Symptoms, diagnosis and treatment of schizotypal personality disorder

General information

Schizotypal disorder (the term was introduced by Sandor Rado, abbreviated from schizophrenic type of phenotype ) is usually called an anomaly of thinking and emotional state in people who are characterized by social and interpersonal insufficiency, eccentric, strange and eccentric behavior. However, they cannot be diagnosed with schizophrenia because they do not meet the criteria of the Statistical Manual of Mental Disorders.
Deviations are accompanied by a small number of symptoms, their weak expression or erasure. Therefore, this disorder is also commonly called sluggish, low-progressive, latent, mild, non-psychotic, neurosis-like, sanatorium, slowly or sluggishly progressing schizophrenia. In addition, previously synonyms such as occult, larval, prodormal, simple or failed schizophrenia could be applied to this psychopathy. People with schizotypal personality disorder are usually characterized by indifference and impartiality, morbid obsession, and a tendency to social isolation. They often have inappropriate emotional reactions and paranoid ideas that do not reach the level of distortion of reality to the level of delusion . In addition, transient quasi-psychotic episodes of illusions and hallucinations .

Schizotypal personality disorder occurs in approximately 3% of the population, men are more susceptible. In psychiatric hospitals, the number of patients with this diagnosis is no more than 4.2%, and many have relatives with schizophrenia.

Causes and risk groups

The main reasons for the development of schizotypal personality disorder include hereditary predisposition and the nuances of upbringing in childhood.

In the first case, there is a risk of transmitting pathology at the genetic level , if such anomalies were diagnosed not only in parents, but also in close relatives.

In the second, a pathological condition can be provoked by ignoring children’s needs, using methods of violence against a child, and various psycho-emotional experiences.

increase the risk of developing schizotypal personality disorder :

• abuse of bad habits (especially the use of alcohol and drugs);
• genetic predisposition (increased production of dopamine and mental disorders in close relatives);
• consequences of frequent stressful situations (as well as a tendency to depression);
• pathological mental states during pregnancy (the consequence will be a negative impact on the formation of the psyche in the unborn child);
• peculiarities of upbringing (lack of attention from parents, excessive guardianship, etc.).

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Intelligence in schizotypal personality disorder:

Pathogenesis

Schizotypal disorder can be considered a characterological phenotypic variant of the schizophrenic genotype. This type of mental disorder belongs to the second axis and is generally considered a character defect, and not a “classical” psychological pathology. Typically, patients experience the development of various oddities of thinking, worldview, behavior and statements, but their severity is not sufficient to make a diagnosis of schizophrenia. And despite the fact that the line between these two concepts is very thin, with this disorder, many patients manage to maintain a level of social adjustment throughout their lives.

People with schizotypal personality disorder tend to demonstrate a complete pattern of deficits in interpersonal and social interactions, which leads to the development of acute discomfort, cognitive impairment and a resulting inability to form close relationships. Patients quite often exhibit distortions in the perception of reality - cognitive and perceptual. A tendency towards eccentric behavior and a whimsical character can be detected from the early years of youth and is expressed in various forms of manifestation and contexts. As a result, a vicious circle is formed: the more unusual and eccentric the patient behaves, the more ridicule and other negativity the patient hears addressed to him, this provokes even greater experiences and the development of social anxiety, which again makes him behave even more strangely and withdraw into isolation. to yourself.

Subsequently, the patient’s behavior increasingly manifests itself as an obsessive state and addiction to performing absurd ritual actions: constant washing of clothes and washing hands is caused by the fear of getting dirty after visiting the toilet, the monotony of daily tasks and their repetition at a certain time, the desire to always maintain the atmosphere in the house in one routine ok. Very often, relatives noted that they pestered them with bizarre requests: to sleep in bed together, to give injections of some self-selected drugs, not to turn on television programs.

Features of the flow

The question of whether schizotypal disorder can be cured is of high relevance. The positive prognosis depends on the characteristics of the course of the disease. There are three main forms of the disease:

1. The latent period is characterized by the appearance of the first symptoms of pathology, which do not have specific features.
2. The active form is an acute period in the development of the disease, characterized by the maximum severity of the clinical picture.
3. Stabilization - this form of progression is characterized by a gradual decrease in the frequency of hallucinatory attacks and delusional ideas. At this moment, changes in the personality spectrum become more pronounced.

Synonyms of schizotypal disorder - sluggish schizophrenia, latent schizophrenia, low-progressive schizophrenia

Latent form

With a latent course of the disease, signs of a decrease in the level of intelligence and social interaction are usually absent. In addition, many patients demonstrate a pronounced desire for various forms of self-realization. The first signs of the disease appear in the form of symptoms of the schizoid circle. They consist in the paradoxical behavior model, mild autism, as well as difficulties in building communication connections.

Many patients experience hysterical realities that make their behavior more demonstrative. Pedantry, anxiety and indecisiveness are specific symptoms of the latent period. Quite often, patients become overly suspicious and attach excessive importance to their person.

Affective period

This period is accompanied by hypomanic states in combination with somatization and neurotic depressive disorders. The appearance of these ailments can be characterized as one of the types of reactions to constant tension in the nervous system. Depression manifests itself in the form of a critical attitude towards oneself, irritability, uncertainty, depression and increased tearfulness. Lack of self-worth and a pessimistic attitude can lead to thoughts of suicide.

The hypomanic state can be described as a one-sided productive period combined with excessive optimism and increased physical activity. Along with this, delusional thoughts, groundless fears and insomnia appear. Most patients during this period suffer from increased excitability of the nervous system, which leads to the appearance of signs of somatic disorders. Dysfunction of internal systems and organs, pain syndromes and vegetative pathologies accompany the affective period of the disease.

Active form

Before talking about how to recover, it should be mentioned that the pathology in question can occur either in the form of attacks or continuously. Exacerbations during puberty are characterized by the occurrence of hypochondriacal or adynamic depression, which disrupts the perception of the surrounding world. In addition, the disease is accompanied by symptoms of senestopathy. At a more mature age, attacks of the disease provoke the development of paranoid and affective disorders. Acute schizotypal personality disorder, the symptoms are as follows:

1. Delusional ideas - manifest themselves in the form of obsessive desires, contrasting thoughts and suddenly developing phobic disorders. Many patients suffer from thoughts that the disease is gradually driving them crazy. The progression of the disease leads to the fact that obsession loses its affective coloring. Delusional thoughts take on a monotonous form, which has a negative impact on the patient’s condition.
2. Depersonalization is characterized as disturbances in the sphere of self-awareness. Patients cease to perceive their own personality. This condition is characterized by a lack of imagination, decreased intelligence, emotional lability and changes in appearance. A person suffering from depersonalization perceives the world around him in the form of a “movie”, the events of which he observes from the outside.
3. Hypochondria - manifests itself in the form of vegetative pathologies that disrupt the functioning of internal organs and systems. Cardiac abnormalities, increased sweating, shortness of breath, insomnia, anorexia and bulimia, as well as attacks of nausea are the primary signs of hypochondriacal disorder. This condition is also characterized by conversion symptoms and pain in various parts of the body.
4. Hysterical state - characterized by gross psychopathic disorders, which manifest themselves in the form of a passion for adventurism, vagrancy and deceit. The patient's behavior becomes demonstrative. Despite the absence of organic brain lesions, the patient gradually loses his writing skills. Under the influence of stress factors, symptoms such as nausea, heaviness in the head and hysterical attacks appear.

Most often, the disease develops before the age of 20, however, the first signs of mental illness may appear at a later age.

Classification

Based on clinical manifestations and available diagnostic data, schizotypal disorder is divided into 6 types and is called:

• Latent schizophrenia , that is, a prepsychotic or prodormal degree of development of schizophrenia, for which psychotic symptoms are not characteristic, but only mild psychopathological manifestations (ICD-10 code: F21.1.).
• Neurosis-like or pseudoneurotic schizophrenia - when the patient’s condition is dominated by psychopathological symptoms resembling neurotic ones, including depersonalization, phobias , obsession, subdepression and hypochondria (ICD-10 code: F21.3.).
• Pseudopsychopathic or psychopathic schizophrenia , including borderline states of patients with schizophrenia, are usually accompanied by character changes and various behavioral disorders (ICD-10 code: F21.4.).
• Poor symptoms or simple sluggish schizophrenia is a type of schizotypal mental disorder, as in primary defect psychosis , negative symptoms most often predominate: apathy , asthenic defect, narrowed or flattened affect, social withdrawal, however, without episodes of delusions or hallucinations (ICD-10 code: F21.5.).
• Schizophrenic reaction - a reactive, psychogenically caused psychotic reaction with signs of schizophrenia (ICD-10 code: F21.2.).
• Unspecified schizotypal psychopathy - if data collection, observation and psychoanalysis do not provide a complete picture - the diagnosis may be labeled “NOS” - without additional instructions (ICD-10 code: F21.9.).

Symptoms and signs

The symptoms of schizotypal personality disorder are similar to those of schizophrenia, but are less severe.

The thoughts and statements of a person with such a deviation are not understandable to the people around him . Because of this feature, his circle of contacts is significantly narrowed. Only close relatives can find a common language with such a person through long-term adaptation.

Symptoms of schizotypal personality disorder manifest themselves in the following conditions:

• social alienation;
• lack of bright emotions;
• tendency to communicate with fictitious personalities;
• eccentric behavior;
• magical coloring of thinking processes;
• desire for an antisocial life;
• disturbance of mental functions;
• excessive isolation;
• tendency to paranoia;
• sudden mood swings;
• unreasonable attacks of aggression;
• the presence of obsessive thoughts and ideas;
• tendency to hallucinate;
• amorphous way of thinking;
• excessive suspicion.

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Schizothymia, schizoid accentuation, schizotypal personality disorder - differences:

Causes

Unlike schizophrenia, where the trigger is a combination of genetic and environmental factors, the manifestations of schizotypal disorder and psychotic disintegration are facilitated by:

• social isolation;
• violent endocrine disturbances;
• attention defects;
• raising children by parents (one is enough) suffering from psychosis ;
• resorting to fantasies due to the lack of opportunity to return to reality through communication with other people;
• increased stress .

Typical signs

First of all, what catches your eye when you see such patients and what they themselves note is deep apathy, powerlessness, and reluctance to do anything. I just want to lie there, without getting up, all day long.

As the patients themselves note, they are not in the mood. They are neither happy nor sad. It seems as if you have died, but your body is still alive. The girl noted that during especially difficult periods she was so indifferent that she would put out a cigarette on herself in order to awaken even the slightest feelings in herself.

But one feeling still remains - anxiety. She is so strong that it is difficult to control her. However, it cannot be said that it has an emotional connotation. Rather, it should be characterized as internal tension. It is manifested by tachycardia, a feeling of heat inside, dizziness, rapid breathing. To reduce its intensity, a person uses various rituals: walking or swaying from side to side, or picking up an object and starting to turn it over in a stereotypical manner. When anxiety decreases, the patient feels weak and exhausted.

Gradually all emotions begin to fade, first good and then bad. An emotional assessment of any event is given only from a logical point of view: the sun is shining - this is good, the car has an accident - this is bad. The instinct of self-preservation decreases.

As the emotional background becomes impoverished, the ability to sympathize and empathize with others is lost.

The poverty of emotions becomes visible, as they say, is obvious: the person seems detached, there is coldness and indifference in his behavior. There is practically no facial expression, the voice is quiet and monotonous.

On the other hand, emotionlessness is replaced by outbursts of aggression and rage. It is very difficult for patients to control themselves at these moments.

Given such emotional swings, patients with SR find it difficult to communicate with people and make new acquaintances. As a rule, they are reserved, uncommunicative and shy. Others may be overly suspicious and believe that they are being harmed.

The patient's appearance is sometimes quite eccentric. He involuntarily attracts attention. The person dresses strangely, eccentrically, and there are also oddities in his behavior. Thus, the guy noted that at the moment of the “heyday” of the disease he was so consumed by apathy that he walked around in dirty and torn clothes, stopped washing and brushing his teeth.

The thinking of these people is inappropriate. They express crazy ideas, their speech is pretentious and incoherent. Sometimes they lose touch with reality. They find it difficult to maintain attention, and they jump from one topic to another, are persistent in their statements and are confident that they are right.

Patients often become interested in magic and mysticism, believe in miracles and a higher power, start going to church or join sects.

Hallucinations in schizotypal disorder are not as obvious as in schizophrenia, and are rather illusory in nature. For example, a person can clearly hear a conversation in the sound of a running computer. Or a pillar is mistaken for a person.

Derealization is manifested by a feeling of unreality of the environment. Everything around becomes blurry, colors lose their brightness, sounds lose volume. This comes upon the sick suddenly. They understand the absurdity of the situation, and this depresses them even more.

This is how a teenage girl suffering from SPD describes her condition: I have no thoughts at all. In order for them to appear, I begin to tell myself something in my inner voice. As for emotions, as a person, I have a lot of them, but I rarely experience them.

Illusions manifest themselves in the fact that in the face of one person I see the features of a completely different person. Sometimes I can see objects that are not really there. Cases of derealization are always sudden and unpredictable for me. At the same time, I feel like I’m in a dream. I went to another city. And suddenly, sitting on the bench, I couldn’t understand where I was, how I got here and what I was doing. A terrible panic seized me, I began to scream and cry.

My anomalous thinking consists of very strange logical chains. If my friend and I are walking together, and she didn’t look at me when I looked at her, strange thoughts appear. It's like this: If she didn't look at me, it means she doesn't value me. Our friendship is not so strong on her part, she does not love me. Our friendship is over.

The symptoms of schizotypal disorder are varied and similar to those of schizophrenia. But they are expressed to a lesser extent, do not lead to loss of reason, and the person understands the painfulness of his condition.

Symptoms of schizotypal personality disorder

Personality disorder of the schizotypal type was usually considered as latent schizophrenia, because such patients have a milder manifestation of symptoms than in schizophrenia and the absence of a weakening tendency of the course. In general, the pathology causes a number of symptoms that are different in nature:

• A complex of obsessive-phobic manifestations occurs in almost half of men with a similar disorder and is expressed in the form of phobias, suspicions and obsessive fears, most often various isolated or social phobias , for example, nosophobia , agoraphobia , mysophobia , etc.
• A mild depressive state is usually combined with hypochondriacal disorder and senesthopathy (patients feel that their head is heating up, their brains are turning over, burning in the genital area, etc.), which causes feelings of fear of getting sick and dying and can be manifested by a constant desire to measure pulse , blood pressure , conduct serological and other studies.
• Symptoms of hallucinatory and delusional experiences are part of the clinical picture, but focused interviews are necessary to identify them.
• Lack of emotion and coldness leads to a lack of close friends, increased anxiety when it is necessary to interact with people, which is not caused by negative self-esteem.
• Strange bizarre appearance and behavior, such as talking to oneself, incoherent, confused speech, unkemptness and disheveled appearance.

The main symptoms of schizotypal disorder negatively affect social life and worldview - magical thinking and ideas of relationships . At the same time, people are convinced that other members of society are looking around at them, paying too much attention and whispering. The condition can be aggravated due to dysmorphophobia - when a person thinks that there is something wrong with his eyes, there is something animalistic in his gaze, the bridge of the nose is too large and it is impossible to convince the patient. As for magical thinking, it negatively affects behavior and does not make it possible to fit into the framework of the subculture. The patient usually exhibits excessive superstition, belief in his own clairvoyance, telepathy, and a developed sixth sense; children and adolescents find bizarre hobbies and make fanciful assumptions.

Some typical automatic thoughts in schizotypal personality disorder

Additional signs

Along with the main above-mentioned signs of schizotypal disorder, the clinical picture also contains other symptoms in both men and women, which are usually found in neurotic diseases, mood, behavioral or personality disorders.

Neurotic manifestations. The most common disorders in schizotypal disorder include anxiety-phobic symptoms - fears, panic attacks, obsessive-compulsive symptoms; heightened introspection, increased reflection, somatoform phenomena, asthenia. There are often cases of painful concern about one’s physical or mental health (hypochondria) or “mysterious” symptoms and diseases that have not been confirmed by specialists.

Eating disorders. Eating disorders, such as anorexia or bulimia, are quite common.

Mood disorders (affective disorders). Concomitant mood disorders are the rule rather than the exception—long-term, shallow depressions or unreasonable mood elevations (euphoria), long-term or short-term, but without psychotic symptoms.

Behavioral disorders. Aggressive, antisocial behavior, absurd actions, and desire disorders in the form of vagrancy, sexual perversions, and alcohol and psychoactive substance abuse may be observed.

Some of the described disorders become permanent or “axial”; others can replace each other or join existing ones, becoming additional, aggravating the patient’s condition.

Depending on the predominance of certain symptoms, there are several main variants of schizotypal personality disorder:

• pseudoneurotic schizophrenia (external resemblance to neurosis)
• pseudopsychopathic schizophrenia (external resemblance to psychopathy)
• schizophrenia, poor in symptoms (characterized by increasing asthenia and decreased ability to work)
• schizotypal personality disorder
• latent schizophrenia

Tests and diagnostics

The International Classification of Diseases, Tenth Revision, identified 9 criteria for diagnosing latent schizophrenia, and at least five of the following points must be met:

• emotional coldness and detached appearance against the background of inadequate or restrained affect;
• eccentric, eccentric and strange behavior;
• social withdrawal, poor networking skills;
• a tendency to strange judgments, suspicion and magical thinking, which can cause eccentric behavior and not correspond to subcultural norms;
• obsessive and paranoid ideas that do not cause internal resistance and are dysmorphic, sexual or aggressive in nature;
• signs of depersonalization, derealization and unusual perception may be accompanied by somatosensory (bodily) or other illusions;
• detailed, metaphorical, hyper-detailed or stereotypical type of thinking, which may manifest itself in strange pretentious speech or in another way, but is not characterized by pronounced fragmentation;
• cases of episodic transient quasi-psychotic disorders, auditory or other hallucinations, illusions, delusional ideas, which most often do not arise in response to external provocations.

In addition, it is important to study pseudoneurotic and pseudopsychopathic manifestations, assess the level of inertia, monotony, clichedness, initiative, activity, emotional coldness, mental productivity and paradoxical judgments. To do this, they also use the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5):

• pathopsychological and delusional ideas of relationships, expressed in a person’s confidence that everyone around him is negative and prejudiced;
• increased social anxiety and difficulty making friends or simply interacting with strangers;
• manifestation of “magical thinking” - superstitiousness, belief in clairvoyants, supernatural powers, telepathic abilities and a sixth sense;
• the emergence of bizarre fantasies and activities, which ultimately affects behavior and does not correspond to social norms;
• cases of bodily illusions;
• oddities of thinking and speech (statements that are vague, long, metaphorical, overly detailed or stereotypical).

A patient can be diagnosed if at least 4 of the above signs are detected and these symptoms have been observed for two or more years. In this case, the most important thing is to distinguish the schizophrenic phenotype from schizoid, delusional and paranoid personality disorder , simple schizophrenia , Asperger's syndrome and neurosis . Typically, the patient’s condition is characterized by a peculiar severity of oddities, a course of the disease similar to a personality disorder, obsessive-phobic, hysterical, depersonalization and psychopath-like symptoms.

Disability

It is important to pay attention to the fact that disability in schizotypal personality disorder is not given to everyone . In the case of this disease, everything depends on the form of the pathology and the symptoms that come to the fore in the clinical picture. The level of social adaptation of the patient and the need for inpatient treatment are also important.

According to experts, the pathology in question develops in each person according to an individual pattern. Some of the patients have the ability to successfully integrate into society and realize their career. Others need financial support from the state, since the disease develops more rapidly, which leads to disruption of many intellectual functions. In this situation, disability is awarded to the second category of patients.

Diet for schizotypal personality disorder

Ducan's diet

• Efficiency: 5 kg in 2 months
• Terms: from 2 months
• Cost of products: from 1800 to 2700 rubles. in Week

Since people suffering from schizotypal psychopathy are prone to self-organization and fixation, limited emotions and a depressive mood, the diet should be selected individually, without causing mental anxiety or aggravating the patient’s condition. For example, if a person wants to eat exactly at 7 in the morning, at 3 in the afternoon and at 12 at night, you should not contradict him, it is best to:

• concentrate on the nutritional value and variety of your diet;
• ensure that the menu contains all the necessary proteins , fats , carbohydrates , minerals and vitamins ;
• do not indulge your addiction to unhealthy foods, but give preference to healthy foods;
• try to make the dishes as attractive and flavorful as possible, so that a person receives pleasure, aesthetic pleasure and experiences positive emotions.

Prognosis for schizotypal personality disorder

The prognosis is considered more favorable compared to the life scenario of people suffering from schizophrenia. As a delusional chronic disorder, it is incurable; it is impossible to achieve complete remission, but it is possible to restore at least partially social and cognitive functions. The condition of such people is usually unstable; when the attack ends, it may improve, but the severity of personal changes remains. Therefore, the likelihood that the patient will be able to lead an active social life, hold a serious responsible position or work with people is very small, because there is a risk of pathology transitioning to clear schizophrenia. In 10% of cases, patients attempt suicide .

How does a low-grade disorder differ from schizophrenia: features

Why are these two pathologies differentiated? As already mentioned, schizotypal disorder is characterized by personality changes, but they are not as pronounced as usual in schizophrenia: complete emotional devastation does not occur, the person is not visited by delusional ideas and colorful hallucinations, moreover, thinking is preserved, although some of its disturbances still occur happen.

This endogenous psychosis develops slowly, so the patient, receiving qualified help, can lead a completely normal life and work, communicate, and have personal and social relationships. That is, he will not be a disabled person in need of constant supervision. Moreover, at the very beginning of the disease, professional success is quite possible.

There are three periods of schizotypal disorder:

• hidden, that is, the latent period, during which nonspecific signs of pathology appear - autism, selfishness, anxiety, pedantry, hysterical reactions, suspicion, demonstrative behavior, etc.;
• active stage with the maximum set of symptoms;
• stabilization. Illusions, hallucinations, delusions become weak, but a change in personality occurs.

Schizotypal disorder occurs continuously, but exacerbations are also possible. In childhood and adolescence, attacks manifest themselves in various types of depression, thinking disorders, causeless bodily sensations - goosebumps, burning sensation, etc. In adults - paranoid disorders, expressed by litigiousness, stupid jealousy, various delusional ideas, etc.