Have you ever come across someone who behaves strangely, believes in supernatural things and avoids social relations? This person has schizotypal personality disorder (SPD); which causes a person to have unusual beliefs, magical thinking, cognitive disorders and severe problems in social communication. Many sufferers are not even aware of the existence of this problem and live with its complications for years. If you care about the mental health of yourself and your loved ones, reading this guide to diagnosing and treating schizotypal personality disorder is essential. Introduction to Schizotypal Personality Disorder (SPD) Schizotypal Personality Disorder (SPD) is one of cluster A disorders in the classification of personality disorders in DSM-5-TR. This disorder is characterized by a stable pattern of abnormal thinking, behavior and social functioning, and affected people usually have magical thinking, paranoid thoughts, perceptual disorders, severe social anxiety and strange or unusual behaviors. The prevalence of schizotypal personality in society is reported to be about 3 to 4 percent. These people often seek refuge in their inner world, have irrational beliefs, and their social behavior is far from the norms of society. Severe discomfort from close relationships, cognitive and perceptual distortions, and strange behaviors are the 3 main features of this disorder. SPD can be confused with other disorders such as schizophrenia, social anxiety disorder, and antisocial personality disorder. Unlike schizophrenia, in SPD there are usually no severe hallucinations or dissociation from reality, but the symptoms can be very close and similar. Treatment of schizophrenia with neurofeedback is considered one of the most up-to-date and practical ways of treatment for this disorder and similar disorders. What are the 9 main symptoms of SPD? Schizotypal personality disorder (SPD) is associated with abnormal patterns of thinking, perception, and social behavior. Early identification of the symptoms of this disorder is very important to prevent its aggravation and start effective treatment. In order to diagnose this disorder according to the diagnostic criteria of DSM‑5, the presence of at least five of the following nine symptoms is required. Experiencing one or two of these symptoms does not mean having SPD, and a definitive diagnosis requires a clinical psychologist or psychiatrist. 1. Ideas of Reference: A person believes that external events or specific messages have a personal meaning for him (other than real hallucinations). 2. **Strange Beliefs or Magical Thinking:** Such as belief in telepathy, special luck, the power to predict the future, or superstitions. These beliefs may not conform to cultural norms. Example: A person believes that he can make someone call by thinking about him. 3. **Abnormal Perceptual Experiences:** Includes mild hallucinations or distorted feelings towards objects or people (such as seeing shadows or hearing voices inaudibly). 4. **Abnormal speech style:** Speaking in vague, metaphorical, overly formal, or illogical terms that are difficult for others to understand. 5. **Suspicion or paranoid thoughts:** Continuous mistrust of other people's intentions or negative interpretation of the behavior of others. 6. Limited or disproportionate emotional feelings and reactions: In social situations, a person may not be able to express his feelings properly or show an emotionless and cold reaction. 7. **Strange and unusual behavior, appearance or dress:** such as clothes with a specific and unconventional color or style, behaviors inconsistent with social conditions. 8. **Lack or weakness in close intimate relationships:** Inability to develop and maintain deep emotional relationships even with family members or close friends. 9. **Severe social anxiety that does not decrease with familiarity:** Unlike normal anxiety, these people do not feel comfortable even knowing more people around them. **How to diagnose schizotypal personality disorder?** The diagnosis of schizotypal personality disorder (Schizotypal Personality Disorder) requires accurate clinical evaluation, structured interview and the use of standard psychometric tools. Because SPD symptoms can be confused with other mental disorders such as schizophrenia, antisocial personality disorder, or anxiety disorders, the use of valid diagnostic tools is critical to ensure accuracy of assessment. To get information about the treatment of stress and anxiety with neurofeedback, refer to the linked page. ### **Evaluation stages of schizotypal personality disorder** 1. First step: a detailed clinical interview based on DSM-5-TR, conducted by a psychologist or psychiatrist, in which they examine the presence of 5 or more of the 9 main symptoms of schizotypal personality disorder. 2. Second step: family and psychiatric history examination, especially the presence of psychiatric disorders such as schizophrenia in the family, is one of the important factors in assessing the risk of SPD. 3. The third step: structured interviews (Structured Clinical Interview for DSM - SCID-5-PD), which is an official and standard tool designed by APA to diagnose personality disorders, including SPD, and has high validity. **Top 3 tools for diagnosing schizotypal personality disorder (SPD)** Accurate diagnosis of schizotypal personality disorder requires the use of standard and scientific tools. Since the symptoms of this disorder may be confused with other disorders such as schizophrenia or schizoid personality, it is important to use valid psychometric tests and structured clinical interviews. In the following, you will learn about the most important and accurate diagnostic tools for SPD. ### **PDQ-4+; Personality disorders screening questionnaire** The PDQ-4+ is a quick and practical self-report questionnaire for the screening of personality disorders, including schizotypal personality disorder. This tool is especially used in epidemiological studies or early stages of psychological assessment. Of course, it should not be used as the final diagnostic tool, but it is better to consider it as a prerequisite for more detailed clinical evaluations. ### **MMPI-2 in-depth assessment of psychological structure and personality** The MMPI-2 test is one of the types of the MMPI test, which is known as the most comprehensive and valid personality measurement tool in the world. This test includes scales that indirectly help to diagnose SPD; including scales related to paranoid thoughts, unusual perceptual experiences and social isolation. Although the MMPI-2 is not a specific instrument for SPD, it can provide valuable information in the comprehensive psychological assessment process. ### **MCMI-IV, a specialized test for personality disorders** MCMI-IV or Millon Clinical Multiaxial Inventory is one of the few instruments specifically designed for the clinical assessment of personality disorders. This test is based on the DSM-5 model and has a specific scale for diagnosing SPD. A high score on the schizotypal scale in this test can indicate the presence of magical thinking patterns, chronic suspicion, and abnormal social interaction style. **Can schizotypal personality disorder be treated?** Many people with schizotypal personality disorder (SPD) wonder if they can return to a normal life without suffering from psychotic symptoms. The answer is yes, but with one condition: the treatment of this disorder requires persistence, commitment and cooperation with mental health professionals. In fact, SPD can be controlled and improved through psychotherapy, medication, and environmental support. In the following, we will examine the most important and widely used methods in the treatment program of schizotypal personality disorder. ### **Psychotherapy is the main pillar of treatment** Cognitive-behavioral therapy (CBT) is one of the most common approaches to helping people with SPD. This therapy helps them identify their irrational thoughts, magical beliefs, and paranoid thinking and replace them with healthier social skills. Interpersonal therapy and social skills are also used to increase the ability to interact with others, reduce social isolation, and increase self-confidence. ### **drug therapy** Although SPD is officially classified as a "personality disorder" and not a "severe psychiatric disorder" like schizophrenia, in some cases, mild antipsychotic medications (second-generation antipsychotics) may be prescribed to reduce symptoms such as abnormal thoughts, severe social anxiety, and suspiciousness. Medications such as risperidone or aripiprazole may be effective at low doses. Also, in case of depression, treating depression using antidepressants also helps the treatment process. ### **Family support and psychoeducation** Educating family and friends about the nature of SPD can play an important role in reducing stress, strengthening relationships, and preventing isolation. Many patients experience significant improvement in supportive environments. Treatment of SPD is usually associated with gradual improvement of symptoms, improvement of the individual's ability to establish interpersonal relationships, and reduction of irrational thoughts. Although some personality traits may remain stable, with proper and consistent treatment, individuals can lead independent and relatively normal lives. **Summary** Schizotypal personality disorder (SPD) is characterized by strange thoughts, unusual behaviors, and social isolation. Although treatment of this disorder takes time, with specialized psychotherapy, medication and professional support, symptoms can be controlled and quality of life can be improved. Dr. Bayat's psychology and neurofeedback center is ready to provide you with specialized services with an experienced team in the field of evaluation and treatment of personality disorders, including SPD. If you are experiencing symptoms of this disorder, now is the time to act. Counseling with a psychologist can be the first step towards mental peace. **Frequently Asked Questions About Schizotypal Personality Disorder** **1_What is schizotypal personality disorder?** Schizotypal personality disorder (SPD) is a cluster A personality disorder characterized by abnormal thought patterns, magical beliefs, strange behaviors, and social isolation. What is the difference between schizotypal and schizophrenia? Unlike schizophrenia, which is associated with hallucinations, delusions, and severe disconnection from reality, people with schizotypal personality disorder usually maintain a connection with reality. They may have abnormal thoughts and strange perceptions, but their level of social functioning is better than schizophrenic patients. **3_Is schizotypal disorder treatable?** Yes, schizotypal disorder is treatable, but it takes time and continuous follow-up. A combination of psychotherapy (especially CBT), medication, and social support can help reduce symptoms and improve a person's functioning. **4\_What drugs are used to treat SPD?** In cases where a person has strange thoughts, severe anxiety, or depression, a psychiatrist may prescribe mild antipsychotics (such as risperidone) or antidepressants. Drug therapy should always be done under the supervision of a specialist doctor.