Schizoid vs. schizotypal personality disorder: What are the differences?

Unlike more commonly diagnosed mental illnesses like depression or anxiety, there is limited public understanding of what it’s like to live with a schizoid personality disorder or schizotypal personality disorder. This might be due to the sheer complexity of the diagnoses, the frequent severity of symptoms, or the way people with personality disorders are sometimes portrayed in the media.  The truth is that personality disorders are treatable and people who have them aren’t inherently predisposed to harmful behavior. With the right support, many people living with personality disorders can function well enough to work, care for themselves, and live satisfying lives. 

What are personality disorders?

Personality disorders are a category of serious mental illness that cause a pattern of behavior that negatively impacts a person’s functioning across different contexts including school, work, and relationships. They also cause an inner experience that deviates significantly from an affected person’s societal and cultural norms.  According to data from the National Institute of Mental Health, personality disorders are estimated to affect approximately 1.4% of adults over the age of 18 in the U.S. These conditions usually show up in late adolescence or early adulthood. If left untreated, they typically worsen over time.

Schizoid personality disorder 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines schizoid personality disorder as “a pattern of detachment from social relationships and a limited range of emotional expression.”  Unlike the similar-sounding “schizophrenia” which causes hallucinations and delusions, people living with schizoid personality disorder are in touch with reality and can effectively communicate with others. However, they have no sincere desire for social connection and prefer to spend time alone. In addition to being socially withdrawn, people living with schizoid personality disorder tend to be emotionally detached and possess a limited range of emotional expression. This can make them seem aloof, cold, or distant. They may avoid tasks or social activities which require an emotional focus.

Causes and risk factors for schizoid personality disorder

While there is limited data on the causes and risk factors for schizoid personality disorder, some research suggests that genetics may play a role. Having a close first-degree relative, like a parent or sibling, who also has a personality disorder or another mental health condition could make you more likely to develop a similar disorder.  There’s also some evidence to suggest that traumatic childhood experiences like abuse or neglect may contribute to the onset of schizoid personality disorder. A link between abnormalities in the brain and schizoid personality disorder has not been established.

Diagnosis and assessment for schizoid personality disorder

The first step in treating schizoid personality disorder is getting an accurate diagnosis from a mental health professional. A therapist will meet with you (either in-person or online) to learn more about your history and your presenting concerns so that they can make an assessment.  During your first few sessions, your provider will ask you about when you first started experiencing symptoms and about how they have impacted your life. You’ll talk about your relationships and your ability to function in various settings. Your provider will then use insights from these conversations along with the diagnostic criteria from the DSM-5 (outlined below) to determine whether your experience is consistent with schizoid personality disorder. 

• You don’t have any desire to feel close to others or be in a relationship of any kind (including being part of a family)
• You prefer to spend time alone doing solitary activities
• You have little to no desire for sexual connection with another person
• In general, you feel very little pleasure in life from any activity
• You don’t have close relationships and don’t typically confide in others 
• You don’t care what other people think of you and neither praise or criticism seems to affect you
• You have a very limited range of emotions and most of the time you appear cold, detached, or aloof 

To be diagnosed with schizoid personality disorder you must present with at least four of these symptoms starting in early adulthood and your symptoms must not be contained to one setting or caused by a different mental health condition.

Schizotypal personality disorder

Schizotypal personality disorder is sometimes confused with schizoid personality disorder because they sound alike. And while these two disorders share some features, they are two distinct conditions that affect people differently.  Schizotypal personality disorder is known to cause unusual beliefs and perceptions, eccentric behaviors, and social anxiety. People living with this disorder often have a distorted view of reality, hold deeply superstitious beliefs, and feel uneasy in close interpersonal relationships. They often believe that everyday occurrences hold special meaning for them and their inability to adhere to social norms often results in them having an odd or unkempt appearance and unusual mannerisms. While social situations tend to make them very nervous, people living with schizotypal personality disorder may express sadness or remorse over their lack of connection with others.

Causes and risk factors for schizotypal personality disorder

While there is no single known cause of schizotypal personality disorder, this condition, like other personality disorders, is known to have a genetic component. Having a first-degree relative, like a sibling or parent, who also has a personality disorder or other mental health condition may make you more likely to develop schizotypal personality disorder.  There is also evidence to suggest that certain brain abnormalities and environmental factors like adverse childhood experiences like abuse or neglect may also be linked to schizotypal personality disorder.

Diagnosis and assessment for schizotypal personality disorder

When it comes to treating schizotypal personality disorder, early intervention is key. A mental health professional will ask you about your history and your experiences to better understand when your symptoms began and how they’ve affected different areas of your life in different settings. From there, they’ll use the diagnostic criteria (outlined below) from the DSM-5 to determine if your symptoms are consistent with schizotypal personality disorder. 

• You believe otherwise mundane experiences hold special meaning for you
• You have superstitious beliefs or engage in magical thinking
• Your perception of reality is distorted 
• You have an unusual or odd way of thinking and speaking
• You have frequent paranoid thoughts 
• Your emotional expression is limited or contextually inappropriate  
• You tend to have eccentric behavior or an odd appearance
• You are mostly without close friends or connections 
• Your pervasive social anxiety does not dissipate once you’re familiar with a person or situation and it’s mainly tied to paranoid fears

To be diagnosed with schizotypal personality disorder you must present with at least five of these symptoms starting in early adulthood, you must be acutely uncomfortable in social situations, and your symptoms must not be contained to one setting or caused by a different mental health condition.

Schizoid vs. schizotypal personality disorder: key differences

Both schizoid personality disorder and schizotypal personality disorder cause unusual behavior and create a profound impairment in a person’s ability to connect with others. But there are some key differences between these two conditions.  People with schizoid personality disorder have no interest in building relationships of any kind. They often appear cold, disinterested, or aloof. Neither praise nor criticism has an impact on how they feel.  In contrast, people with schizotypal personality disorder often wish to have relationships but their social anxiety and odd or eccentric thoughts and behaviors prevent them from doing so.

What treatments are available?

While there is no cure for personality disorders, there are some treatment options that can help people manage their symptoms and improve their quality of life.  People living with schizoid personality disorder or schizotypal personality disorder may benefit from talk therapy and long-term support in the form of life and social skill training.  Medication has not been proven effective in treating these disorders although it can help alleviate some symptoms. 

Find support for personality disorders with help from Rula

At Rula, we know how difficult it can be to find the right treatment and support for personality disorders. But with a network of over 8,000 therapists who offer care in over 80 clinical specialties, we can quickly and easily match you with a therapist who takes your insurance and offers the individualized support you deserve.  In just a few seconds, we can connect you with a provider, help you make your first appointment, and answer any questions you may have along the way. With options for individual, group, and family therapy in addition to medication management services, Rula can help you find the support you need to navigate a personality disorder.  Find a therapist with Rula