Schizoid and schizotypal personality disorders both belong to the group of cluster A personalities. They have many similarities, but one is considered closer to schizophrenia. These are people often living on the margins of society. Understanding them better can help you to be compassionate.
Personality disorders, or character disorders, are a consistent pattern of thought, emotions and behaviors that are notably out of tune with the surrounding culture. Every person can have a number of traits from any personality type. When these traits cluster together, and are fixed and inflexible, they create a disorder.
Schizoid and schizotypal personality disorders are both classified by the Diagnostic and Statistical Manual of Mental Health, the DSM, as belonging to cluster A personalities. The two are similar in many ways, but have enough distinctive features to be classified as separate disorders.
Schizoid Personality Disorder
People with schizoid personality are detached from society. They don't have close friends, and more importantly, show no desire to have any. They are loners. They express little emotion and seem to take little pleasure in anything. To others they appear cold and odd.
These features can also be part of depression or schizophrenia--in order to diagnose schizoid personality disorder, this pattern must be lifelong and not due to another psychiatric or medical condition.
Schizotypal Personality Disorder
People with this type of personality disorder have a combination of impaired social interaction and odd thinking. Ideas of reference are common, which means that they feel events are related to them, or even perpetrated against them, despite these events having no objective relationship to them. Their unusual beliefs and magical thinking deviate significantly from cultural norms. They might have a strong belief in telepathy and be very superstitious. Their behavior is seen as peculiar and their emotional responses are 'off key'. Often they have no close friends and have intense social anxiety. Unlike other people with social anxiety, their anxiety does not diminish with time and familiarity.
Schizoid vs Schizotypal Personality Disorders
The division between the two is somewhat artificial, as some schizotypal patients are more withdrawn and close to schizoid in their behavior. A major reason for the separation is the relationship between schizotypal personality and schizophrenia. There is a much higher prevalence of schizophrenia among first degree relatives of these patients than among relatives of people with other personality disorders. Thinking in schizotypal personality is much more distorted and closer to psychosis than in schizoid patients.
Living on the Margins
Both schizoid and schizotypal patients are often considered eccentric and looked upon as misfits. They often live a marginal, isolated existence, functioning far below their educational level. When people feel sorry for them and try to help, they don't know how to deal with it. Despite appearing cold, internally the schizoid individual might be extremely sensitive and emotionally needy.
Patients with schizoid personality disorder are more likely to seek therapy. They can benefit from a long term, supportive and cautious psychotherapeutic approach. Trying to get them to talk about their feelings too early will lead them to withdraw. Group therapy can be very beneficial, since it helps patients learn how to socialize.
Schizotypal patients are less likely to seek therapy, but more likely to find a group of eccentrics who share similar beliefs. When they do go to therapy, the therapist must be respectful of their eccentricities and not try to dissuade them from holding magical beliefs.
1. "Psychodynamic Psychiatry in Clinical Practice, third edition"; Glen Gabbard; 2000.
2. "Diagnostic and Statistical Manual of Mental Disorders"; American Psychiatric Association; 2000