Schizotypal Personality Disorder

Anne Silliman, Cathleen Mellor, Molly Sputh, and Sophia Mastandrea

Background Information

Willy Wonka

• Age: Unclear
• Sex: Male
• Race/Ethnicity: Caucasian
• Nationality: American
• Socioeconomic Status: Wealthy
• Occupation: Chocolatier and factory owner
• Employment History: Consistent with occupation

continued...

• Medical History: Unclear
• Psychiatry History: Unclear
• Family History: Ran away from his father as a child to start his own candy factory
• Housing Status: Lives in his candy factory with the Oompa Loopas
• Relationship Status: Single, never married
• Drug History: No evidence of any

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Diagnostic Criteria

Criteria A.

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts...

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(American Psychiatric Association, 2013)

As indicated by five (or more) of the following:

1. Ideas of reference

(American Psychiatric Association, 2013)

2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms

(American Psychiatric Association, 2013)

3. Unusual perceptual experiences, including bodily illusions

(American Psychiatric Association, 2013)

4. Odd thinking and speech

(American Psychiatric Association, 2013)

5. Suspiciousness or paranoid ideation

​

(American Psychiatric Association, 2013)

6. Inappropriate or constricted affect

(American Psychiatric Association, 2013)

6. Inappropriate or constricted affect

​

(American Psychiatric Association, 2013)

7. Behavior or appearance that is odd, eccentric, or peculiar

(American Psychiatric Association, 2013)

(continued)

8. Lack of close friends or confidants other than first-degree relatives

9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

(American Psychiatric Association, 2013)

Criteria B.

Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.

Schizophrenia

Schizotypal Personality Disorder

Brief Psychotic Disorder

Delusional Disorder

Schizophreniform Disorder

Schizoaffective Disorder

(American Psychiatric Association, 2013)

Distinguishable Characteristics from Schizoid PD

Prevalence Rates

Prevalence of SPD

• DSM-5
• .02% ¹
• LPR range
• 1-4%²
• Family members with schizophrenia. ³
• SPD most common among Cluster A disorders. ³

1 (American Psychological Association, 2013), 2 (Quirk, Berk, Pasco, Brennan-Olsen, Chanen, et al. & Williams, 2016), 3 (Esterberg, Goulding, & Walker, 2010)

Gender Differences

Gender Differences for SPD

• DSM-5
• Men > Women ¹
• Males:
• earlier onset ²
• more severe negative symptoms and disorganized speech ³
• Females:
• more social anxiety & paranoid symptoms ³

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1 (American Psychological Association, 2013), 2 (Hui, Leung, Chang, Chan, Lee, & Chen, 2014), 3 (Bora & Arabaci, 2009)

Age of Onset

Age of Onset for SPD

• DSM-5
• 18 y/o ¹

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• Adolescence-Middle Age ²
• Most PD occurs younger ²

1 (American Psychological Association, 2013), 2 (Quirk, Berk, Pasco, Brennan-Olsen, Chanen, et al. & Williams, 2016)

Biopsychosocial Risk

Biological Influences

• Family History
• Paternal mental illness ⁵
• Cognitive Issues
• Moderate cognitive impairment ³
• Decrease in corpus callosal size ⁴
• Abnormalities in the temporal lobe volume ²
• Dysregulation of the HPA axis ¹

1. (Fung & Raine, 2012) 2. (Siever, Koenigsberg, Harvey, Mitropoulou Lauelle, Abi-Dagham… & Buchsbaum, 2002) 3. (Mitropoulou, Harvey, Zegarelli, New, Silverman & Siever, 2005) 4. (Downhill, Buchsbam, Spiegel-Cohen, Hazlett, Haznedar… & Siever, 2000). 5. (Helgeland, & Torgersen, 2004)

Psychological Influences

• Attachment Issues ²
• Previous diagnosis of ADHD ¹

1.. (Miller, Miller, Harty, Newcorn & Halperin, 2008) 2. (Martins, 2010)

Sociocultural Influences

• Poor parenting ⁴
• Abuse ^{1, 2, 3, 4, 5}
• Neglect ^{3, 4, 5}
• Living in an urban setting ²
• Stressful life events ^{1, 2}
• Peer victimization ²
• Childhood trauma ⁵
• Environmental instability ³

1. (Esterberg, Goulding & Walker, 2010) 2. (Fung & Raine, 2012) 3. (Helgeland & Torgersen, 2004) 4. (Martens, 2010) 5. (Berenbaum, Thompson, Milanak, Boden & Bredemeier, 2008)

(Fung & Raine, 2012)

Maintenance Factors

Maintenance Factors

• Isolation ^{1, 2}
• Having a lower socioeconomic status ³
• Peer victimization ¹
• Family Situation ²

1. (Fung & Raine, 2012) 2. (Fonseca-Pedrero, Ortuño-Sierra, Lucas-Molina, Debbané, Chan, Cicero… Voracek, 2018) 3. (Esterberg, Goulding & Walker, 2010)

Protective Factors

Protective Factors

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• High self-esteem
• Superior school performance
• Above average intellectual skills
• Talents in areas other than school or profession
• Strong social support network

(Helgeland & Torgersen, 2004)

Development of Disorder

Development of SPD

• Temperament ¹
• Experience ¹
• Depressive Position ²
• Emotional Deprivation ²
• Abuse ³
• Life Event Stressors ³
• Peer Victimization ⁴

​

1 (Esterberg, Goulding, & Walker, 2010), 2 (Martens, 2010), 3 (Berenbaum, Thompson, Milanak, Boden, & Bredemeier, 2008), 4 (Fung & Raine, 2012)

Course of Disorder

Course of SPD

• About 20-30% develop another psychotic disorder ¹

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• Only ⅓ do NOT develop another personality disorder ³

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• High levels of SPD features tend to worsen over time ²

​

1. (Albert at al., 2017), 2. (Geng et al., 2013), 3. (Rosell, Futterman, Mcmaster, & Siever, 2014)

Course of SPD

(Geng et al., 2013)

Chance of Recovery

• Life-long symptoms ¹
• Possible remission

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• Cognitive impairments and memory problems ²

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• Less likely than other personality disorders to: ³
• Live on their own
• Have higher education

1. (Ryan, Macdonald, & Walker, 2013), 2. (McClure, Barch, Flory, Harvey, & Siever, 2008), 3. (Mcclure, Harvey, Bowie, Iacoviello, & Siever, 2013)

Comorbidity

Comorbidity

• Personality Disorders (66.7%) ²
• Borderline Personality Disorder ¹
• Antisocial Personality Disorder ¹
• Paranoid Personality Disorder ¹
• Narcissistic Personality Disorder ¹
• Avoidant Personality Disorder ³

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1. (Rosell, Futterman, Mcmaster, & Siever, 2014), 2. (Pulay et al., 2009), 3. (Ryan, Macdonald, & Walker, 2013)

Comorbidity

• Mood Disorders (44.4%) ²
• Bipolar I and II Disorders ¹

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• Anxiety Disorders (56.1%) ²
• Specific Phobias

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• Other Disorders
• Posttraumatic Stress Disorder (29.6%) ^{1, 2}
• Substance-Use Disorder (44.1%) ²

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1. (Rosell, Futterman, Mcmaster, & Siever, 2014), 2. (Pulay et al., 2009)

Treatment

• Medications:
• Stimulants ¹
• Antipsychotics ²
• Omega-3 Fatty Acids ³

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• Cognitive-Behavioral Therapy and Cognitive Training ³

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• Debated treatments:
• Antidepressants ¹

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1. (Rosell, Futterman, Mcmaster, & Siever, 2014), 2. (Koenigsberg et al., 2003), 3. (Ryan, Macdonald, & Walker, 2013)

References

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