Schizotypic personality disorder

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Classification according to ICD-10
F21 Schizotypal Disorder
Schizotypal Personality Disorder
ICD-10 online (WHO version 2019)

The schizotypic personality disorder (STP) or schizotypal disorder is characterized by a profound behavioral deficit in the interpersonal and psychosocial area. This manifests itself in behavior peculiarities, a lack of ability to close personal relationships and distortions in thinking and perception. The demeanor is often quirky and eccentric.

Overall, little research has been done on this personality disorder . It is assumed that 0.5–3% of the population are affected. Some authors assume that this disorder, especially in its severe form, affects only 0.05–0.1% of the population.

The schizotypic personality disorder shows a chronic course with varying intensity. Although it occasionally turns into definite schizophrenia (up to 1/4 of the time), the majority of people affected never develop psychosis . No exact beginning can be determined; Development and course usually correspond to a personality disorder. Schizotypal disorder is more common in people with manifest schizophrenia in the family. It is therefore believed that it embodies part of the genetic spectrum of schizophrenia and that it is a weakened form.

To the subject

There are a number of outdated names for schizotypal disorder, such as: B. borderline schizophrenia , latent schizophrenic response, or pseudoneurotic schizophrenia . The term “schizotypical” was originally intended as an abbreviation for “schizophrenic phenotype ”. It was coined in 1956 by Sándor Radó and referred to people who, in his opinion, had a genetic link to schizophrenia in common, but did not show any psychotic behavior. Paul Meehl then developed this idea further in his work on schizotaxia .

description

The schizotypic personality disorder is characterized by an often involuntary social withdrawal. Schizotypes rarely make social contacts, and they find it difficult to maintain them because they distrust people very much. Even if you are together for a long time, this is not reduced, but rather stronger. It is not uncommon for this to lead to irritable and aggressive behavior. Other people notice her inaccessible, low-spirited and indifferent behavior.

Unconventional behavior is described as typical, which manifests itself in a bizarre and grotesque to unkempt external appearance or an idiosyncratic language. Even when it comes to creative work, they occasionally stand out from the general public with extraordinary works of art that are due to their high level of sensitivity. Highly schizotypical people, however, are rarely artistically gifted, but rather think and act in a technical-functional and abstract way.

The over-sensitive nature of schizotypes causes overstimulation. That is why they often build up a “spiritual protective wall”, which also prevents the expression of feelings. In crisis situations they find it difficult to think logically and they have problems distinguishing unimportant information from important information.

diagnosis

According to DSM

In the DSM-5 , the schizotypic personality disorder, together with the schizoid and paranoid personality disorder, belong to the schizophrenia- related personality disorders ( cluster A ).

It is a profound pattern of social and interpersonal deficits characterized by an inability to develop close relationships or acute discomfort within them. Furthermore, distortions of perception or thinking and peculiar behavior occur. The disorder begins in early adulthood and manifests itself in a variety of situations. At least five of the following criteria must be met:

  1. Relationship ideas (but no relationship delusions ),
  2. Strange beliefs or magical thoughts that influence behavior and do not correspond to the norms of the respective subcultural groups (e.g. superstition, belief in clairvoyance, telepathy or in the "sixth sense"; bizarre fantasies and occupations in children and adolescents),
  3. Unusual perceptual experiences including body-related illusions,
  4. Strange ways of thinking and speaking (e.g. vague, awkward, metaphorical, overly precise, stereotypical),
  5. Suspicion or paranoid beliefs,
  6. Inadequate or limited affect ,
  7. Behavior or appearance is strange, eccentric or strange,
  8. Lack of close friends or confidants other than first-degree relatives,
  9. Pronounced social anxiety that does not decrease with increasing familiarity and which is more related to paranoid fears than to negative self-assessment.

The symptoms must not be better explained by another disorder (e.g. schizophrenia, bipolar disorder or depressive disorder with psychotic characteristics, another psychotic disorder, or an autism spectrum disorder ).

According to ICD

In the ICD-10 , schizotypal disorder (F21) is not assigned to personality disorders , but to " schizophrenic and delusional disorders ".

It is an eccentric behavior disorder with abnormalities in thinking and mood that is schizophrenic, although there have never been clear and distinctive symptoms. There is no dominant or typical characteristic. Those affected have exhibited at least four of the following characteristics, either continuously or repeatedly, over a period of at least two years:

  1. Inadequate and restricted affect so that those affected appear cold and unapproachable,
  2. Strange, eccentric and peculiar behavior and appearance,
  3. Little social reference and tendency towards social withdrawal,
  4. Weird beliefs or magical thinking that affects behavior and does not conform to subcultural norms,
  5. Mistrust or paranoid ideas,
  6. Brooding without internal resistance, often with dysmorphophobic , sexual or aggressive content,
  7. Unusual perceptions, including body sensation disorders, illusions, depersonalization or derealization experiences ,
  8. Vague, awkward metaphorical, contrived and often stereotypical thinking that expresses itself in strange language or in some other way, without being clearly confused,
  9. Occasional, transient quasi-psychotic episodes with intense illusions, acoustic or other hallucinations and delusional content; these episodes generally occur without any external cause.

Demarcation

A major problem with diagnosis is the overlap with other diseases.

Other personality disorders

Schizotypic people have the same interpersonal problems as schizoid people. However, with the difference that schizotypical people suffer from social isolation, while schizoids apparently do not value interpersonal contacts. In addition, schizoids usually do not show abnormalities such as magical thinking, bizarre beliefs and strange ways of speaking.

The biggest difference to borderline personality disorder is the lack of impulsiveness and mood lability. Borderliners are also more extraverted and sociable, although their relationships are rarely stable. Narcissistic personalities show a more pronounced self-confidence, at least outwardly, and are much better able to establish contacts, even if these are often selfish.

In the case of social phobia and anxious-avoidant personality disorder , it is the fear of the value judgment of others that makes contact more difficult for those affected. Schizotypic people, on the other hand, are more concerned that others want to take advantage of them or want to harm them.

Schizophrenia

Schizophrenic disorders can have similar symptoms, but more pronounced in the form of delusions and hallucinations. They are a common misdiagnosis. It should be noted that up to 25% of all schizotypic people actually develop psychosis as well .

There is also overlap, especially with the negative symptoms that occur in schizophrenia simplex ( weak will , impoverished thinking and flattened affect ). The schizotypic disorder, however, is a lifelong constant pattern, while the schizophrenia simplex represents a sudden decline in previously inconspicuous people.

autism

Differentiating it from Asperger's Syndrome , which begins in childhood, is also not easy, especially since some people with autism also show schizotypal characteristics. In the case of disorders of the autism spectrum, however, symptoms such as limited ability to experience and express themselves, paranoid ideas and suspicion are not the focus. Schizotypic personalities usually recognize social cues (gestures, facial expressions, etc.), but then over-interpret them in a rather suspicious manner (“hyper-mentalizing”). People with Asperger's Syndrome have more problems with perceiving and reading social signs at all (“hypo-mentalizing”).

In contrast to autistic people, schizotypical people also have a Theory of Mind (ToM). In the Imprinted Brain Theory by Bernard Crespi (should be according to which autism and psychosis opposite extremes) are compared with schizotypal PS and Asperger's syndrome, analog and each attenuated form.

causes

A multi-causal history is assumed. Possible causes include:

  • Genetic predisposition : Schizotypic personalities are often found in families with cases of schizophrenia . It is therefore assumed that both diseases share a common genetic disposition. The incidence of schizotypic PS among first-degree relatives of schizophrenic patients is about 7–14%. Initial molecular genetic studies show a certain overlap with the velocardiofacial syndrome and, to a lesser extent, with the fragile X syndrome
  • Early childhood trauma : People with schizotypic personality disorder often report experiences of sexual abuse and physical abuse . A difficult birth comes as a traumatic experience into consideration.
  • Early childhood neglect : Many schizotypic people were unable to develop close ties with their parents in their childhood, either because they (or one of them) did not live up to their responsibilities or because they (or one of them) were also mentally ill are. Also Hospitalism is a possible cause.

Neurobiology

New results from neurobiology and neuroimaging increasingly show the relationship between the schizotypic personality disorder and the schizophrenic psychoses. For example, a slightly smaller brain volume in the striatum and in the parietal and temporal cortex was observed in the imaging of both disorders . In schizophrenia, however, these anatomical structural changes were more pronounced and also affected the frontal lobe .

fMRI studies also confirm frontal underactivation of mental challenges in schizotypal people. But unlike schizophrenic patients, they can apparently activate additional areas there (e.g. the frontopolar prefrontal cortex) in order to compensate for loss of performance. Possibly these better frontal capacities can offer some protection against the onset of psychosis . In neuropsychological tests shows that schizotypal people in their executive functions are between healthy people and schizophrenia Affected: While schizophrenia patients on average here two standard deviations soft schizotypal patients are under the control group, about one standard deviation from.

treatment

Schizotypic people rarely seek treatment on their own initiative. Often they even resist it at first. They usually only get involved in therapy if they are persuaded or forced to do so, or if they develop additional problems such as depression or addiction.

Medication

Drug treatment therefore only makes sense if it is based on a trusting therapeutic relationship. Otherwise, there is often a low level of compliance due to reservations about medication or treatment discontinuation. Then you always resort to substances from the group of so-called atypical neuroleptics (e.g. risperidone , aripiprazole , olanzapine and quetiapine ). According to the current state of science (April 2017), these drugs are the most modern that is currently available for the treatment of a schizotypic personality disorder. Nevertheless, it must be mentioned that even these modern drugs do not work for every patient and some side effects can certainly occur.

For acute anxiety and panic attacks, sedatives from the benzodiazepine group are used, such as alprazolam or dipotassium chlorazepate . However, due to their addictive potential, these are only intended for short-term use.

psychotherapy

In most cases it is also necessary to start comprehensive and long-term treatment by suitable psychotherapists as early as possible. Cognitive behavioral therapy , supportive and depth psychological methods are primarily considered. Target can e.g. B. the change from paranoid beliefs and perceptual distortions to more realistic assessments. Sociotherapeutic measures have also been examined and are promising.

Example personalities

After studying King Ludwig II, the psychiatrist Hans Förstl went public with the thesis that the Bavarian King's disposition, which was diagnosed as “paranoia” in Ludwig's time, should be clearly classified as a “schizotypal disorder” according to modern criteria.

literature

  • Burghard Andresen, Reinhard Maß (Hrsg.): Schizotype: Psychometric developments and biopsychological research approaches . Hogrefe, Göttingen u. a. 2001, ISBN 3-8017-1015-7 .
  • Kurt-Heinrich Weshavel: Schizotypic personality disorder, borderline personality disorder, social phobia. With a comparative comparison . Self-published, Münster 2003, ISBN 3-8330-0382-0 .

Web links

Individual evidence

  1. ↑ a b c d Claas-Hinrich Lammers, Thomas Schömig (2010): The schizotypal personality disorder . Ed .: Psychiatry and Psychotherapy Up2date. Thieme Journals, p. 335, 337, 342 , doi : 10.1055 / s-0030-1248514 .
  2. ↑ a b Obsolete names for concepts similar to schizotype disorder (ICD-10)
  3. ↑ Theodore Millon: Chapter 12 - The Schizotypal Personality . (PDF) In: Personality Disorders in Modern Life . 2nd edition. Wiley, 2004, ISBN 0-471-23734-5 .
  4. ↑ a b Hans-Peter Kapfhammer: The Schizoid Concept in Psychiatry - From Schizoid to Schizotype to Cluster A Personality Disorders . In: neuropsychiatry . tape 31 , no. 4 , 2017, p. 155-171 , doi : 10.1007 / s40211-017-0237-y ( springer.com ).
  5. ↑ a b c d e Thomas Suslow (2009): Schizophrenia-related personality disorders . In: The neurologist (CME training) . S. 343 - 350 , doi : 10.1007 / s00115-008-2589-9 .
  6. ↑ a b Peter Falkai, Hans-Ulrich Wittchen (ed.): Diagnostic and statistical manual of mental disorders DSM-5 . Hogrefe, Göttingen 2015, ISBN 978-3-8017-2599-0 , pp. 898 .
  7. ↑ AWMF : Old S2 guidelines for personality disorders (valid from 2008 to 2013) ( Memento from January 23, 2013 in the Internet Archive ). P. 8
  8. ↑ Appendix B - Criteria Lists and Axes Intended for Further Research. In: DSM-IV-TR , 2003, ISBN 978-3-8017-1660-8 , p. 831 f.
  9. ↑ Differential diagnosis of personality disorders related to schizophrenia (p. 760) In: Fritz-Georg Lehnhardt u. a (2013) .: Diagnostics and differential diagnosis of Asperger's syndrome in adulthood. ( Memento of the original from May 4, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Deutsches Ärzteblatt. @1@ 2Template: Webachiv / IABot / www.leonhardschilbach.de
  10. ↑ E. Kumbier et al. a. (2010): Autism and Autistic Disorders . In: The neurologist . tape 81 , no. 1 , p. 61 , doi : 10.1007 / s00115-009-2820-3 ( springer.com ).
  11. ↑ Matthias Dose, Katja Weber (2012): Autism, Asperger's Syndrome and Schizotypic Personality Disorder . In: Hans Förstl (Ed.): Theory of Mind. Springer, ISBN 978-3-642-24916-7 . (limited preview on GoogleBooks )
  12. ↑ Henning Saß (2001): On the etiological position and therapy of schizoid and schizotypic personality disorder. doi: 10.1055 / s-2001-16542 .
  13. ↑ Chapter 7: The Schizoid and Schizotypic Personality Disorder. In: Aaron T. Beck : Cognitive Therapy of Personality Disorders. Beltz, 1995, ISBN 978-3-621-27155-4 .
  14. ↑ Maximilian Gerl: What the fairy tale king really suffered from . In: sueddeutsche.de . August 27, 2016 ( sueddeutsche.de [accessed on August 27, 2016]).