I believe my 26 year old nephew has Schitzotypal Personality Disorder. He also has OCD. At this point I don't believe he is aware (although he wouldn't share it if he was). He hasn't worked in a couple of years and has only held a job for two months at the most. My family is very concerned for him and would like to approach him about this subject but we are also afraid of alienating him forever. At this point, I do not know what to do and would love to hear from people who have STPD.
Hi, thank you for the ask! Sorry it took a while to answer, hopefully you still see this response.
Hmm, coming to people out of concern for them can always be tricky, since how they react will really depend on the personality of the individual. Even two people who have StPD may both respond very differently in that situation due to their own individual personal traits, so it’d be a bit hard for me to give any advice that’d be broadly applicable. I’ll try to just give a few notes that could be helpful..
I guess what could be important, is that we often can struggle with symptoms of paranoia, so we may be suspicious and less trusting of others. You would need to make sure to be very gentle, non-accusatory, non-confrontational, and non-assumptive (like, not assuming how he must feel, telling him he has a bunch of problems, doubting or minimizing his experiences if he did open up about anything, etc.). Especially if he has any odd beliefs/magical thinking, strange behavior/appearance, etc. don’t challenge those things or draw attention to them (like obviously don’t just go ‘You dress weird and look weird and have wrong ideas, this is all bad and you clearly have problems’ etc., that would just make someone feel very alienated and defensive, especially if they’re already suspicious of others). I would suggest simply finding a way to open a dialogue about if there are things going on with him that are distressing him, if he feels okay, if he feels like he could use any extra help, etc. Frame it less like “here’s what I think is wrong with you” and more just as expressing that you support him and care about him and want to check in to see if he’s alright, etc.
(And, if he doesn’t want to discuss it or brushes it off, don’t keep pushing. I would just leave it and maybe try to discuss it later. You want to establish trust, and open communication, so being over-bearing could just be off-putting and make him even more reluctant to ever discuss anything or confide in you.)
Since I can be really easily suspicious of others, Also try to keep the conversation very normal, and don’t do anything out of the ordinary to preface it, like giving him a gift, or being excessively polite/nice to try and get him in a good mood to have the conversation. When people are really nice to me or suddenly want to do me favors out of nowhere or etc., instead of it seeming like a kind gesture, I usually get suspicious and assume they want something from me.
AND don’t approach him as a group!!! I don’t know him personally, but I think most anyone who suffers with paranoia or etc. really dislikes communicating in group scenarios, and especially if the whole goal of the conversation is to try to broach a sensitive topic like this, I would feel cornered and afraid if it was an entire group of people, even if they were my family or people I knew lol.
Also, I think the main thing is to focus less on the diagnosis of specifically saying he has StPD or etc. (especially since from the wording of the ask, it sounds like something you suspect, but that hasn’t actually been diagnosed), and more on the specific symptoms that are causing him distress. If you come to someone just saying “Hey, I think you have StPD”, they could get defensive if it sounds like you’re labeling/diagnosing them, especially if they don’t see themselves the same way. But, if you frame it around something that has been causing them trouble already (like “Hey, I notice it seems like you’ve been having a lot of anxiety around others lately, is everything okay?”, etc.), then it comes across more clearly as genuine concern, without trying to assume anything.
(as a side note - there are combinations of things that could mimic what seems like ‘StPD’ symptoms to the outside observer (but actually aren’t), and people can also be “schizotypal” without actually having a personality disorder (it’s possible to have some schizotypal traits, but without them genuinely causing a level of distress/functional impairment/etc. that would be clinically significant. Kind of like how everyone experiences social anxiety at some-point or another, but only some people would experience it to a severe enough degree/frequency that it’d be considered a disorder. Or how literally everyone dissociates to a certain degree under certain circumstances, but only in some cases would it cause enough impairment to be a dissociative disorder. All human traits are on a spectrum). I’d be cautious about attributing labels to him from afar, especially since you don’t know what’s going on internally with him/inside his mind. Your guess may be right based on what behavior of his you’ve observed or etc., but don’t be too attached to the idea or let it influence how you go about this too much if he were to open up to you and his experiences don’t seem to match that as much as you thought, or etc. It can also be overwhelming for some people, especially in an already possibly tense conversation, to have random medical terms thrown at them. Just try to let the conversation occur naturally without bringing up diagnosis or making too many assumptions (unless he brings it up first or something/shows he’s interested in specifically talking about that. Even then, be gentle how you go about it.))
Also, be sure to pay attention to what his concerns are, VS. yours/your family's. For example, I don’t socialize very often, and it’s not distressing at all to me. I don’t have secret underlying needs that I’m repressing or hidden agony at the fact that I go months without speaking to others, I just genuinely have a very low social need. Other people sometimes see this and worry for me, telling me “Oh you must be so lonely! It must be so terrible!!”, and try to invite me places or introduce me to people to “help” me, even after I repeatedly express it’s unnecessary/that the “help” is completely unwanted, so then it just comes across as invasive, and like they don’t trust that I know my own experiences.
Everyone is different and has different ways of existing that are comfortable for them, and some of them may not make sense to other people, but that doesn’t mean it’s actually distressing for them just because it seems foreign to you. In the conversation, I would make sure to pay attention to HIS concerns first and foremost. Obviously, you can voice your own concerns for him and give your reasoning or etc., but if he says something isn’t a problem for him or doesn’t actually bother him, I wouldn’t push at that too much, since it’s just going to feel like you’re not really listening to him, or are trying to impose.
If you do end up finding he has concerns of his own, pay attention and learn the symptoms that are distressing him personally, or impairing his functioning, and what exactly he feels like he needs help with. Then I guess the most important thing to work towards would be trying to help and support him through the process of resolving those concerns. Regardless of if he has StPD or has impairments from something else, it could help to maybe get some sort of treatment, a therapist (though make sure it’s a therapist that has worked with people with PDs, OCD as well, etc.), etc. Make this as easy as possible and ask if you could do anything to help, maybe you could help him look for therapists, or offer to drive him to appointments, you could help him look up resources to cope with symptoms in the mean time, etc. etc. (But again, don’t continuously impose help if he refuses it. Sometimes we like to sort things out on our own, as many people with StPD tend to be solitary. If he turns down offers to help, don’t get mad or something, just let him know you’re there for him and that you’re willing to help in any way he needs, if he ever does, and if not, that’s okay also.)
If it’s an issue that he doesn’t have a job (since you mentioned it), you could try helping him through that process. A pattern of dropping jobs like that could mean it’s actually difficult for him to work, so maybe look into disability programs, or something that could help him be able to support himself and have an income, even if due to his symptoms he’s unable to keep employment. If you live in the US., you could try going to a Vocational Rehabilitation center (though obviously maybe not right now due to things being closed from the pandemic, etc.). I’ve heard they can help arrange temporary part time jobs/work-trials to help evaluate if someone is capable of working, they can also handle things to get you a free psych evaluation, disability laywer if needed, etc. etc. and maybe could be useful in terms of job concerns. If outside of the US., there might be similar resources where you are, and looking for those could be a good place to start.
And of course, again, these have to be things HE wants to do (or is at least open to), based on his own personal concerns. Going to therapy wouldn’t even be helpful if he just resented the entire process, and had no motivation. You can present options and helpful suggestions, but ultimately it has to be something he sees a point in actually doing. Make sure to listen to him about his own concerns, what he feels comfortable with doing, any anxieties he has over anything in the process, etc. Really just respect his needs, listen, and be supportive in any way you can without being forceful or alienating.
Also, lastly, don’t be disappointed if this isn’t just a Single Conversation sort of thing. Especially for people who are suspicious/untrusting, some may not open up very easily. It could take a while for him to confide in you or express his concerns, or be open to having that type of conversation. Additionally, he may have to figure things out himself as well. I’ve personally always been extremely introspective, even as a child I was constantly trying to question my own thought process, analyze myself, etc., so I’ve also been very keenly attuned to my own mental state and it’s easy for me to identify my own needs and what exactly I’m struggling with. But some people aren’t the same way. If a person isn’t used to thinking about themselves or evaluating how they are, they might not know specifically how they feel, or only have vague ideas, etc. It could take time to actually work through and think about just the main question of if he feels he needs help in any way, how he’s doing, etc. Again, really just listen to him and his needs, try to help respectfully, give him space, don’t assume things, be gentle, try to form trust and be supportive in whatever way possible.
Hopefully some of that is helpful at least, in some way? I know it’s kind of rambly and maybe not the best organized lol. And of course, I’m not an expert or medical professional, and these situations are so highly individualized and dependent on the exact temperament of the person in question, your family dynamic, personal opinions of the individual (for example some people see mental illness as a weakness or have negative views, so suggesting they could have an issue like that seems offensive to them based on their own personal biases, etc.) etc. etc., many things that I could never know just over an ask. But, maybe at least a little could be useful. Good luck!! - Luca
~~ ALSO, if anyone else with StPD has any advice or something, feel free to leave it in replies, or contribute it somehow. This is just my one perspective, and could maybe also be helpful to hear from others. ~~
