The study of schizotypal personality disorder (SPD) is important clinically, as it is understudied, challenging to treat, often under-recognized or misdiagnosed, and associated with significant functional impairment. SPD also represents an intermediate schizophrenia-spectrum phenotype, and therefore, can provide a better understanding of the genetics, pathogenesis, and treatment of related psychotic illnesses. In this review we discuss recent findings of SPD related to epidemiology and functional impairment, heritability and genetics, working memory and cognitive impairments, social-affective disturbances, and neurobiology. Additionally, we examine the challenges associated with treating patients with SPD, as well as clinical recommendations. Finally, we address future directions and areas in need of further exploration.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Hummelen B, Pedersen G, Karterud S. Some suggestions for the DSM-5 schizotypal personality disorder construct. Compr Psychiatry. 2012;53:341–9. This study comprehensively examines the factor structure and psychometric properties of SPD criteria among a large clinical population of personality disordered patients assessed by structured interview.
Lien YJ, Tsuang HC, Chiang A, et al. The multidimensionality of schizotypy in nonpsychotic relatives of patients with schizophrenia and its applications in ordered subsets linkage analysis of schizophrenia. Am J Med Genet B Neuropsychiatr Genet. 2010;153B:1–9.
Cohen AS, Matthews RA, Najolia GM, Brown LA. Toward a more psychometrically sound brief measure of schizotypal traits: introducing the SPQ-Brief Revised. J Personal Disord. 2010;24:516–37.
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;11:53–67.
McClure MM, Harvey PD, Bowie CR, Iacoviello B, Siever LJ. Functional outcomes, functional capacity, and cognitive impairment in schizotypal personality disorder. Schizophr Res. 2013;144:146–50. This studies establishes the importance of working memory/cognitive dysfunction in determining functional outcomes in SPD.
McGurk SR, Mueser KT, Mischel R, et al. Vocational functioning in schizotypal and paranoid personality disorders. Psychiatry Res. 2013;210:498–504. This study assesses the role of cognitive impairent and other factors in the vocational function of both SPD and PPD patients.
Battaglia M, Bernardeschi L, Franchini L, Bellodi L, Smeraldi E. A family study of schizotypal disorder. Schizophr Bull. 1995;21:33–45.
Torgersen S, Lygren S, Oien PA, et al. A twin study of personality disorders. Compr Psychiatry. 2000;41:416–25.
Kendler KS, Myers J, Torgersen S, Neale MC, Reichborn-Kjennerud T. The heritability of cluster A personality disorders assessed by both personal interview and questionnaire. Psychol Med. 2007;37:655–65.
Battaglia M, Fossati A, Torgersen S, et al. A psychometric-genetic study of schizotypal disorder. Schizophr Res. 1999;37:53–64.
Linney YM, Murray RM, Peters ER, MacDonald AM, Rijsdijk F, Sham PC. A quantitative genetic analysis of schizotypal personality traits. Psychol Med. 2003;33:803–816.
MacDonald AW, III, Pogue-Geile MF, Debski TT, Manuck S. Genetic and environmental influences on schizotypy: a community-based twin study. Schizophr Bull. 2001;27:47–58.
Machon RA, Huttunen MO, Mednick SA, et al. Adult schizotypal personality characteristics and prenatal influenza in a Finnish birth cohort. Schizophr Res. 2002;54:7–16.
Lentz V, Robinson J, Bolton JM. Childhood adversity, mental disorder comorbidity, and suicidal behavior in schizotypal personality disorder. J Nerv Ment Dis. 2010;198:795–801.
Fung AL, Raine A. Peer victimization as a risk factor for schizotypal personality in childhood and adolescence. J Personal Disord. 2012;26:428–34.
Peskin M, Raine A, Gao Y, Venables PH, Mednick SA. A developmental increase in allostatic load from ages 3 to 11 years is associated with increased schizotypal personality at age 23 years. Dev Psychopathol. 2011;23:1059–68.
Schurhoff F, Laguerre A, Fisher H, et al. Self-reported childhood trauma correlates with schizotypal measures in schizophrenia but not bipolar pedigrees. Psychol Med. 2009;39:365–70.
Savitz J, van der Merwe L, Newman TK, Stein DJ, Ramesar R. Catechol-o-methyltransferase genotype and childhood trauma may interact to impact schizotypal personality traits. Behav Genet. 2010;40:415–423.
Avramopoulos D, Stefanis NC, Hantoumi I, Smyrnis N, Evdokimidis I, Stefanis CN. Higher scores of self reported schizotypy in healthy young males carrying the COMT high activity allele. Mol Psychiatry. 2002;7:706–11.
Docherty AR, Sponheim SR. Anhedonia as a phenotype for the Val158Met COMT polymorphism in relatives of patients with schizophrenia. J Abnorm Psychol. 2008;117:788–98.
Schurhoff F, Szoke A, Chevalier F, et al. Schizotypal dimensions: an intermediate phenotype associated with the COMT high activity allele. Am J Med Genet B Neuropsychiatr Genet. 2007;144B:64–8.
Smyrnis N, Avramopoulos D, Evdokimidis I, Stefanis CN, Tsekou H, Stefanis NC. Effect of schizotypy on cognitive performance and its tuning by COMT val158 met genotype variations in a large population of young men. Biol Psychiatry. 2007;61:845–53.
Sheldrick AJ, Krug A, Markov V, et al. Effect of COMT val158met genotype on cognition and personality. Eur Psychiatry. 2008;23:385–9.
Minzenberg MJ, Xu K, Mitropoulou V, et al. Catechol-O-methyltransferase Val158Met genotype variation is associated with prefrontal-dependent task performance in schizotypal personality disorder patients and comparison groups. Psychiatr Genet. 2006;16:117–24.
Leung WW, McClure MM, Siever LJ, Barch DM, Harvey PD. Catechol-O-methyltransferase Val158Met genotype in healthy and personality disorder individuals: Preliminary results from an examination of cognitive tests hypothetically differentially sensitive to dopamine functions. Neuropsychiatr Dis Treat. 2007;3:925–34.
Roussos P, Bitsios P, Giakoumaki SG, et al. CACNA1C as a risk factor for schizotypal personality disorder and schizotypy in healthy individuals. Psychiatry Res. 2013;206:122–3. This study demonstrates an association between CACNA1C and paranoid ideation in healthy participants, and with SPD compared to healthy subjects.
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;39:1252–60. This study demonstrates, in a large population of healthy participants, an association between ZNF804A and paranoid ideation/ideas of reference.
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;66:134–41.
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. In this study, the p250GAP gene was associated with schizotypal symptoms, namely Interpersonal, in healthy participants.
Mitropoulou V, Harvey PD, Maldari LA, et al. Neuropsychological performance in schizotypal personality disorder: evidence regarding diagnostic specificity. Biol Psychiatry. 2002;52:1175–82.
Bedwell JS, Kamath V, Compton MT. The relationship between interview-based schizotypal personality dimension scores and the continuous performance test. Schizophr Res. 2009;108:158–62.
Schmidt-Hansen M, Honey RC. Working memory and multidimensional schizotypy: dissociable influences of the different dimensions. Cogn Neuropsychol. 2009;26:655–70.
Abi-Dargham A. Probing cortical dopamine function in schizophrenia: what can D1 receptors tell us? World Psychiatry. 2003;2:166–71.
Abi-Dargham A, Xu X, Thompson JL, et al. Increased prefrontal cortical D(1) receptors in drug naive patients with schizophrenia: a PET study with [(1)(1)C]NNC112. J Psychopharmacol. 2012;26:794–805.
Abi-Dargham A, Mawlawi O, Lombardo I, et al. Prefrontal dopamine D1 receptors and working memory in schizophrenia. J Neurosci. 2002;22:3708–19.
Thompson JL, Rosell DR, Slifstein M et al. Prefrontal dopamine D1 receptors and working memory in schizotypal personality disorder: a PET study with [C]NNC112. Psychopharmacology (Berl). 2014. doi:10.1007/s00213-014-3566-6
McClure MM, Harvey PD, Goodman M, et al. Pergolide treatment of cognitive deficits associated with schizotypal personality disorder: continued evidence of the importance of the dopamine system in the schizophrenia spectrum. Neuropsychopharmacology. 2010;35:1356–62.
McClure MM, Barch DM, Romero MJ, et al. The effects of guanfacine on context processing abnormalities in schizotypal personality disorder. Biol Psychiatry. 2007;61:1157–60.
Goldstein KE, Hazlett EA, Savage KR, et al. Dorso- and ventro-lateral prefrontal volume and spatial working memory in schizotypal personality disorder. Behav Brain Res. 2011;218:335–40. In this study, a differential relationship is described between the prefrontal cortex and working memory in SPD compared to healthy participants.
Levitt JJ, McCarley RW, Dickey CC, et al. MRI study of caudate nucleus volume and its cognitive correlates in neuroleptic-naive patients with schizotypal personality disorder. Am J Psychiatry. 2002;159:1190–7.
Levitt JJ, Styner M, Niethammer M, et al. Shape abnormalities of caudate nucleus in schizotypal personality disorder. Schizophr Res. 2009;110:127–39.
Levitt JJ, Westin CF, Nestor PG, et al. Shape of caudate nucleus and its cognitive correlates in neuroleptic-naive schizotypal personality disorder. Biol Psychiatry. 2004;55:177–84.
Koenigsberg HW, Buchsbaum MS, Buchsbaum BR, et al. Functional MRI of visuospatial working memory in schizotypal personality disorder: a region-of-interest analysis. Psychol Med. 2005;35:1019–30.
Vu MA, Thermenos HW, Terry DP, et al. Working memory in schizotypal personality disorder: fMRI activation and deactivation differences. Schizophr Res. 2013. doi:10.1016/j.schres.2013.09.013. This is a recent, and one of the few studies to examine functional neural correlates of working memory in SPD.
Koychev I, Deakin JF, Haenschel C, El-Deredy W. Abnormal neural oscillations in schizotypy during a visual working memory task: support for a deficient top-down network? Neuropsychologia. 2011;49:2866–73.
Gooding DC, Pflum MJ. Theory of Mind and psychometric schizotypy. Psychiatry Res. 2011;188:217–23.
Pflum MJ, Gooding DC, White HJ. Hint, hint: theory of mind performance in schizotypal individuals. J Nerv Ment Dis. 2013;201:394–9. This a recent study describing the theory of mind deficits associated with schizotypy; the specificity for postive compared to negative schizotypy is also demonstrated.
Abbott G, Byrne LK. Schizotypal traits are associated with poorer identification of emotions from dynamic stimuli. Psychiatry Res. 2013;207:40–4. This is another recent study describing emotion recognition deficits associated with global schizotypy, as well as specific schizotypal dimensions.
Abbott GR, Green MJ. Facial affect recognition and schizotypal personality characteristics. Early Interv Psychiatry. 2013;7:58–63.
Zaki J, Bolger N, Ochsner K. It takes two: the interpersonal nature of empathic accuracy. Psychol Sci. 2008;19:399–404.
Ripoll LH, Zaki J, Perez-Rodriguez MM, et al. Empathic accuracy and cognition in schizotypal personality disorder. Psychiatry Res. 2013;210:232–41. This is a recent and comprehensive study examining mentalization in SPD.
Henry JD, Green MJ, Restuccia C, et al. Emotion dysregulation and schizotypy. Psychiatry Res. 2009;166:116–24.
Martin EA, Cicero DC, Kerns JG. Social anhedonia, but not positive schizotypy, is associated with poor affective control. Personal Disord. 2012;3:263–72. This study demonstrates that specific dimensions of schizotypy are associated with a laboratory task of emotion regulation.
Hazlett EA, Zhang J, New AS, et al. Potentiated amygdala response to repeated emotional pictures in borderline personality disorder. Biol Psychiatry. 2012;72:448–56. Although the focus of this study is BPD, patients with SPD are shown to exhibit differential amygdala activation patterns during novel and repeated exposures to affective stimuli.
Premkumar P, Ettinger U, Inchley-Mort S, et al. Neural processing of social rejection: the role of schizotypal personality traits. Hum Brain Mapp. 2012;33:695–706.
Soliman A, O'Driscoll GA, Pruessner J, et al. Limbic response to psychosocial stress in schizotypy: a functional magnetic resonance imaging study. Schizophr Res. 2011;131:184–91. This study demonstrates differential neural responses to stress as a function of positive vs. negative schizotypy.
Soliman A, O'Driscoll GA, Pruessner J, et al. Stress-induced dopamine release in humans at risk of psychosis: a [11C]raclopride PET study. Neuropsychopharmacology. 2008;33:2033–41.
Hazlett EA, Buchsbaum MS, Haznedar MM, et al. Cortical gray and white matter volume in unmedicated schizotypal and schizophrenia patients. Schizophr Res. 2008;101:111–23.
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;35:1957–64. This study (and the one below) demonstrate differences in the extent and progression of temporal lobe abnormalities between SPD and schizophrenia.
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;119:65–74.
Dickey CC, McCarley RW, Voglmaier MM, et al. An MRI study of superior temporal gyrus volume in women with schizotypal personality disorder. Am J Psychiatry. 2003;160:2198–201.
Dickey CC, McCarley RW, Voglmaier MM, et al. Smaller left Heschl's gyrus volume in patients with schizotypal personality disorder. Am J Psychiatry. 2002;159:1521–7.
Asami T, Whitford TJ, Bouix S, et al. Globally and locally reduced MRI gray matter volumes in neuroleptic-naive men with schizotypal personality disorder: association with negative symptoms. JAMA Psychiatry. 2013;70:361–72. This study comprehensively examines neuroanatomical differrences associated with SPD.
Kuhn S, Schubert F, Gallinat J. Higher prefrontal cortical thickness in high schizotypal personality trait. J Psychiatr Res. 2012;46:960–5.
Modinos G, Mechelli A, Ormel J, Groenewold NA, Aleman A, McGuire PK. Schizotypy and brain structure: a voxel-based morphometry study. Psychol Med. 2010;40:1423–31.
Shihabuddin L, Buchsbaum MS, Hazlett EA, et al. Striatal size and relative glucose metabolic rate in schizotypal personality disorder and schizophrenia. Arch Gen Psychiatry. 2001;58:877–84.
Chemerinski E, Byne W, Kolaitis JC, et al. Larger putamen size in antipsychotic-naive individuals with schizotypal personality disorder. Schizophr Res. 2013;143:158–64. This is a recent, large, well performed study examining anatomical differences in the striatum in SPD patients compared to healthy participants.
Mitelman SA, Canfield EL, Chu KW, et al. Poor outcome in chronic schizophrenia is associated with progressive loss of volume of the putamen. Schizophr Res. 2009;113:241–5.
Koo MS, Levitt JJ, McCarley RW, et al. Reduction of caudate nucleus volumes in neuroleptic-naive female subjects with schizotypal personality disorder. Biol Psychiatry. 2006;60:40–8.
Hazlett EA, New AS, Newmark R, et al. Reduced anterior and posterior cingulate gray matter in borderline personality disorder. Biol Psychiatry. 2005;58:614–23.
Takahashi T, Suzuki M, Kawasaki Y, et al. Volumetric magnetic resonance imaging study of the anterior cingulate gyrus in schizotypal disorder. Eur Arch Psychiatry Clin Neurosci. 2002;252:268–77.
Takahashi T, Suzuki M, Zhou SY, et al. Lack of normal gender differences of the perigenual cingulate gyrus in schizophrenia spectrum disorders. A magnetic resonance imaging study. Eur Arch Psychiatry Clin Neurosci. 2004;254:273–80.
Chanraud S, Zahr N, Sullivan EV, Pfefferbaum A. MR diffusion tensor imaging: a window into white matter integrity of the working brain. Neuropsychol Rev. 2010;20:209–25.
Nakamura M, McCarley RW, Kubicki M, et al. Fronto-temporal disconnectivity in schizotypal personality disorder: a diffusion tensor imaging study. Biol Psychiatry. 2005;58:468–78.
Gurrera RJ, Nakamura M, Kubicki M, et al. The uncinate fasciculus and extraversion in schizotypal personality disorder: a diffusion tensor imaging study. Schizophr Res. 2007;90:360–2.
Hazlett EA, Collazo T, Zelmanova Y, et al. Anterior limb of the internal capsule in schizotypal personality disorder: fiber-tract counting, volume, and anisotropy. Schizophr Res. 2012;141:119–27.
Abi-Dargham A, Kegeles LS, Zea-Ponce Y, et al. Striatal amphetamine-induced dopamine release in patients with schizotypal personality disorder studied with single photon emission computed tomography and [123I]iodobenzamide. Biol Psychiatry. 2004;55:1001–6.
Woodward ND, Cowan RL, Park S, et al. Correlation of individual differences in schizotypal personality traits with amphetamine-induced dopamine release in striatal and extrastriatal brain regions. Am J Psychiatry. 2011;168:418–26. This is one of the few studies that have examined the relationship between dopamine release and schizotypal traits.
Chen KC, Lee IH, Yeh TL, et al. Schizotypy trait and striatal dopamine receptors in healthy volunteers. Psychiatry Res. 2012;201:218–21.
Howes OD, Shotbolt P, Bloomfield M, et al. Dopaminergic function in the psychosis spectrum: an [18F]-DOPA imaging study in healthy individuals with auditory hallucinations. Schizophr Bull. 2013;39:807–14. This is an important, albeit, negative, study that examines dopamine synthesis in healthy participants with subclinical auditory hallucinations.
Koenigsberg HW, Reynolds D, Goodman M, et al. Risperidone in the treatment of schizotypal personality disorder. J Clin Psychiatry. 2003;64:628–34.
Stone M. Schizotypal personality: psychotherapeutic aspects. Schizophr Bull. 1985;11:576–89.
Compliance with Ethics Guidelines
Conflict of Interest
Daniel R. Rosell has received support for travel and payment from writing or reviewing manuscript from the Department of Veterans Affairs.
Shira E. Futterman has received support from a grant from the National Institute of Mental Health awarded to LJS.
Antonia McMaster has received a support from a grant from the National Institute of Mental Health awarded to LJS.
Larry J. Siever has received grants and travel support from the National Institute of Mental Health and the Department of Veterans Affairs. He also received travel support from the Mental Illness Research, Education and Clinical Centers. Dr. Siever also has receive payment for writing or reviewing manuscripts from the Department of Veterans Affairs, the Mental Illness Research, Education and Clinical Centers, and Mount Sinai.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Personality Disorders
About this article
Cite this article
Rosell, D.R., Futterman, S.E., McMaster, A. et al. Schizotypal Personality Disorder: A Current Review. Curr Psychiatry Rep 16, 452 (2014). https://doi.org/10.1007/s11920-014-0452-1
- Personality disorder
- Frontal lobe
- Temporal lobe
- Working memory
- Social cognition
- Affect processing
- Magical thinking
- Perceptual aberration
- Social anhedonia