Theodore Millon himself wrote the following description of schizotypal personality disorder in 1969:
“Detachment from others and alienation from self are principal features of this personality. Notable are: deficient social behaviors (a lack of social competence and intelligence derivable from and contributing to deficits in interpersonal interest and feelings of social unworthiness); cognitive disjunctiveness (unable to orient thoughts logically; they lack “touch” with other sand are unable to order ideas in terms of relevant to reciprocal social communications); depersonalization anxiety (feel themselves to be insusbstantial, foreign and disembodied, detached and uninvolved observers of the passing scene, looking from the outside in); impoverished affect (blandness of mood, listlessness and lack of spontaneity, a lack of ambition and interest in life activities).”
The DSM-III itself described schizotypal personality disorder in the following manner:
“This pattern is typified by a marked deficit in social interest, a shunning of close interpersonal relationships, frequent behavioral eccentricities, non-delusional autistic thinking and depersonalization anxieties. There is a tendency to follow meaningless, idle and ineffectual lives, drifting aimlessly and remaining on the periphery of societal living. Some possess significant activation, affective and cognitive deficiencies, appearing listless, bland, unmotivated and obscure, only minimally connected to the external world. Others are anxiously tense and withdrawn, fearful and intentionally seclusive, inclined to damp down hypersensitivities and to disconnect from anticipated external threats.
An appraisal of personal background and history reveals both of the following:
1. Social attainment deficits (e.g., experienced serious, self-precipitated setbacks in scholastic, marital or vocational pursuits; repeated failure to maintain durable, satisfactory and secure roles consonant with age and aptitudes).
2. Periodic mini-psychotic episodes (e.g., experienced several brief and reversible periods in which either bizarre behaviors, extreme moods, irrational impulses or delusional thoughts were exhibited; short-lived breaks from “reality,” however are often recognized as peculiar or deviant).
Since adolescence or early adulthood at least 3 of the following have been present to a notably greater degree than in most people and were not limited to discrete periods nr necessarily prompted by stressful life events.
1. Social detachment (e.g., prefers life of isolation with minimal personal attachments and obligations; has drifted over time into increasingly peripheral social and vocational roles).
2. Behavioral eccentricity (e.g., exhibits frequent odd or peculiar habits; is perceived by others as unobtrusively strange or different).
3. Non-delusional autistic thinking (e.g., social communication interspersed with personal irrelevancies, obscurities and tangential asides; appears self-absorbed and lost in daydreams with occasional blurring of fantasy and reality).
4. Either (a) Anxious wariness (e.g., reports being hypersensitive, apprehensively ill-at-ease, particularly in social encounters; is guarded, suspicious of others and secretive in behavior) or (b) Emotional flatness (e.g., manifests a drab, sluggish, joyless and spiritless appearance; reveals marked deficiencies in activation and affect).
5. Disquieting estrangement (e.g., reports periods of depersonalization, derealization and dissociation; experiences anxious feelings of emptiness and meaninglessness).”
The ICD sees schizotypal personality disorder as part of a broad schizophrenic disorders spectrum. The DSM-IV emphasized cognitive elements such as odd or magical thinking inconsistent with subcultural norms, and discussed interpersonal deficits, especially when it comes to close relationships.
The ICD-10 describes it in the following way:
A disorder characterized by an enduring pattern of inability to establish close relationships coupled with cognitive or perceptual distortions, odd beliefs and speech, and eccentric behavior and appearance.
A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia.
Personality disorder characterized by eccentric thoughts and appearance, inappropriate affect and behavior, extreme social anxiety, and limited interpersonal interaction.
Latent schizophrenic reaction
Schizotypal personality disorder
Acute exacerbation of chronic latent schizophrenia
Acute exacerbation of subchronic latent schizophrenia
Chronic latent schizophrenia
Latent schizophrenia in remission
Latent schizophrenia, chronic
Latent schizophrenia, chronic, w acute exacerbation
Latent schizophrenia, subchronic
Latent schizophrenia, subchronic, w acute exacerbation
Schizophrenia, latent, chronic
Schizophrenia, latent, chronic, acute exacerbation
Schizophrenia, latent, in remission
Schizophrenia, latent, subchronic
Schizophrenia, latent, subchronic, acute exacerbation
Subchronic latent schizophrenia
Type 2 Excludes
Asperger’s syndrome (F84.5)
schizoid personality disorder (F60.1)
ICD-10-CM F21 is grouped within Diagnostic Related Group (MS-DRG v30.0):
883 Disorders of personality and impulse control.”
The DSM-IV described it in the following way:
“A. A pervasive pattern of social and interpersonal deficits marked by
acute discomfort with, and reduced capacity for, close relationships
as well as by cognitive or perceptual distortions and eccentricities of
behavior, beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following:
1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is
inconsistent with subcultural norms (e.g., superstitiousness,
belief in clairvoyance, telepathy, or “sixth sense”; in children and
adolescents, bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial,
metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree
9. Excessive social anxiety that does not diminish with familiarity
and tends to be associated with paranoid fears rather than
negative judgments about self.
10. Does not occur exclusively during the course of Schizophrenia,
a Mood Disorder With Psychotic Features, another Psychotic
Disorder, or a Pervasive Developmental Disorder.
Note: If criteria are met prior to the onset of Schizophrenia, add
“Premorbid,” e.g., “Schizotypal Personality Disorder (Premorbid).”
The DSM-V describes it in the following way:
“A. Significant impairments in personality functioning manifest by:
1. Impairments in self functioning:
a. Identity: Confused boundaries between self and others;
distorted self-concept; emotional expression often not
congruent with context or internal experience.
b. Self-direction: Unrealistic or incoherent goals; no clear set
of internal standards.
2. Impairments in interpersonal functioning:
a. Empathy: Pronounced difficulty understanding impact of
own behaviors on others; frequent misinterpretations of
others‟ motivations and behaviors.
b. Intimacy: Marked impairments in developing close
relationships, associated with mistrust and anxiety.
B. Pathological personality traits in the following domains:
1. Psychoticism, characterized by:
a. Eccentricity: Odd, unusual, or bizarre behavior or
appearance; saying unusual or inappropriate things.
b. Cognitive and perceptual dysregulation: Odd or unusual
thought processes; vague, circumstantial, metaphorical,
over-elaborate, or stereotyped thought or speech; odd
sensations in various sensory modalities.
c. Unusual beliefs and experiences: Thought content and
views of reality that are viewed by others as bizarre or
idiosyncratic; unusual experiences of reality.
2. Detachment, characterized by:
a. Restricted affectivity: Little reaction to emotionally
arousing situations; constricted emotional experience and
expression; indifference or coldness.
b. Withdrawal: Preference for being alone to being with
others; reticence in social situations; avoidance of social
contacts and activity; lack of initiation of social contact.
3. Negative Affectivity, characterized by:
a. Suspiciousness: Expectations of – and heightened
sensitivity to – signs of interpersonal ill-intent or harm;
doubts about loyalty and fidelity of others; feelings of