Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Schizotypal personality disorder: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis

Daniel R Rosell, MD, PhD
Section Editor
Andrew Skodol, MD
Deputy Editor
Richard Hermann, MD


Schizotypal personality disorder is a chronic disorder with manifestations beginning in childhood and adolescence. Phenomenologic characteristics of the disorder include cognitive-perceptual problems (such as magical thinking or paranoia), oddness or disorganization, and interpersonal problems such as social anxiety and a lack of close friends.

Schizotypal personality disorder is under-recognized and understudied. Its lifetime prevalence in the general United States population has been estimated at just under 4 percent. The disorder is associated with significant disability, as well as a wide range of psychiatric comorbidities. Schizotypal personality disorder is challenging to treat.

This topic reviews the epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of schizotypal personality disorder. Treatment of schizotypal personality disorder is reviewed separately. The clinical presentation and treatment of other personality disorders are also reviewed separately. Establishing and maintaining a therapeutic relationship in patients with personality disorders are also reviewed separately. (See "Borderline personality disorder: Epidemiology, clinical features, course, assessment, and diagnosis" and "Treatment of borderline personality disorder" and "Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis" and "Treatment of antisocial personality disorder" and "Narcissistic personality disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Treatment of narcissistic personality disorder" and "Overview of personality disorders" and "Approaches to the therapeutic relationship in patients with personality disorders".)


Not studied as extensively as many mental disorders, estimates of the prevalence of schizotypal personality disorder have ranged from less than 1 percent to nearly 4 percent:

Based on face-to-face interviews of a nationally representative sample of 34,653 adults, the United States National Epidemiologic Survey of Alcohol and Related Disorders (NESARC) estimated the lifetime prevalence of schizotypal personality disorder to be 3.9 percent (4.2 percent in men and 3.7 percent women) [1].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 14, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Pulay AJ, Stinson FS, Dawson DA, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV schizotypal personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. Prim Care Companion J Clin Psychiatry 2009; 11:53.
  2. Coid J, Yang M, Tyrer P, et al. Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 2006; 188:423.
  3. Samuels J, Eaton WW, Bienvenu OJ 3rd, et al. Prevalence and correlates of personality disorders in a community sample. Br J Psychiatry 2002; 180:536.
  4. Torgersen S, Kringlen E, Cramer V. The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 2001; 58:590.
  5. Quirk SE, Berk M, Pasco JA, et al. The prevalence, age distribution and comorbidity of personality disorders in Australian women. Aust N Z J Psychiatry 2017; 51:141.
  6. Hummelen B, Pedersen G, Karterud S. Some suggestions for the DSM-5 schizotypal personality disorder construct. Compr Psychiatry 2012; 53:341.
  7. Fossati A, Citterio A, Grazioli F, et al. Taxonic structure of schizotypal personality disorder: a multiple-instrument, multi-sample study based on mixture models. Psychiatry Res 2005; 137:71.
  8. Ericson M, Tuvblad C, Raine A, et al. Heritability and longitudinal stability of schizotypal traits during adolescence. Behav Genet 2011; 41:499.
  9. Lin CC, Su CH, Kuo PH, et al. Genetic and environmental influences on schizotypy among adolescents in Taiwan: a multivariate twin/sibling analysis. Behav Genet 2007; 37:334.
  10. Coolidge FL, Thede LL, Jang KL. Heritability of personality disorders in childhood: a preliminary investigation. J Pers Disord 2001; 15:33.
  11. Asarnow JR. Childhood-onset schizotypal disorder: a follow-up study and comparison with childhood-onset schizophrenia. J Child Adolesc Psychopharmacol 2005; 15:395.
  12. Savitz J, van der Merwe L, Newman TK, et al. Catechol-o-methyltransferase genotype and childhood trauma may interact to impact schizotypal personality traits. Behav Genet 2010; 40:415.
  13. Tomppo L, Hennah W, Miettunen J, et al. Association of variants in DISC1 with psychosis-related traits in a large population cohort. Arch Gen Psychiatry 2009; 66:134.
  14. Stefanis NC, Hatzimanolis A, Avramopoulos D, et al. Variation in psychosis gene ZNF804A is associated with a refined schizotypy phenotype but not neurocognitive performance in a large young male population. Schizophr Bull 2013; 39:1252.
  15. Ohi K, Hashimoto R, Nakazawa T, et al. The p250GAP gene is associated with risk for schizophrenia and schizotypal personality traits. PLoS One 2012; 7:e35696.
  16. Schürhoff F, Laguerre A, Fisher H, et al. Self-reported childhood trauma correlates with schizotypal measures in schizophrenia but not bipolar pedigrees. Psychol Med 2009; 39:365.
  17. Berenz EC, Amstadter AB, Aggen SH, et al. Childhood trauma and personality disorder criterion counts: a co-twin control analysis. J Abnorm Psychol 2013; 122:1070.
  18. Kendler KS, Aggen SH, Czajkowski N, et al. The structure of genetic and environmental risk factors for DSM-IV personality disorders: a multivariate twin study. Arch Gen Psychiatry 2008; 65:1438.
  19. Hazlett EA, Buchsbaum MS, Haznedar MM, et al. Cortical gray and white matter volume in unmedicated schizotypal and schizophrenia patients. Schizophr Res 2008; 101:111.
  20. Takahashi T, Zhou SY, Nakamura K, et al. A follow-up MRI study of the fusiform gyrus and middle and inferior temporal gyri in schizophrenia spectrum. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1957.
  21. Takahashi T, Suzuki M, Zhou SY, et al. A follow-up MRI study of the superior temporal subregions in schizotypal disorder and first-episode schizophrenia. Schizophr Res 2010; 119:65.
  22. Suzuki M, Zhou SY, Takahashi T, et al. Differential contributions of prefrontal and temporolimbic pathology to mechanisms of psychosis. Brain 2005; 128:2109.
  23. Buchsbaum MS, Nenadic I, Hazlett EA, et al. Differential metabolic rates in prefrontal and temporal Brodmann areas in schizophrenia and schizotypal personality disorder. Schizophr Res 2002; 54:141.
  24. Hazlett EA, Lamade RV, Graff FS, et al. Visual-spatial working memory performance and temporal gray matter volume predict schizotypal personality disorder group membership. Schizophr Res 2014; 152:350.
  25. Cicero DC, Krieg A, Becker TM, Kerns JG. Evidence for the Discriminant Validity of the Revised Social Anhedonia Scale From Social Anxiety. Assessment 2016; 23:544.
  26. Martin EA, Cicero DC, Bailey DH, et al. Social Anhedonia Is Not Just Extreme Introversion: Empirical Evidence of Distinct Constructs. J Pers Disord 2016; 30:451.
  27. McClure MM, Harvey PD, Bowie CR, et al. Functional outcomes, functional capacity, and cognitive impairment in schizotypal personality disorder. Schizophr Res 2013; 144:146.
  28. Poyurovsky M, Faragian S, Pashinian A, et al. Clinical characteristics of schizotypal-related obsessive-compulsive disorder. Psychiatry Res 2008; 159:254.
  29. Brakoulias V, Starcevic V, Berle D, et al. The clinical characteristics of obsessive compulsive disorder associated with high levels of schizotypy. Aust N Z J Psychiatry 2014; 48:852.
  30. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  31. Barneveld PS, Pieterse J, de Sonneville L, et al. Overlap of autistic and schizotypal traits in adolescents with Autism Spectrum Disorders. Schizophr Res 2011; 126:231.
  32. Dinsdale NL, Hurd PL, Wakabayashi A, et al. How are autism and schizotypy related? Evidence from a non-clinical population. PLoS One 2013; 8:e63316.
  33. Lee HJ, Cougle JR, Telch MJ. Thought-action fusion and its relationship to schizotypy and OCD symptoms. Behav Res Ther 2005; 43:29.
  34. Stanley MA, Turner SM, Borden JW. Schizotypal features in obsessive-compulsive disorder. Compr Psychiatry 1990; 31:511.