path to better mental health involves building and maintaining social support.

Challenge negative assumptions. You might enter social interactions expecting the worst: “This person is prying so they can trick me.” Make a habit of catching and challenging those assumptions. For instance, is there evidence that the other person wants to deceive you? What are other possibilities? Perhaps they want to get to know you better because they think you’re interesting. By challenging your suspicions, you might ease your social anxiety.

Schedule time to socialize. If social anxiety makes it difficult for you to reach out to others, having a regularly scheduled meet-up with a trusted person can make things a little easier. You could arrange to have a weekly coffee with a coworker, dinner with a family member, or go on a bike ride with a friend.

Build your social skills. If you’re not used to socializing, you might feel a little awkward when interacting with new people. It’s also possible that your disorder makes it more difficult for you to decipher nonverbal cues. Take time to practice your social skills. Some steps to try:

• If you’re confused or uncertain about what the other person is trying to convey, ask for clarification.
• If you’re at a loss for what to say next, get curious and ask a question.
• If you’re feeling overwhelmed by anxiety, have a go-to breathing exercise or mindfulness technique for quick stress relief.

Understanding and coping with schizotypal personality disorder in a loved one

Whether they’re a friend or family member, supporting a loved one who has STPD can be a challenge. You may feel perplexed by their odd beliefs, or embarrassed by their strange behaviors. Their overly suspicious nature can leave you feeling frustrated and impatient. Try to be empathetic, remembering that their behavior stems from a complex mental health condition. While it might seem daunting at times, your care and understanding can make a significant difference in their life.

Here’s how you can be there for them:

Educate yourself on schizotypal personality disorder

The first step is to learn as much as you can about schizotypal personality disorder and personality disorders in general. Read first-hand accounts from people who either have STPD or support someone with the disorder. Aim to understand the symptoms, the many ways in which they can manifest, and the best coping strategies.

Find strategies for supporting a loved one with schizotypal personality disorder

Encourage them to pursue professional treatment. No matter how much support you provide, your loved one will likely benefit from a personalized treatment plan through a medical provider. When making the case for therapy, try to cite specific ways in which STPD symptoms are affecting your loved one’s life. If they deny having a personality disorder, you might focus on how a therapist can help them manage social anxiety or a related issue.

Make them feel heard. The things they say or do will likely seem strange or irrational. Don’t belittle them for their quirks or dismiss their strange beliefs. Ask them questions, give them space to talk, and acknowledge their perspective. If you don’t agree with what they’re saying, aim to address their feelings. For example, if they’re having paranoid thoughts, acknowledge their discomfort. “I can see why that might be scary or uncomfortable.”

Make them feel safe. Remember that they’re likely struggling with intense anxieties or feeling alone in the world. From quiet movie nights to peaceful strolls through nature, think of ways to make them feel at ease yet connected to you. In doing so, you’ll build trust.

Help them improve their social skills. You might offer to introduce them to other people or accompany them on brief social outings. Rather than pressuring them to socialize, simply offer them an invitation and, if they decline, respect their decision. Let them know you’ll continue to extend them invites in the future.

Expect setbacks. Maybe your loved one seems to be getting more comfortable with socializing, only to suddenly backslide into self-isolation. Or perhaps they start therapy but give up after a few sessions. Although you care for your loved one, acknowledge that you can’t force them to socialize or pursue therapy. Instead, celebrate signs of progress—even small victories—and continue to show you care.

Practice self-care. This can involve taking time to engage with your favorite hobbies, foster other relationships, or focus on spiritual practices. Self-care might also require you to set boundaries. For instance, you might decide to set limits on how much time you spend together if you find yourself emotionally exhausted and in need of some time alone.

Seeking help for STPD

Schizotypal personality disorder goes beyond just “odd behavior.” The symptoms can cause distress and have a real impact on a person’s well-being. However, the disorder can be managed with a combination of social support, stress-reduction strategies, and professional treatment. Whether you or someone you love has STPD, know that there’s a path to a meaningful life and healthy relationships.

Last updated or reviewed on April 11, 2025