According to Theodore Millon, the schizotypal personality tends to exhibit numerous eccentricities in thought, behavior and perception. This is typical of the DSM description as well. They resemble schizophrenia in numerous respects (hence the similarity of name) but fall short of a straightforward diagnosis thereof. Millon says that these eccentricities contribute to, and are also a product of, profound social alienation. He sees this syndrome as a serious structural pathology and groups it among the most severe and intractable personality disorders.
While he associates it, in terms of structural severity, with borderline, paranoid and decompensated personality types, he also compares it with pleasure-deficient personality styles such as the avoidant and schizoid personalities. This is because they distance themselves from close relationships, exhibit an impoverished social life, and engage in “autistic,” though non-delusional, forms of thinking. They thus exhibit strong functional similarities to these personality disorders. The schizotypal individual tends to live on the margins of social life. His eccentricities both alienate him from others, and are bolstered by a life of perpetual solitude, which avoids the checks provide against developing unusual tendencies. This is true of the other personality types, the schizoid and the avoidant, as well. Theodore Millon says it well:
“…the more individuals turn inward, the more they lose contact with the styles of behavior and thought of those around them. As they become progressively estranged from their social environment, they lose touch with the conventions of reality and with the checks against irrational thought and behavior that are provided by reciprocal relationships. Increasingly detached from the controls and stabilizing influences of repetitive, though ordinary, human affairs, they may lose their sense of behavioral propriety and suitability, and gradually begin the process of acting, thinking, and perceiving in peculiar, unreal, and somewhat “crazy” ways – hence, their manifest and prominent eccentricities.”
The schizotypal tends to be unable or unwilling to share the joys of life with others. They tend to become numb and zombie-like, wandering in a fog, from one unusual activity to another. They are pessimistic about the possibility of interpersonal contact providing them with anything like joy or enjoyment. They become “like automatons possessing impenetrable barriers to shared meanings and affections, but also estranged from the aspirations, spontaneity, delight and, and triumph, of selfhood.”
Like the term “borderline,” a great deal of controversy has historically surrounded the diagnostic category of “schizotypal.” It was disputed a great deal by the members of the DSM-III Task Force. Part of this had to do with the possibility of confusing the term “schizotypal” with the similar-sounding (yet diagnostically distinct) “schizoid.” Indeed, some of the members of the committee were reluctant to allow both in the DSM, lest confusion erupt. Theodore Millon himself wrote:
“I took upon myself the opportunity to explore empirically views …concerning possible confusions that might exist with the terms schizoid and schizotypal as separate personality disorders…my own data, limited though they are in terms of the size and diversity of the sample, show that many would be inclined to thin that schizoid and schizotypal are synonymous, particularly in suggesting dispositions to schizophrenia…[I| think the introduction of the term schizotypal and the reapplication of the label schizoid to mean something different than it meant in DSM-II, is only going to lead to confusion and to a diminishment in the utility of the Personality Disorders Axis.”
Other Task Force members added:
“Using both schizoid and schizotypal is asking for trouble. I have a nagging feeling that if we cut out schizoid and leave schizotypal then what will happen is that people will equate schizotypal with schizoid and not understand the other term. INtroducing the term Schizotypal, which will be new to most clinicians, met with dismay and annoyance when I described it to a sophisticated clinical group here. Both Schizoid and Schizotypal Personality Disorders are described with a central criterion of severe social isolation.”
Thus, not only are the two diagnostic categories similar-sounding, but there are certain important respects in which they overlap with one another. The important differences between the two must therefore always be kept in mind. The term emerged around the 1950s, although the set of traits which it is purposed to cover can be found in clinical descriptions predating the word itself. This is particular true of observations concerning personality eccentricities occurring within the context of social isolation observed by clinicians throughout the ages.