Schizotypal Personality Disorder vs. Schizophrenia: Understanding Key Differences

Wednesday, March 27

Schizotypal personality disorder (SPD or STPD) and schizophrenia might seem to be similar disorders. Is SPD just a less severe type of schizophrenia? Are the symptoms and treatments the same?

The short answer is no. Although both conditions may impact similar areas of a person’s life, SPD and schizophrenia are separate mental health conditions that present very differently. 

Since it’s easy to confuse these conditions, let’s go over the differences between them. 

What is schizotypal personality disorder (SPD)?

SPD is a personality disorder that includes eccentric or odd thoughts and behaviors. It’s sometimes grouped with schizophrenia spectrum disorders, like schizoaffective disorder.

SPD typically includes severe anxiety in social situations. People with this condition might also have unusual mannerisms, beliefs, thoughts, or speech. 

SPD may interfere with daily activities or affect a person’s life in many ways, as it impacts the ability to form and maintain relationships. While there’s no cure for this condition, it’s manageable with the right treatment plan. 

What is schizophrenia?

Schizophrenia is a psychotic disorder. Those who have this condition may occasionally experience mental breaks from reality or dissociative symptoms. These psychotic episodes may include delusions, auditory and visual hallucinations, and trouble thinking clearly and logically. 

This condition usually includes cognitive symptoms, like trouble remembering things or learning new information. It may also include other symptoms like withdrawing from social life or losing motivation. 

Schizophrenia is a chronic condition. Without treatment, it may have detrimental effects on a person’s quality of life. Treatment approaches for this disorder include medication and psychotherapy. It’s important to note that this disorder presents differently between individuals, and it’s possible that higher levels of care may temporarily be needed in some cases. 

Key differences between SPD and schizophrenia

Schizophrenia and SPD are both complex disorders that can have serious effects when left untreated. While they have some similarities, it’s important to remember that they’re separate and distinctive disorders. 

In what ways do they differ? In the following sections, we’ll discuss some of the most notable differences between SPD and schizophrenia to help better understand these conditions. 

Psychotic vs. nonpsychotic symptoms 

The types of symptoms that occur with SPD and schizophrenia differ. Individuals with SPD usually don’t experience psychotic symptoms. Those with schizophrenia do have psychotic symptoms. 

Examples of non-psychotic symptoms of SPD include extreme social anxiety, peculiar thinking patterns, and magical thinking, such as a belief in clairvoyance or superstitions. People with SPD may also have distorted perceptions, such as thinking ambient noises are actually voices. But these don’t include hallucinations.

Examples of psychotic symptoms of schizophrenia include delusions and hallucinations, like hearing voices or seeing things that aren’t really there.

Risk factors 

Much like other personality disorders, the definitive causes of Schizophrenia and SPD aren’t known. However, there are certain risk factors that could raise a person’s risk for having either condition. Brain changes, such as changes in gray matter in the temporal lobe and other areas, are a risk factor for both schizophrenia and SPD. 

Having a biological family member with schizophrenia or other psychotic disorders may raise the risk of SPD or schizophrenia. With SPD, learned behaviors and environmental factors, such as childhood trauma, may also play a role. 

With schizophrenia, other risk factors may include using psychoactive or other mind-altering substances in early adulthood or as a teen. Complications during pregnancy or childbirth, like exposure to viruses, may also be a risk factor for this condition.

Learning about risk factors may be helpful, but having them doesn’t indicate a definite diagnosis or risk of developing either disorder. Research into both conditions is ongoing, and only a licensed practitioner can give a formal diagnosis. 

Diagnostic criteria 

The Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, gives certain criteria for diagnosing schizophrenia or SPD. For SPD, criteria include distorted thoughts or perceptions and eccentricities, such as ideas of reference or odd speech and thinking. Note that these do not include hallucinations or delusions. 

For schizophrenia, examples of criteria include psychotic symptoms, like disorganized speech and delusions, and cognitive symptoms. These symptoms must be present for significant amounts of time within a certain time period for a formal diagnosis by a licensed practitioner. 

Treatment and management 

SPD doesn’t have a specific treatment approach. Instead, treatment varies from person to person, depending on symptoms and other factors. 

Psychotherapy, such as cognitive behavioral therapy (CBT), is a common way to manage SPD. Medications may be used if another mental health condition, like an anxiety disorder, is also present. 

On the other hand, medication, psychosocial treatment, and other approaches are usually part of a comprehensive treatment plan for schizophrenia. Antipsychotic medications may help ease the intensity of psychotic symptoms. 

CBT and other forms of psychotherapy or talk therapy — used along with medication — can help manage symptoms and build social skills. Other kinds of treatment, like coordinated specialty care, may be needed to manage this serious disorder. 

Challenges in daily life with schizotypal personality disorder 

SPD may make it hard to have close relationships or handle any kind of social situation due to anxiety. This disorder may also affect other areas of a person’s life, such as their job or school. 

In the following sections, we’ll explore the challenges that are often part of life with SPD. Experiencing these challenges may understandably be frustrating or stressful. However, as you read, keep in mind that there is support available to help navigate these daily challenges more effectively.

Managing social interactions 

Severe social anxiety may make it difficult to feel at ease around others. This might lead to avoiding social interactions if possible. These situations might cause symptoms to worsen due to distress.

Interacting with others is also tough for those who don’t understand social cues. They may not be able to carry on conversations with others. Or they might not make eye contact during interactions, making it harder to connect with others. 

Odd social behaviors that are part of SPD may also make it difficult to engage in interpersonal relationships. Others might not understand what someone with SPD is going through. Peculiar speech or mannerisms, for example, might prevent these individuals from being able to form close relationships. 

Managing SPD involves working on overcoming social anxiety and understanding social cues. It also involves learning to navigate interpersonal relationships in order to build strong connections with others. 

Coping with unusual beliefs 

People with SPD tend to have odd beliefs. They might believe that they can read other people’s minds, for example. Or they may believe that they’re psychic or clairvoyant. 

These unusual thoughts and beliefs may affect their interactions with others or cause considerable distress — potentially making symptoms worse. 

Part of managing SPD is learning to recognize and challenge these thoughts and beliefs. This may help ease symptoms, making it easier to handle day-to-day activities. 

Maintaining focus and motivation

Individuals with SPD might have cognitive impairments that affect memory, attention, or planning, which may cause challenges in many areas of their lives. They might have a hard time handling everyday tasks, like paying bills or remembering appointments. 

Treating SPD involves learning to manage these impairments. This allows these individuals to focus better and improve their motivation to accomplish tasks or achieve goals.

Developing healthy coping mechanisms 

Stress may make SPD symptoms worse and lead to the use of maladaptive coping mechanisms to handle these emotions. For example, some people turn to substance use when certain emotions cause stress.

Let’s say someone really struggles with social anxiety. Being in a social setting might make them feel distressed. SPD symptoms, like odd mannerisms, might become more extreme in these situations. 

SPD treatment involves learning healthy ways to manage stress. These adaptive coping mechanisms can help people handle difficult emotions without becoming distressed. 

Challenges in daily life with schizophrenia 

Many symptoms of schizophrenia are not only distressing but make it hard to get through daily life. Those who have this disorder may not be able to tell what’s real or not — especially during episodes of psychosis. 

Below, we’ll explore some of the challenges these individuals may experience with this disorder. Remember that treatment can help them deal with these challenges more effectively, improving their quality of life and mental health overall.

Managing psychotic symptoms 

Psychotic symptoms are characteristic of schizophrenia. During these episodes, individuals might hear voices or see things that aren’t there, known as hallucinations. Or they might have delusions — which are exaggerated or intense beliefs that aren’t true. 

They might also have severe difficulty thinking clearly or engage in repetitive movements. Psychotic symptoms change the way people perceive reality. This can cause significant distress and other problems in their ability to function.

Managing psychotic symptoms generally involves prescribed medications (like antipsychotics) alongside therapy to help people more adaptively handle episodes of psychosis. 

Maintaining self-care and independence 

Schizophrenia may cause cognitive challenges that affect physical and mental well-being. This might make it hard for these individuals to care for themselves, which could affect their ability to live independently. For example, they might neglect personal hygiene, such as not brushing their teeth or showering.

They might have trouble with memory or attention. They might struggle with planning. This can make it hard to handle everyday tasks, like cooking meals or cleaning their home.

A therapist can help individuals with schizophrenia better manage day-to-day life and mitigate symptoms of this disorder.

Building and maintaining relationships 

Those with schizophrenia likely experience psychotic symptoms. While these symptoms are out of their control, these episodes may lead to issues with trust and communication with other people in their lives. 

Schizophrenia may also cause social impairments that make it tough to interact with others. They might have difficulty following conversations. Or they might have a flat affect or speak in a monotone voice. 

Treating this disorder first involves managing psychotic symptoms, such as through an intensive or inpatient program that usually involves taking prescription antipsychotic medication. After achieving stability, treatment can then include meeting with a therapist to work on developing social skills, building trust, and communicating more effectively with others. 

Sticking to your treatment plan

Following a treatment plan is crucial in order to manage schizophrenia. But this can be difficult. Those who have this disorder might face stigma due to other people’s misconceptions about it. Or they might have side effects from taking medication to manage psychotic symptoms. 

Keep in mind that medication and therapy are common (and effective) ways to treat this disorder. Antipsychotic medications help ease psychotic symptoms, and psychotherapy or talk therapy, such as cognitive behavioral therapy (CBT), can help with learning adaptive coping mechanisms and building social skills.

Throughout treatment, a psychiatrist usually manages prescriptions and can help address any needed changes due to the side effects of antipsychotic medication. Meanwhile, therapists can help individuals cope with the stigma associated with this condition and form adaptive habits and valuable life skills.

Get started with SonderMind today to connect with a therapist to support you on the path to better mental well-being. 


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