Schizotypal personality disorder


  • A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior

Clinical Features

  • Five (or more) of the following criteria, beginning in early adulthood and present in a variety of contexts:[1]
    • Ideas of reference (excluding delusions of reference).
    • Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”: in children and adolescents, bizarre fantasies or preoccupations).
    • Unusual perceptual experiences, including bodily illusions.
    • Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
    • Suspiciousness or paranoid ideation.
    • Inappropriate or constricted affect.
    • Behavior or appearance that is odd, eccentric, or peculiar.
    • Lack of close friends or confidants other than first-degree relatives.
    • Excessive social anxiety that does not diminish with familiarity and tends to be as­sociated with paranoid fears rather than negative judgments about self.
  • Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder

Differential Diagnosis

Psychiatric Disorders with Psychotic Symptoms


  • Neurodevelopmental disorders
  • Personality change due to another medical condition
  • Substance use disorders
  • Other personality disorders and personality traits


  • A clinical diagnosis; however if entertaining other organic causes may initiate workup below

General ED Psychiatric Workup


  • Ask for clarification of any unclear terminology, be genuinely curious
  • Know patient may underreport symptoms due to desire to end social interaction with you
  • Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, and antipsychotics medications


  • Discharge

See Also

External Links


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.