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Simone Hoermann, Ph.D.Simone Hoermann, Ph.D.
A blog about the personality disorders (borderline, narcissistic, etc.) with a focus on research and therapy

Schizotypal Personality Disorder and Schizophrenia

Simone Hoermann, Ph.D. Updated: Aug 29th 2009

images of brain scanPeople with Schizotypal Personality Disorder (SPD) tend to be very uncomfortable with other people and therefore often only have a few close relationships. Based on the definition in DSM IV-TR, they can come across as reserved and distant, as well as odd and eccentric.  People with SPD frequently experience unusual perceptions, for instance, noticing flashes of light or seeing objects or shadows in the corner of their eyes and then realizing that nothing is there.  They often have a hard time trusting other people, even when they get to know them or are close to them.  People with Schizotypal Personality Disorder often dress, talk, or behave in ways that are unusual- for instance, talking in metaphors, or wearing a winter coat in the middle of the summer.  They may have spiritual or religious beliefs that do not fit into their culture and that would be considered extreme by people in their environment, for instance, about telepathy, superstitions, or a sixth sense.

Schizotypal Personality Disorder can look somewhat similar to Schizophrenia, a severe mental illness that has to do with perceiving reality in a way that is extremely different from other people.  Symptoms of schizophrenia include hallucinations, for instance, seeing or hearing things that are not actually there, as well as delusions, which means having beliefs that are irrational or not true.  Examples of delusions would be the belief that the television is sending special messages, or that someone is controlling one’s thoughts.  The expression of emotions can be impacted, too, in that often people with schizophrenia can appear like they are withdrawn and emotionally expressionless. Moreover, the way someone who has schizophrenia thinks and speaks can be affected. Thoughts can come and go rapidly, attention and concentration can be affected, and the thoughts can come out on a way of speaking that can be disorganized and jumbled.  Depending upon the specific combination of these symptoms, someone with schizophrenia can present as withdrawn, lacking in motivation, and disengaged, or, alternatively, as agitated and preoccupied.

Emil Cocarro and Larry Siever, who have done a lot of research on schizotypal personality disorder and its genetic and biological underpinnings, quote studies on families with schizophrenia showing that relatives of people with schizophrenia are at increased risk of having Schizotypal Personality Disorder. There is some indication that there is a strong genetic relation between the two disorders, since some of the symptoms and abnormal patterns in brain chemistry, brain structure, and brain functioning found in people with schizophrenia can also be found in people with Schizotypal Personality Disorder.  Some experts argue that schizotypal personality disorder might be a mild form of schizophrenia, whereas other researchers suggest that there is evidence that schizotypal personality disorder shares some characteristics with schizophrenia and that there are similar deficits in certain areas, but that there are also important differences in other brain functions that prevent people with schizotypal personality disorders from developing schizophrenia.

            It is difficult to estimate how common Schizotypal Personality Disorder is, because people with SPD tend to be socially withdrawn, which is why they may not seek help as frequently as other people, so we may not see people with SPD in our practices and clinics, and they may be less likely to participate in research studies than other people.  Estimates of how prevalent SPD is in the community range from 1% to 3% of the population.


Simone Hoermann, Ph.D.Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

Reader Comments
Discuss this issue below or in our forums.

I actually feel this relates to me - Cassandra Hernandez-Ruiz - Aug 19th 2012

Thank you for the article.

There's StPD, but also Normal Personality Disorder - shratt - Dec 15th 2011

I was diagnosed with this disease when I was 17 years old, I am 22 now, and still suffering from it. I am hyper-asocial, and I hate people much. I accept that I have a personality disorder, but so far I always used to blame myself, like saying I am crazy, I have to die, I am nothing, I am outrageous, I am a freak, and so on.. But I said so far.. Now, when I think in a more general perspective, I see other people and think: People used to bully me a lot ok, I am crazy.. but what are they if they bully a miserable person? Why normal people fight with each other persistently, and try to get rid of different, and intelligent people? Why do wars break out?..  I thought of these, then I come up with a term: "Normal Personality Disorder". Also when I did google it, I confronted such term also used by some other people as well. Normal people are noone but piece of sh** (sorry for using this word, but I am so angry towards people) robotic ones, they always repeat same things all through their lives, they humiliate poor, miserable people, they benefit from "mobbing" in job life, they gossip all through the time, they cannot be much emotional, they manipulate one another for their benefits, and so on.. In short NORMALITY IS NOTHING BUT A MILD FORM OF PSYCHOPATHY, as StPD is alleged to be a mild form of schizophrenia. What I am trying to say is that, schizotypals shouldn't blame themselves always due to their low self-esteem, if they look around, they would see that "normal" people are noones but the actual, miserable sicks deserving to have the actual low self-esteem. My proposal is that first normal (psychopathic) people should be treated first, if it happens, then there'd be such a greater world in which there is no unhappiness, or wars, or crying.

your fault - rob - Jul 12th 2011

Perhaps if the system stopped feeding us all this procesed rubbish and artificial stimulant foods our genetics wouldn't have been predisposed to be reformatted in such a way that is unnatural for the human body. stop making us worry about our futures in a monetary system of corrupt hierachys and constant b.s. our freedoms have been confined to question only ourselves now becuase we are so estranged from one another because of a label you "medical professionals" choose to stick on our names. From my experience doctors are a bunch of quacks that dont really give  aflying turd about your personal well being as they would much rather write you a prescription and get the next patient in their room. Perhaps if you took the time to diagnose a problem correctly and thouroughly people would not end up as frightened and mislead as they do sometimes. 2 cents + 5 more for good measure. I may be schizophrenic or I may be a human being. YOU DECIDE

Dont take the label - Dr BOB - Sep 30th 2010

I have every one of the diagnostic criteria for schizotypal, but i refuse to believe this is actually an illness. Having done some intense spiritual practice and awakening within me a profound realisation of God and how he communicates with us. To anyone who may be struggling to find a place in this world, i suggest finding spiritual persons who understand either in a church or healing group. Just because most of the world has not been fortunate enough to turn this internal reciever within thier mind on, does not mean we have to accept the fear based labels. Keep confidantly quiet and use your gift to heal others. Pray my friends.

Parental Support - Concerned Parent - Sep 22nd 2010

Dear Dr. Hoermann, I am a concerned parent of twenty one year old a daughter whom I believe has a personality disorder. It might be schizotypal, might be paranoid, might be avoidant, might be borderline. It might be a combination of any or all. One thing is for sure: she is not willing to get diagnosed or helped. Although she lives at home and our parental interactions with her can still impact her ultimate personality outcome, we have no way to know effective stategies because there is nothing written or programmed for parents of adult children. And these are diseases of adults only. The issues she brings to the table are beyond our expertise of effective "treatment". We are her only "treatment" and yet we are handicapped by our ignorance of effective strategies. Please email me back and let me know stategies or support mechanisms for people in our position. Thank you for your good work.

Rose - Mike - Mar 23rd 2010

The first thing you must always do is breathe. There is a deep psychological feedback loop between what you expect and what will occur. This means that if you begin to objectify yourself as potentially "having this disorder", you will miss the equal likelihood that you are afflicted with some element of what is being discussed there, but that it is not a fundamental break in your person. If that makes sense. You have to realize that thinking yourself one direct way as an object (especially i you see yourself as broken) is a bad place to start. You need to realize that while you may be afflicted with non-adaptive tendencies which hurt your emotional or cognitive life, that does not mean "you" are "any one thing", which might be "broken". Thinking like that, reinforces a reality where you will be and feel broken.

I think that you should work to find someone who can help you in a therapeutic situation, and at the same time find ways to be happy with who you are as you already are. Many people in the psychiatric community want to believe their DSM is somehow an authority for every human being alive, but this is a fairytale and a form of religious belief in your own worldview. What is true about these disorders, or the afflictions we associate with them, is that they can impact your life happiness, so in that sense we should attempt to address our lives with honesty and a willingness to isolate habits of behavior and thought which power certain feedback loops in your habitual behvaior.


Remember, the difference between below average and above average is completely invisible to average. So many of the things that become problems for people with this sort of thing could just as well be a gift if it had been nurtured in any environment where it was not considered "pathological".

If these people think that its pathological to have an extra sensory capacity to feel the emotions of other people, then I have about as much faith in these people as I do in fundamentalist religious zealots. Many things are possible, but what is most important is finding a way to love who you are already, and realizing that trusting in yourself and shining a light of honesty on your deepest secrets can be a good thing if you are willing to put faith in the process of discovery itself. Just remember that you might have far more talents than can fit in the social box, and they don't know what to do with that from a young age, and many of your problems might stem from not being properly nurtured in who you are. So you are not broken, you might just not be a great fit within the average bands of consciousness, and therefor the mis-match is what causes your problems, not you being fundamentally "broken".. If it is getting too much for you to handle be willing to ask for help and know that it will be ok if you put faith in the process of becoming happier with who you are and how you are.

Me and my disorder - Chris - Nov 19th 2009

I have been diagnosed with Epilipsy, M.S., Bipolar 1 and paranoid schizophrenia. Many years I have been hallucinations since I was a kid, and I have assoasiated this with normal. I am a very intelligent person with a state test IQ of 137. I see these things you say are dellusions, but they dont bother me, I believe they are not reality. Can intelligence mask my hallucinations and create a logical world around it. I still see things and I believe I see auras after years of research even though I don't believe that science. I am an extrovert and I have many friends can multiple personality disorders mutate a normal diagnosis. Please send me your advice or just your opinion.

image - Kashya - Nov 4th 2009

Can StPD be seen on MRI or other ways on the brain? Or only from the behavior?

I'm really worried... - Rose - Oct 29th 2009

I'm really worried because lately I've been suspecting that I may have Schizotypal Personality Disorder. After reading this article, I am sure of it. I am only 15 years old, but I have always been extremely shy (used to be thought of as Selective Mutism) and I do dress and talk strangely, or so others say. Lately, I've been having minor hallucinations (occasional flash of light, but I know it's not really there, or occasional "buzz" of light that looks slightly Tinkerbellish that I also knew immediately afterwards was not ever really there.) I do have some strange beliefs, though I really think they are true, but like I said, they are very strange (the thought is that my family is supernatural). I do not have such a trust problem, but I have a very hard time talking to people. I do have ADD/ADHD, diagnosed at 3. I also have had thoughts that I may perhaps have telepathy and not know it, but I'm not so sure anymore. What should I do? I'm really afraid. Does anyone know if Schizotypal Personality Disorder can turn into Schizophrenia? Schizophrenia does run in my family, so I'm really scared. What should I do?

What the difference? - Arczap - Oct 26th 2009

I have schizophrenia or perhaps schizoaffective disorder or maybe schizotypal personality disorder. But my shrink just says Schizophrenia and I agree. Reading this article, I think, really, you doctors are confusing yourselves. I think it should be easy as; ‘one who hears voices’ and ‘ones who do not’.  Everything else – delusions, being withdrawn, anti- social behaviour, disorganisation, personal hygiene etc etc is pretty much the same across the board. Now “SPD”?, really, stop picking out bits of the main disorder (schizophrenia), schizophrenics behaviour differ a bit but very much have the same thing. Instead: improve medications, and provide strategies for recovery and prevention in young adults. Make the links in disorders in children. Stop the behaviour identification process and start making SOLUTIONS!!!!!



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