Schizotypal personality disorder: unusual thinking, social difficulty and support

Personality is made up of the thoughts, feelings and behaviours that shape how we see the world and relate to others. Rethink Mental Illness explains that these traits sit along a scale, and that when they cause significant problems for you and others you may be diagnosed with a personality disorder. The NHS describes it as a person who thinks, feels, behaves or relates to others very differently from the average person.

Schizotypal personality disorder is one of the group A types in the DSM-5 system, together with paranoid and schizoid personality disorders. Rethink says people in this group can find it hard to relate to other people, and their behaviour may seem unusual or eccentric. What marks out the schizotypal type is the combination of social difficulty with unusual ways of thinking and expressing feelings.

The name can suggest a link to schizophrenia, and the two overlap in some features, but they are separate diagnoses. Someone with schizotypal personality disorder has a long-standing pattern of personality and relationships, whereas the NHS describes schizophrenia as a long-term condition causing hallucinations, delusions and muddled thinking.

According to Rethink, if you live with schizotypal personality disorder, starting and maintaining relationships with others may feel difficult. You might have unusual thoughts or beliefs, feel cautious around people or act differently from what others expect. You may also express your feelings in ways that surprise others or are sometimes hard for them to understand.

NHS inform lists other possible features across personality disorders, including avoiding other people, being overwhelmed by feelings such as anxiety or distress, difficulty keeping stable close relationships and periods of losing contact with reality. Not everyone will have all of these. The NHS adds that someone with a personality disorder may also have other mental health problems, such as depression or drug addiction.

There is no single known cause. The NHS says personality disorders are thought to result from a combination of inherited genes and early environmental influences, such as a distressing childhood experience of abuse or neglect. Rethink adds that many people diagnosed with personality disorders have experienced trauma, but that this does not mean all who experience trauma will develop one.

NHS inform says personality disorders are a common mental health problem and usually emerge in adolescence and continue into adulthood. Research cited by Rethink suggests around 1 in 20 people live with a personality disorder.

NHS inform says diagnoses of personality disorders are made by specialist mental health services after a GP referral. Rethink says only a psychiatrist can make the diagnosis. The assessment covers symptoms and experiences, thoughts and feelings, physical health, relationships, use of drugs or alcohol and past experiences, and it is not a test or exam.

The way diagnosis is made is changing. The NHS explains that instead of a named type, someone may now be diagnosed with mild, moderate or severe personality disorder with particular traits. Rethink says the ICD-11 grades severity, while the DSM-5 still lists 10 types in 3 groups. Diagnosis can be difficult because symptoms overlap with other conditions, such as complex post-traumatic stress disorder or bipolar disorder, and because heavy drug or alcohol use can make it harder to reach the right diagnosis.

Treatment usually involves talking therapy, which the NHS says can last several months or years depending on severity and other problems. Therapy is usually long term and often involves group work, according to Rethink. Therapeutic communities are an option for some people, though only a few exist in the UK.

Medicine may be prescribed for associated problems such as depression, anxiety or psychotic symptoms, but Rethink says there is no recommended medication for personality disorders as such. It adds that NICE has guidelines for borderline and antisocial personality disorders only, so care for other types is planned individually with your team.

Many people with a personality disorder recover over time, according to the NHS, and sometimes support is all that is needed. The NHS stresses that treatment should be tailored to the person, and that having a personality disorder can have a big effect on life and on family and friends, but support is available.

Rethink notes that specialist NHS personality disorder services are not available in every area, but your GP should still be able to arrange treatment through NHS mental health services. It also points families to carers organisations for advice and support.

The NHS route is GP referral to a community mental health team or a specialist personality disorder service, where available. Long-term talking therapy can involve a wait.

Some people choose a private psychiatric assessment or private psychotherapy to be seen sooner. Check registration and experience with personality disorders, and keep your GP informed so that diagnosis and treatment are recorded consistently.