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Dual Diagnosis – Schizoid and Schizotypal Personality Disorders

This is the eighth article in our series on Dual Diagnosis. 

Schizoid personality disorder is characterized by a lack of interest and detachment from social relationships, and an atypically low need for social interactions. This personality disorder often compares to being an introvert, only with more extreme symptoms. The patient has a hard time expressing their emotions and even when they do, it’s in a very restricted range. Patients are often described as the typical “loner”, they don’t express their emotions, and would rather spend time by themselves, are emotionally cold and secretive.

Schizotypal personality disorder, on the other hand, involves odd behaviors and beliefs (magical, paranormal) that are the center of the patient’s life. As a result, the patient finds it difficult to connect with other people and maintain positive relationships in a work or family environment. Patients suffering from this disorder show severe social anxiety and paranoia, followed by a feeling of discomfort. They avoid bonding with other people as well as maintaining close relationships because of the belief that others have negative feelings and thoughts toward them.schizotypal PD and addiction

Schizoid and schizotypal personality disorders, together with paranoid personality disorder are part of Cluster A, known as the cluster of “odd” personality disorders. Cluster A research suggests there is a connection between schizotypal personality disorder, schizoid personality disorder, and schizophrenia. Apparently, the connection is between certain genetic and environmental factors where schizoid PD is more common with people that have relatives suffering from schizotypal personality disorder and schizophrenia.

Symptoms of Schizoid Personality Disorder

The person diagnosed with this type of personality disorder must have four or more of the following symptoms:

  • Lack a desire for intimacy and forming close relationships with others.
  • Spending most of their time alone, not socializing with other people.
  • Showing little or minimal interest in having a sexual bond with another person.
  • Don’t enjoy being part of a family or a friend group.
  • Participate in only a few, if any, activities.
  • Don’t have close friends or relatives.
  • Don’t show any emotions when others criticize or praise them.
  • These patients show indifference, emotional coldness, and detachment.

The Connection Between Schizoid PD and Substance Abuse

schizoid personality disorder symptomsFor patients suffering from this personality disorder, substance and alcohol abuse serve as substitutes for human relationships. They tend to form a relationship with the substance they abuse and get close to it. Also, these patients experience a state of fantasy that allows them to distance from others, at the same time relieving the feeling of emptiness and failure in social activities. However, this only leads to further isolation of the patient and results in more problems in their lives, on a family and professional level.

Aside from its connection with addiction, schizoid PD comorbid with other mental disorders, including depression, avoidant, paranoid, and schizotypal personality disorder.

Symptoms of Schizotypal Personality Disorder

Patients with schizotypal personality disorder show:

  • Odd beliefs. They preoccupy with odd thought patterns and magical thinking that keep them from forming a normal relationship with others.
  • Act different, odd in social situations. Don’t respond to questions or talk to themselves.
  • Show unusual, odd, behaviors, followed by intense illusions.
  • Feel discomfort in social interactions associated with paranoid fears.
  • Express paranormal beliefs or obsessions (preoccupied with E.T., conspiracy theories or similar).
  • Don’t form close relationships because they get suspicious.
  • Show inappropriate affect.

The Connection Between Schizotypal PD and Substance Abuse

According to NIDA, six out of ten people struggling with substance abuse suffer from a mental health disorder. People suffering from schizotypal personality disorder use substances to deal with their social anxiety. Studies show that patients with a schizotypal personality disorder that use methamphetamine are at a greater risk of developing psychosis.

Aside from substance abuse, this personality disorder shows a similarity between symptoms present in borderline personality disorder, narcissistic personality disorder, avoidant personality disorder, and dependent personality disorder. Schizoid personality disorder often co-occurs with major depressive disorder, social phobia, obsessive-compulsive disorder, and the most common, schizoid, paranoid, avoidant, and borderline.

Diagnosis and Treatment

Because of the long-term patterns of behavior, these personality disorders are usually diagnosed in adulthood. When diagnosed in childhood, their symptoms must be present longer than a year. This is because children are under constant development and for whatever reason or situation they might be going through, it’s possible to show some of the symptoms of the Cluster A, B, or C personality disorders. When diagnosing personality disorders, many therapists use the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Schizoid and schizotypal personality disorders are more common in men than women.personality disorders treatment

Schizoid and schizotypal personality disorders are diagnosed by a trained mental health professional like psychiatrist or psychologist. Even though the causes of these two personality disorders are unknown, research shows a slightly increased risk of children inheriting the disorder from their parents. So, it’s crucial to get help from a mental health professional for diagnosis and treatment. Other practitioners lack the training and experience to make this type of diagnosis.

Most people seek help when the symptoms significantly interfere or impact their lives. Mental health professionals compare the symptoms and history of the patient and determine whether they meet the criteria for schizoid or schizotypal PD. Mainly, schizotypal personality disorder is easier to diagnose but hardest to treat.

Learn more: The Connection Between Addiction and Mental Illness


Treatment for schizoid personality disorder involves:

  • Long-term psychotherapy. For more precise diagnose and treatment, the therapist should have experience in this type of disorder. Treatment for these patients typically doesn’t last long. They quit therapy after a while or after getting help with their problem or immediate emergency situation. Also, long-term therapy isn’t the best approach as it leads to poor treatment outcomes and financial burden because of its length.
  • At the initial phase, therapists should avoid recommending group therapy. Because of the disorder’s characteristics, patients leave the whole therapy prematurely.
  • Medications. Usually used for curing a short-term, acute psychiatric problem.
  • Self-Help. This type of therapy is unusual for these types of patients. It involves social groups that serve for healing and helping the person connect to the environment. Because of the lack of professionals as members in this type of self-help groups, mental health professionals don’t recommend them.

Treatment for schizotypal personality disorder includes:

  • Individual, long-term psychotherapy. These patients distort reality more than patients with schizoid PD. It’s crucial to point out the influence of that magical and delusional thinking. Patients often describe experiences of not “fitting in” and being different than others. It’s a difficult disorder where the person needs to learn basic social skills and leave behind the magical thinking.
  • Medications. For more acute phases of psychosis, therapists prescribe medications. The psychosis isn’t permanent, but these patients need medications to deal with it especially when it’s a result of extreme stress.

Learn more: How to Choose the Best Treatment Center?

When dealing with a dual diagnosis, the patient should seek help for both problems – the disorder and substance abuse problem. Therefore, every patient needs to find a reliable, experienced, and knowledgeable mental health and addiction professional that is able to provide an accurate diagnosis through an evaluation. After the evaluation, every patient detoxes from substances and continues the recovery by showing the symptoms of the disorder – without being influenced by drugs or alcohol. This enables the expert staff to diagnose the patient’s disorder.

For more information please call our Addiction Treatment Helpline at (844) 439-4765. This is a Free and completely confidential call. We are available 24/7. In many cases, your health insurance company will cover 100% of the treatment cost. So please call now.

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