Cluster A: Schizotypal PD

Question 1

Cluster A

Answer 1

Odd or eccentric

Question 2

Main characteristics

Answer 2

• Cognitive or perceptual distortions
• Discomfort in close relationships
• Eccentricities in behaviors

Question 3

Criteria for schizotypal

Answer 3

• A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of beahvior, beginning in early adulthood and present in a verity of contexts, as indicated by five (or more) of the following:
  1. Indeas of reference (excluding delusions of reference)
  2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense” in children and adolescents, bizarre fantasies or preoccupations)
  3. Unusual perceptual experiences, including bodily illusions
  4. Odd thinking and speech (e.g., cague, circumstantial, metaphorical, overlaborate, or stereotyped)
  5. Suspiciousness or paranoid ideation
  6. Inappropriate or constricted affect
  7. Behavior or apperance that is odd, eccentric, or perculiar
  8. lack of close friends or confidants other than first-degree relatives
  9. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgement about self
• Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder

Question 4

Individual characteristics

Answer 4

• Often seen as odd, eccentric, or peculiar
• Exhibit discomfort with close relationships and tend to be socially anxious
• experience unusual perceptions (e.g., bodily illusions), odd beliefs (e.g., magical thinking), and paranoid ideation
• Prefer isolation due to feeling “different” or not fitting in
• Social anxiety is persistent and driven more by paranoid fears that negative self-judgement
• Speech may be vague, metaphorical, or overly elaborate
• Appearence or behavior is often odd or eccentric

Question 5

Diagnostic features

Answer 5

• Core feature: pattern of social/interpersonal deficits and cognitive-perceptual distortions
• begins in early adulthood
• strong discomfort with closeness; prefers solitude due to feeling odd or “different”
• social anxiety does not dimish with familiarity
• Magical thinking and perceptual distortions are key identifiers

Question 6

Differential diagnoses

Answer 6

• Psychotic disorders: must differentiate from schizophrenia and other psychotic disorders - STPD lacks persistent psychosis
• Autism spectrum disorder (ASD): has more severe impairments in social reciprocity and stereotyped behaviors
• Communication disorders: differentiated by language-deficits identified via assessment
• Personality change due to medical condition: Traits result from effects on CNS
• Substance use disorder: must rule out symptoms due to substance use
• Other PDs: differs from schizoid and paranoid PDs by presence of cognitive/perceptual distortions and eccentric behavior

Question 7

Associated features

Answer 7

• May seek treatment for anxiety or depression, not the PD itself
• May experience transient psychotic episodes
• 30-50% may also meet criteria for major depressive disorder
• interpersonal relationships are difficult; often lack friends outside family

Question 8

Gender and prevalence

Answer 8

• Slightly more common in males
• Prevalence: 3.9% General U.S. population; 0-1.9% Clinical settings; up to 4.6% in some U.S. communities

Question 9

Cultural considerations

Answer 9

• Cultural and religious beliefs (e.g., voodoo, sixth sense, speaking in tongues) must be considered before diagnosing.
• Beliefs and behaviors should be viewed in the context of the individual’s culture to avoid mislabeling as schizotypal

Question 10

Early signs (risk factors)

Answer 10

• Often first evident in childhood or adolescence
• Signs: solitariness, poor peer relationships, social anxiety, underachievement, hypersensitivity, perculiar language/thoughts
• May attract teasing for being “odd” or “eccentric”
• Family history: may share genetic risk with schizophrenia-spectrum disorders