Can Schizotypal Disorder Disintergrate Into Frankschizophrenia

Schizotypals are often described as odd and eccentric and seemingly engrossed in their own world. Most researchers believe that the schizotypal personality lies on a continuum with schizophrenia called schizotypy. Schizotypals, like schizophrenics, experience both positive and negative symptoms. As one of the three structurally defective personalities (the paranoid and the borderline are the other two), schizotypals are set apart from other personalities in that they rarely find a comfortable niche in society and repeat the same setbacks again and again. However, most schizotypals are able to pull themselves together enough to prevent slipping into more serious decompensated states.

Despite the severe nature of this personality disorder, there are normal variants in society. Oldham and Morris (1995) describe the idiosyncratic style that "marches to a different drummer" and is highly open to new experiences and often attracted to the occult and supernatural. Normalizing the DSM-IV criteria also provides a more normal variant of schizotypals that draws inspiration from their own internal world and may hold certain superstitious beliefs but is able to suspend them to function effectively in society.

Some variations on the schizotypal personality are proposed by Millon (1990). The insipid schizotypal exaggerates the schizoid, passively detached pattern in addition to schizotypal features and is likely to have had a family background of indifference and formality. The timorous schizotypal shares the more actively detached style of the avoidant and is likely to have been belittled and rejected while growing up.

The schizotypal personality is a relatively new construct that has its origins in both the writings of Kraepelin and Bleuler, who studied dementia praecox patients and noticed how diverse their symptoms were. Bleuler conceptualized these patients on a continuum with schizophrenics at the most severe end and with schizotypals closer to normal because they could often appear to "walk about life" like any "normal" person. In 1956, Rado coined the term schizotype as an abbreviation for schizophrenic phenotype. He believed that schizotypals were not destined to decompensate into schizophrenia but could fluctuate between compensated and decompensated states and perhaps even live a normal life. Later family and genetic studies have supported this idea of a spectrum of schizophrenia.

The emerging viewpoint, stemming from biological research, is that schizotype is the fundamental disorder with schizophrenia being a special case and schizotypal personality being the general case. Brain studies that have been conducted with schizophrenics are currently being explored as to their applicability to schizotypal personality and to see if new light can be shed on this research with the perspective that schizotype is the fundamental disorder. This research shows a promising line of thought that involves not only brain anatomy and neurotransmitters but also neurovirology.

Psychodynamic theory would predict that schizotypals would regress to a stable, but primitive, ego state with temporary psychotic episodes. They lack a basic integration of the self and other object-representations; thus they are considered a structurally defective personality. The interpersonal perspective gives another slant on the schizotypal personality that highlights their tendency to obscure fact from fantasy and their isolation that prevents them from experiencing a corrective feedback. Schizotypals seem to lack an understanding of basic social codes and norms and often miss social cues that cause them to chronically misinterpret social situations. Benjamin presents a developmental account through an interpersonal understanding that focuses on parents sending illogical or contradictory messages about the child's learning to be autonomous.

Schizotypals seem unable to organize their thoughts; this disorganization seems to be from the bottom up. A possible explanation of this disorganization is a malfunctioning in their neural network. Schizotypals also are easily distracted, and many develop disorders in the productivity of speech. From a biopsychosocial perspective, the schizotypal personality lies on the continuum between the schizoid and the avoidant and usually develops symptoms more closely aligned with one of these disorders. As the level of pathology increases, the structural matrix seems to disintegrate.

The schizotypal shares traits with not only the schizoid and avoidant but also the paranoid and borderline personalities. They are vulnerable to developing dissociative episodes, psychotic symptoms, and depression. Therapy is extremely difficult with the schizotypal because of their thought disorder as well as their paranoid ideation, and success depends heavily on the severity of the thought disturbances. Their therapeutic goals depend on whether there are more avoidant or more schizoidal traits. Developing a strong therapeutic alliance is critical before distortions of reality can be confronted. Cognitive interventions must take into account schizotypals' limited attention span as well as address their automatic thoughts. Overall, cognitive therapy combined with medication will likely prove to be the most effective treatment for the schizotypal personality.

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