#stpd info

[psychresources]

Speech in Schizotypal Personality Disorder (StPD)

One of the DSM-5 criteria for StPD involves "odd speech." But what does this mean exactly?

Many individuals with StPD report feeling like they have difficulties communicating their feelings and expressing their emotions. (1)

When speaking, people with StPD have significantly more pauses, speak more slowly, have less fluctuation in pitch, and express less emotion compared to neurotypicals. This was detectable even when they only said a fraction of a word! (1)

Why is this the case?

People with StPD often struggle to understand and decode emotions in tone of voice. This may affect their ability to use tone of voice "properly" (in a way that aligns with neurotypical expectations) themselves. (2)

People with StPD were found to recall more idiosyncratic words and fewer semantically related words when prompted. This is called "atypical semantic cognition" and is associated with "eccentric speech and thinking". Basically, this means that people with StPD are more likely to think of seemingly unrelated words and concepts than connected ones, which contributes to speaking differently compared to neurotypicals. (3)

People with StPD have auditory processing abnormalities that are thought to affect their speech patterns, as well as language difficulties in general. (4)

Some good news:

These speech abnormalities are often detectable to other people. However, this did not affect whether the raters wanted to hear more from them, especially when the individuals with StPD are more self-aware and in touch with their own emotions. (1)

Further reading:

Reddit thread with examples of "odd thought and speech"

Reddit thread discussing over-elaborate speech

Tumblr post elaborating on odd metaphorical thinking

PsychCentral disorganized speech 101

References:

(1) Dickey, C. C., Vu, M. T., Voglmaier, M. M., Niznikiewicz, M. A., McCarley, R. W., & Panych, L. P. (2012). Prosodic abnormalities in schizotypal personality disorder. Schizophrenia Research, 142(1–3), 20–30. https://doi.org/10.1016/j.schres.2012.09.006 (PDF)

(2) Wickline, V. B., Nowicki, S., Bollini, A. M., & Walker, E. F. (2011). Vocal and facial emotion decoding difficulties relating to social and thought problems: Highlighting schizotypal personality disorder. Journal of Nonverbal Behavior, 36(1), 59–77. https://doi.org/10.1007/s10919-011-0125-2 (PDF)

(3) Petersen, L. S., Vestergaard, M., Meisner, M. W., Foldager, M., & Simonsen, E. (2024). Atypical semantic cognition in schizotypal personality disorder and borderline personality disorder. Journal of Clinical and Experimental Neuropsychology, 46(3), 218–232. https://doi.org/10.1080/13803395.2024.2340813 (PAYWALLED; information from abstract)

(4) Dickey, C. C., Morocz, I. A., Niznikiewicz, M. A., Voglmaier, M., Toner, S., Khan, U., Dreusicke, M., Yoo, S., Shenton, M. E., & McCarley, R. W. (2008). Auditory processing abnormalities in schizotypal personality disorder: An fMRI experiment using tones of deviant pitch and duration. Schizophrenia Research, 103(1–3), 26–39. https://doi.org/10.1016/j.schres.2008.04.041 (PDF)

[hauntedselves]

The Schizotaxic Personality Disorders in the SWAP-200 Personality Disorder Assessment

Schizoid PD:

Schizotypal PD:

Avoidant PD:

From Zachary Wheeler, Treatment of Schizoid Personality [dissertation] (2013)

[hauntedselves]

Attachment Styles in Schizophrenic Spectrum PDs

See also: Attachment styles and personality disorders.

From Zachary Wheeler, Treatment of Schizoid Personality [dissertation] (2013)

[hauntedselves]

With all of the PDs, how much of the criteria do you have to fit?

PPD: 4 or more

Suspects w/o evidence that people are planning to harm them

Preoccupied w/ doubts about loyalty & trustworthiness

Reluctant to share info about themselves out of fear that it’ll be used against them

Misinterprets innocent remarks or behaviours as threats

Holds grudges

Quick to get angry or [counter]attack people based on what they think are threats

Suspects partner of cheating

+ Must not be part of schizophrenia, other psychotic disorder, bipolar disorders, but can be premorbid to schizophrenia

SZPD: 4 or more

Doesn’t enjoy close relationships

Almost always chooses to be alone

Asexual

Finds little pleasure in activities

Lacks close friends, other than family

Appears indifferent to praise or criticism

Flat/cold emotional expression

+ Must not be part of schizophrenia, other psychotic disorder, bipolar disorders or autism, but can be premorbid to schizophrenia

STPD: 5 or more

Ideas of reference (not delusional)

Odd beliefs or magical thinking (not delusional)

Unusual perceptions/illusions (not hallucinations)

Odd thinking & speech

Suspicion or paranoia

Inappropriate or flat emotional expression

Strange behaviour or appearance

Lacks close friends, other than family

Social anxiety & paranoia about social interactions

+ Must not be part of schizophrenia, other psychotic disorder, bipolar disorders or autism, but can be premorbid to schizophrenia

ASPD: 3 or more

Doesn’t conform to social norms esp. in regards to the law

Deceitful

Impulsive

Irritability & aggression

Reckless & disregards their & others’ safety

Irresponsible

Lacks remorse

+ Must be at least 18, have had symptoms of Conduct Disorder before 15, & not be part of schizophrenia or bipolar disorders

BPD: 5 or more

Frantically avoids abandonment

Splitting, unstable relationships

Unstable sense of self

Damaging impulsivity

Self harm & suicidal behaviour

Mood swings

Feeling empty

Intense anger

Dissociation &/or paranoia

HPD: 5 or more

Uncomfortable w/o attention

Inappropriate sexual behaviour

Mood swings

Uses appearance to get attention

Speech mimics others’, lacks detail

Dramatic

Suggestible

Overestimates intimacy

NPD: 5 or more

Grandiose sense of self

Fantasies of success, power, etc

Feels special & unique

Needs admiration

Feels entitled

Exploitative

Lacks empathy

Jealous

Arrogant

AVPD: 4 or more

Avoidance b/c of fear of criticism, disapproval, rejection

Unwilling to have relationships unless certain they’ll be liked

Restrained in relationships b/c fear of shame, humiliation

Preoccupied with fears of criticism or rejection

Restrained in social situations b/c of fear

Views self as inadequate

Reluctant to do new things out of fear of embarrassment

DPD: 5 or more

Difficulty making everyday decisions

Needs others to be responsible for major areas of life

Difficulty being assertive b/c fear of loss of support

Difficulty doing things by themselves b/c lack self-confidence

Feels uncomfortable or helpless when alone

Urgently finds a new relationship when one ends

Unrealistically preoccupied w/ fears of being alone

OCPD: 4 or more

Preoccupied with details, rules etc so that the point of the activity is lost

Perfectionism that interferes with life

Workaholicism that interferes with life & relationships

Overly inflexible & hyperaware of morals, values

Things have to be done their way

Hoards money in case of future need

Rigid & stubborn

[hauntedselves]

Personality Disorder Attributes by Personality Domain

(Includes some of Millon’s theorised PDs - Depressive, Sadistic, Negativistic & Masochistic)

- From Millon, Personality Disorders in Modern Life (2004)

[hauntedselves]

Millon on AVPD vs:

SZPD:

Withdrawing from relationships are features of both

People with SZPD are indifferent or passive to relationships

Lacking strong desires and emotions is part of SZPD, where people with AVPD are anxious and hypersensitive

People with SZPD find relationships boring, while people with AVPD find them punishing

People with AVPD often have a strong internal fantasy as an escape method

Thought processes in AVPD and SZPD can seem tangential and disconnected.

Both struggle with focusing, for different reasons: anxiety and feeling overwhelmed in AVPD, and boredom in SZPD

STPD:

Concentration problems, social anxiety, and fantasy as an escape method in AVPD are similar to eccentricism, social detachment, and low self-esteem in STPD

In AVPD, concentration issues aren’t pervasive - when alone or with a trusted person, they are able to concentrate

In STPD, eccentricity is pervasive. They are more “dramatically bizarre” and can experience psychosis, which is not a feature of AVPD

PPD:

Anxiety, fear, mistrust and fear of embarrassment or humiliation are part of both PPD and AVPD

In AVPD, they believe that the root of this fear is themselves - that they are inadequate and deserving of embarrassment

In PPD, it’s the opposite, that other people are attempting to humiliate them

Although people with PPD and AVPD are often lonely, both are reluctant to confide in others; people with AVPD are afraid it will cause embarrassment for them, while people with PPD are afraid the person will use the information against them

DPD & OCPD:

Since DPD, AVPD and OCPD are all Cluster C disorders, there is a lot of overlap, particularly in anxiety

AVPD and DPD both result in the person feeling inadequate, but their response to this feeling is different: people with DPD seek people who they can depend on, while people with AVPD avoid for fear of their negative self-view being voiced by others

People with AVPD do well on their own, while people with DPD tend to feel increasingly helpless

When faced with criticism, people with AVPD avoid the situation, while people with DPD stay and try to please

Both people with AVPD and OCPD are anxious over being criticised. People with AVPD withdraw, while people with OCPD direct their anxiety into increased preoccupation with rules, details, lists, etc

- From Millon et al., Personality Disorders in Modern Life (2004)

[hauntedselves]

What are the concrete differences between schizoid lack of enjoyement for close relationships and schizotypal "acute discomfort in close relationships"?

STPD = social anxiety SZPD = no anxiety, just don't enjoy/want it

discomfort in STPD is about social anxiety that doesn’t fade as you get to know the person(s). a person with STPD may (or may not) desire friendships, but will still feel uncomfortable in them. the anxiety is usually part of paranoid ideation.

the DSM says:

“Individuals with schizotypal personality disorder experience interpersonal relatedness as problematic and are uncomfortable relating to other people. Although they may express unhappiness about their lack of relationships, their behavior suggests a decreased desire for intimate contacts. As a result, they usually have no or few close friends or confidants other than a first-degree relative. They are anxious in social situations, particularly those involving unfamiliar people. They will interact with other individuals when they have to but prefer to keep to themselves because they feel that they are different and just do not “fit in.” Their social anxiety does not easily abate, even when they spend more time in the setting or become more familiar with the other people, because their anxiety tends to be associated with suspiciousness regarding others’ motivations. For example, when attending a dinner party, the individual with schizotypal personality disorder will not become more relaxed as time goes on, but rather may become increasingly tense and suspicious.”

discomfort in SZPD is about lack of desire for friendships. relationships just don’t do it for them, though there may be exceptions.

the DSM says:

“Individuals with schizoid personality disorder appear to lack a desire for intimacy, seem indifferent to opportunities to develop close relationships, and do not seem to derive much satisfaction from being part of a family or other social group. They prefer spending time by themselves, rather than being with other people. They often appear to be socially isolated or “loners” and almost always choose solitary activities or hobbies that do not include interaction with others.”

some posts on SZPD relationships:

“do you [a schizoid person] have friends?”

all-or-nothing thinking in schizoid relationships

interest and intimacy in schizoid/schizotaxic relationships

fading relationship bonds

 “can you have friends but not really care about them?“

some posts on STPD relationships:

“can you have STPD and still have friends?”

“is it actually possible for a person with STPD to have close friends?”

magical thinking & schizotypal relationships

also check out my interpersonal relationships in PDs tag

[hauntedselves]

do you know the difference between Hebephrenic schizophrenia/disorganized schizophrenia vs schizotypal PD ? let me know if you need more information on this question i am asking

Firstly, hebephrenic / disorganised schizophrenia isn't a diagnosis anymore.

This was the definition of hebephrenic / disorganised schizophrenia from the ICD-10:

"A form of schizophrenia in which affective changes are prominent, delusions and hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable, and mannerisms common. The mood is shallow and inappropriate, thought is disorganized, and speech is incoherent. There is a tendency to social isolation. Usually the prognosis is poor because of the rapid development of "negative" symptoms, particularly flattening of affect and loss of volition. Hebephrenia should normally be diagnosed only in adolescents or young adults."

and from the DSM-IV-TR:

"The essential features of the Disorganized Type of Schizophrenia are disorganized speech, disorganized behavior, and flat or inappropriate affect. The disorganized speech may be accompanied by silliness and laughter that are not closely related to the content of the speech. The behavioral disorganization (i.e., lack of goal orientation) may lead to severe disruption in the ability to perform activities of daily living (e.g., showering, dressing, or preparing meals). Criteria for the Catatonic Type of Schizophrenia are not met, and delusions or hallucinations, if present, are fragmentary and not organized into a coherent theme. Associated features include grimacing, mannerisms, and other oddities of behavior. Impaired performance may be noted on a variety of neuropsychological and cognitive tests. This subtype is also usually associated with poor premorbid personality, early and insidious onset, and a continuous course without significant remissions. Historically, and in other classification systems, this type is termed hebephrenic."

Essentially, it's a type of schizophrenic presentation characterised mostly by negative psychotic symptoms, especially formal thought disorder (disorganised thinking & speech).

The main difference between schizophrenia (SZA) and StPD is the presence of positive psychotic symptoms (delusions, hallucinations, thought disorder). But since hebephrenic schizophrenia is mostly about negative psychotic symptoms (avolition, anhedonia, alogia, flat affect/diminished emotional expression etc) & disorganised symptoms (thought disorder) we can't really use positive psychotic symptoms to differentiate the two. StPD can have some symptoms of thought disorder and negative psychotic symptoms, but not to a SZA degree (e.g. StPD speech can be weird, but SZA speech can be downright impossible to understand).

The other difference between SZA and StPD is persistent psychosis. So the symptoms of hebephrenic SZA are persistent, and aren't episodic or triggered by stress, while psychosis in StPD is episodic and often triggered by stress.

People with StPD also meet the general criteria for a personality disorder, while someone with SZA won't.

StPD can be premorbid (turn into) to SZA. StPD is relatively stable over a person's lifetime, while SZA is strongly associated with a decline in functioning.