Disorder or Personality Disorder?

When searching “schizotypal” around the net, you may have seen it referred to either as a personality disorder or simply a disorder.

Why is that, and what’s the difference?

I’ve dug through a few internet pages including APA’s (American Psychiatric Association) homepage and various danish sites on psychiatry and mental health information pages.

Far as I can tell, the main difference lies simply in the diagnostics system. There are two distinct, primary diagnostics systems used in psychiatry largely depending on where you live in the world: ICD (International Classification of Disease) and DSM (Diagnostic and Statistical Manual of Mental Disorders).

ICD is developed by WHO (World Health Organization). It is primarily used in Europe and various countries connected to WHO. It is the official diagnostics system used in Denmark, where I live. The newest iteration and currently used version is ICD-10. In this system, schizotypal is listed as a disorder. Here, it is loosely grouped with psychotic disorders such as Schizophrenia, paranoid delusions and acute or passing psychoses. This, I believe is due to the relationship and similarity to schizophrenia.

DSM is published by APA and is primarily used in USA, Canada and Australia. If memory serves correctly, it is also the system most commonly used in research papers. The newest iteration and current version in use is DSM-5. In this system, schizotypal is listed as a personality disorder. It is classed as a cluster A personality disorder, which is known as the “eccentric personality disorders” along with schizoid and paranoid personality disorders.

There are a total of 3 clusters of personality disorders in DSM-5.
B is the dramatic, emotional, irratic cluster, which consists of antisocial, histrionic, narcissistic and borderline personality disorders. cluster C is the fearful, anxious cluster and consists of avoidant, dependant and obsessive compulsive personality disorders.
So, what is a personality disorder? It is a type of disorder so deeply ingrained in a person’s behavior and way of thinking that it could be considered a distinct part of their personality. Roughly speaking. Symptoms typically become apparent during adolescence and cause long-term difficulties in personal relationships and function in society.

Essentially, Schizotypal Disorder and Schizotypal Personality Disorder are the same disorder, only classified differently, with slight variations. Symptoms are essentially the same. In DSM-5, the symptoms have to appear even without outside stressors, whereas ICD-10 is slightly more lenient in this. In practice, there’s hardly any difference that I could detect.

I might remember this wrong, but I believe the difference in classification comes from the structure of the diagnostics system. In ICD-10, disorders are largely classified on a spectrum or several, like autism spectrum disorders, whereas in DSM-5, they are largely categorical.

By calling it a personality disorder, DSM-5 focuses on the distinct pattern of thought and behavior in people with schizotypal personality disorder, which deviates from what is considered normal in society. Personality disorders affect the way one thinks of oneself, relates to other people, responds emotionally and controls one’s behavior. These problematic behaviors and thinking patterns persist over very long periods of time and treating a personality disorder can be a lengthy endeavor both with psychotherapy and if needed, medication. The fact that psychotic symptoms such as delusions and hallucinations are very limited or entirely non-existent probably also plays a role in this classification.

ICD-10 on the other hand seems to primarily consider the similarity of shizotypal disorder to schizophrenia. Research has shown a fairly strong familial relationship between schizophrenia and schizotypal disorder where families with cases of schizophrenia are more likely to also have cases of schizotypal disorder. Another reason for this classification might be the hierarchical nature of ICD-10, where disorders are ranked by numbers where the lower numbers take priority over lower numbers. So if someone has symptoms fitting into several different disorders, it is the disorder listed first in the system that takes priority. That way if I have enough symptoms to be diagnosed with both schizotypal disorder and bipolar disorder, depression or anxiety, it is the schizotypal disorder that is diagnosed first while any symptoms of the other disorders are treated as part of my schizotypal disorder. I’d guess this is to prevent over-long, messy diagnoses.

I am slightly more familiar with ICD-10, but I am by no means an expert in either diagnostics system, so there’s a good chance I got some things wrong. If you spot any mistakes, please correct me in the comments.

In this blog I use the term schizotypal disorder, because that is the term I am most familiar with.

TL;DR version: DSM-5 is American and calls it a personality disorder, ICD-10 is European and calls it a disorder related to schizophrenia.

Diagnosis, yay or nay?

Let’s talk diagnoses for a second. Unlike with physical illnesses, mental illnesses often carry a stigma and a sense of judgement. This can, for some, make certain diagnoses very hard to accept and creates conflict, which gets in the way of healing.

For many, being told you have a mental illness, such as schizotypal disorder, is like being told you’re a crazy person. Just hearing “schizo” might lead the mind to images of raving mad, paranoid lunatics babbling about some absurd conspiracy, or going on about voices only they can hear, telling them to do horrible things. It can be incredibly hard to see something like that in yourself or a loved one. Reality tends to look a lot different than in the movies. And sometimes reality described by one person can look very different for another. Maybe you went and read a quick description of the disorder and thought: “That doesn’t sound like me (or whoever), at all!” It can be a bit hard to interpret general descriptions into individual cases.

Most of us have an idea of what it means to be mentally ill. But when faced with it in reality, it becomes something different entirely and suddenly, we don’t know how to deal with it. Perhaps you’ve heard others say: “But you look/sound perfectly normal to me,” or “everybody gets a little X sometimes, doesn’t mean they’re sick,” or any such similar comment, which leaves you feeling misunderstood and dismissed. Maybe just imagining such reactions prevents you from talking about it at all. It’s such a difficult thing to come to terms with. If it’s not totally obvious, it’s far too easy to simply ignore.

Now then, the unthinkable’s happened: You’ve come home with/to a brand new mental illness. How do you take it? How should you take it?

There are several ways to view diagnoses, and depending on the perspective, the tone and feel of the word can change quite a bit. It can be a helpful tool, or a curse. If for one reason or another, you truly can’t accept your diagnosis, you don’t necessarily have to force yourself to. Just like with any medical diagnosis, there’s always the option of getting a second opinion from another professional, if you suspect the diagnosis doesn’t quite fit your problem. It is possible to receive a wrong diagnosis and if that is the case, it’s best to find the real problem as soon as possible.

Regardless of diagnosis, the important thing is that you receive the help you need. The aim is a better quality of life, not judgement. If that means adopting a certain label or accepting a certain diagnosis, perhaps it is better to focus on the opportunities offered rather than the constraints. The point of diagnosis is to identify the problem and establish a common ground for communication so the proper treatment can be found.

Just remember one thing: You are not your diagnosis! This way of thinking can, in some cases, be more harmful than good. There is a risk of becoming complacent in your illness.  It could be used as an excuse not to move beyond your comfort zone and thus prevent you from improving your life. i.e. “This is just who I am, so I don’t need to/can’t change”. Of course, that doesn’t mean you have to push yourself beyond your capabilities. Always know your limits.

So how do I view diagnoses, and how did I react to being diagnosed with Schizotypal Disorder?

To be honest, it was a relief. I felt validated somehow. Suddenly, I had proof that yeah, there actually was something wrong with me. And most importantly: there was a way to fix it, that there were people who could help me get me better. With the diagnosis came the treatment plan and others who lived with similar problems to mine. I was no longer quite so alone.

I like to see diagnoses as simply labels. Like on foods. When I say lasagna, we all know what I’m talking about. There’s the special pasta-sheets, the tomato sauce, bechamel sauce and cheese baked together into delicious, Italian goodness. In the same manner, Schizotypal disorder is simply a label with which to identify my personal set of mental problems. Like with lasagna, the specific ingredients that make up the individual case might vary, but there are enough similarities to justify the common label. Both lasagna bolognese and lasagna al forno fit under the label lasagna, even though they have inredients that set them apart.

(Edit: It occurred to me that lasagna is actually a terrible comparison and probably doesn’t make a whole lot of sense. Feel free to completely disregard the entire paragraph above. I apologize for the confusion, and the possible lasagna-craving.)

If I wanted, I could name each ingredient or symptom individually; but in most cases, simply using the label is more convenient. It’s not perfect, but it works well enough for me.

In between writing and editing this entry, I had an interesting conversation that made me rethink this whole topic. I found out someone I know could possibly have a schizoid personality disorder and my reaction upon hearing that was: That guy? Nooo, really? But he has a girlfriend and everything? I mean, isn’t someone with a schizoid personality disorder like a total misanthrope who wants nothing to do with other people at all? And that’s when I realized, I’ve still got so much to learn!

Labels aren’t just labels, they usually come with a certain understanding or preconception, maybe you’ll have some experience with a label, sometimes you don’t. But the thing to remember is: First judgement doesn’t have to be the final judgement. Taking an immediate dislike to a diagnosis is perfectly understandable. We judge things all the time. Sometimes we’re right, sometimes we’re wrong. I’ve had very negative first impressions of plenty of things I’ve ended up changing my mind on. Acceptance comes with understanding. The best thing we can do, is keep learning.

Perhaps I’ll write a bit about schizoid and other personality disorders as well once I know a little more about them.

 

TL;DR version:

Mental illness is hard to understand and unfair judgement sucks.

Reality is different from movies. Also, reality is sometimes different from reality.

If you don’t like the name, maybe just change it. The important thing is, you receive the help you need.

Your opinion and feelings do matter.

It’s okay to get something wrong, you can always change your mind. Seriously.

Introduction

Hello, dear reader and welcome.

This is a blog dedicated to discussing mental health in general and Schizotypal Disorder, or Schizotypal Personality Disorder in particular.

Searching the net, there’s plenty of pages to tell you what Schizotypal Disorder is in a general and clinical sense. It is, shortly and rather crudely put, a mild form of schizophrenia. It has a list of symptoms shared with schizophrenia, however the so-called “psychotic symptoms” are very limited or non-existent. But what does all that mean, really? How is it diagnosed, how can you treat it and what is it like to live with it? What on earth do they mean by symptoms such as “ruminations” and “magical thinking” and what-not? Researching the diagnosis and symptoms, I found some of these terms very difficult to understand and found it a little hard to recognize in my own daily life. Assuming I wasn’t the only one, I decided to try and write a blog about it. Both to help organize my thoughts and hopefully make a difference for others.

Mental illness can be a very touchy subject, very hard to understand and accept, both for those living with it and their relations. Many who suffer from these illnesses find themselves feeling misunderstood, isolated and alone. It’s as if there’s something more shameful about having a broken mind than a broken body, simply because the damage is harder to see with the naked eye.

Over the last several years, acceptance of mental illnesses such as depression and anxiety has slowly spread as more and more are diagnosed with them, and more people speak up about what it’s truly like to live with these and other psychiatric diagnoses and how treatment helped them better their lives.  But I think there’s still a ways to go, before the stigma of mental illness is truly gone.

By writing about my own experiences living with Schizotypal Disorder, it is my hope to help shed more light on this and similar disorders. Whether you have been diagnosed with a mental illness, know someone who has, or are simply curious about the subject, I hope you’ll find something helpful in my writings.

I’ve never made a website or written a blog before, so please bear with me as I learn. Comments and suggestions for the site are welcome and greatly appreciated. If you wish to share your own experiences, you’re also more than welcome to do so in the comments.