Szeszko, P. R., Kowalchyk, M., Chu, K.-W., Aladin, S., Dolgopolskaia, E.-S., Ng, S., Hollander, S., Perez-Rodriguez, M. M., McClure, M. M., Kahn, R. S., Chan, C. C., Haznedar, M. M., Goldstein, K. E., Fleysher, L., & Hazlett, E. A. (2025). Investigation of brain white matter and social cognition in schizophrenia and schizotypal personality disorder using neurite orientation dispersion and density imaging. Molecular Psychiatry, 30(10), 4792–4800. https://doi-org.ccl.idm.oclc.org/10.1038/s41380-025-03074-1


Neuroscience of Schizotypal Personality Disorder

Behind every great claim is the research to back it up

References

While there are many factors attributing to the onset of SPD, one that is particularly referenced is the idea that Schizotypal Personality Disorder should be classified under the schizophrenia Spectrum of disorders. Originally, the concept of SPD emerged from observations of personality characteristics common in relatives of schizophrenic patients. Building off of this idea, researchers have called attention to modifiable ELF for SPD and inform readers of possible future interventions to reduce developmental risks, such as parent‐training or environmental enrichment programs


Epidemiology of SPD

From various research, psychologists have found that potential treatment options are:
1) Psychopharmacological treatment options for schizophrenia spectrum disorders include antipsychotic drugs such as Thorazine, Chlorpromazine, Clozaril, Risperdal, and Abilify.
2) Psychological treatment options for schizophrenia spectrum disorders include CBT, the goal of which is to improve the interpretations and understandings of symptoms (and experiences) which will reduce associated distress.
3) Family interventions for schizophrenia spectrum disorders include psychoeducation, problem￾solving skills, cognitive-behavioral therapy (CBT), social skills training, and inpatient/partial hospitalizations.


Treatment for SPD 

Criterion A: 2+ in the following areas:
1) Identity: Confused boundaries between self and others; distorted self-concept; emotional expression often not congruent with context 
2) Self-direction: Unrealistic or incoherent goals; no clear set of internal standards.
3) Empathy: Difficulty understanding the impact of own behaviors on others; frequent misinterpretations of others' motivations and behaviors.
4) Intimacy: Marked impairments in developing close relationships associated with mistrust and anxiety.

Criterion B: 4+ of the following traits
1) Cognitive and perceptual dysregulation: Odd thought processes; vague, circumstantial, metaphorical, overelaborate, or stereotyped thought or speech; odd sensations in various sensory modalities.
2) Unusual beliefs and experiences: Thought about reality that are viewed as bizarre or idiosyncratic; unusual experiences of reality.
3) Eccentricity: Odd behavior or appearance; saying unusual or inappropriate things.
Restricted affectivity: Little reaction to emotionally arousing situations; constricted emotional experience and expression; indifference or coldness.
4) Withdrawal: Preference for being alone; reticence in social situations; avoidance of social contacts and activity; lack of initiation of social contact.
5) Suspiciousness: Expectations of, and heightened sensitivity to, signs of interpersonal ill-intent or harm; doubts about loyalty and fidelity of others; feelings of persecution.

Criteria for Schizotypal Personality Disorder

Based on the available research, schizotypal personality disorder occurs concurrently with other psychological disorders 

Comorbidity of SPD

The etiology of Schizotypal Personality Disorder (SPD) is multifaceted, encompassing a combination of neurological, neurocognitive, and metacognitive factors that contribute to the development and presentation of the disorder.

Etiology of Schizotypal Personality Disorder

Psychotherapy approaches that may benefit people with schizotypal personality disorder include cognitive-behavioral therapy, supportive therapy, and family therapy. Although no medication treatment is identified as established, antidepressants may be useful for some patients.

Schizotypal Personality Disorder Treatments

A personality disorder characterized by: 
- Various oddities of thought, perception, speech, and behavior that are not severe enough to warrant a diagnosis of schizophrenia

Symptoms may include:
- Perceptual distortions
- Magical thinking
- Social isolation 
- Vague speech without incoherence
- Inadequate rapport with others due to aloofness or lack of feeling
- Symptoms not because of schizophrenia, other psychotic disorder, or ASD

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- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder

Cluster A Personality Disorders:

The DSM-5-TR separates Schizophrenia and Other Psychotic Disorders into the following specific disorders and groups:

- Schizotypal (Personality Disorder)
- Delusional Disorder
- Brief Psychotic Disorder
- Schizophreniform Disorder
- Schizophrenia
- Schizoaffective Disorder
- Substance/Medication-Induced Psychotic Disorder
- Psychotic Disorder Due to Another Medical Condition
- Catatonia*
- Other Specified Schizophrenia Spectrum and Other Psychotic Disorder
- Unspecified Schizophrenia Spectrum and Other Psychotic Disorder


[DSM-5-TR] List of Schizophrenia Spectrum and Other Psychotic Disorders

American Psychological Association. (n.d.). Clinical psychology. American Psychological Association. https://www.apa.org/ed/graduate/specialize/clinical 

American Psychological Association: Clinical Psychology

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

A personality disorder characterized by:
- Pervasive, unwarranted suspiciousness and distrust (ex. expectation of trickery or harm, over-concern with hidden motives and meanings)
- Hypersensitivity (ex. being easily slighted or offended, readiness to counterattack)
- Restricted affectivity (ex. emotional coldness, no true sense of humor)
-  Offended easily
- Excludes psychotic symptoms, including paranoid delusions and hallucinations

Paranoid Personality Disorder

A personality disorder characterized by:
- Long-term emotional coldness
- Absence of tender feelings for others
- Lack of desire for and enjoyment of close relationships
- Indifference to praise or criticism and to the feelings of others
- Symptoms not a result of schizophrenia or other psychotic disorders

Schizoid Personality Disorder

Previously referred to as paranoid disorder, delusional disorder is characterized by an inability to recognize reality from false beliefs called delusions. It occurs more often in middle age or later in life. This disorder is diagnosed when someone holds one or more non-bizarre delusions as truth for a month or more. These delusions cannot be sourced from culture or other causes. Symptoms include irritability and hallucinations.  

Delusional Disorder

Brief psychotic disorder is a psychotic disorder marked by a sudden onset of symptoms such as delusions, hallucinations, disorganized speech, or disorganized or catatonic behavior. The episode lasts more than one day but less than one month and is followed by complete remission. It may occur with or without a marked stressor, and future relapse is possible.

Brief psychotic disorder

Schizophreniform disorder is a psychotic disorder that affects action, thought, relationship with others, emotional expression, and reality perceived within one to six months lasting duration.

Schizophreniform Disorder

Schizophrenia is a severe psychological disorder that leads to a profound breakdown in an individual's ability to function, often necessitating hospitalization. It is characterized by significant disruptions in thought, perception, emotion, and behavior, including symptoms like hallucinations, delusions, incoherent thinking, bizarre actions, flat emotions, and a lack of motivation for basic activities. It is important to distinguish schizophrenia from dissociative identity disorder ('split personality'), as the term 'schizophrenia' refers to a 'splitting of psychic functions,' not a divided personality.

Schizophrenia

An uninterrupted illness featuring at some time a major depressive episode, manic episode, or mixed episode concurrently with characteristic symptoms of schizophrenia (e.g., delusions, hallucinations, disorganized speech, catatonic behavior) and, in the same period, delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. DSM–5 identifies the mood episodes only as either major depressive or manic and emphasizes that mood disturbances must be present for a majority of the time.

Schizoaffective Disorder

Substance/medication-induced psychotic disorder occurs when a specific substance (e.g., cocaine, dexamethasone) causes the delusions and/or hallucinations, or other schizophrenic-like symptoms. It is not to be confused with Substance/Medication-Induced Sleep Disorder.

Substance/Medication-Induced Psychotic Disorder

This condition is when hallucinations and delusions occur are physiologically caused by a separate medical condition. Psychosis appears outside states of delirium as well. The disorder significantly interferes with major areas of life.

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