Personality change due to another medical condition. Schizotypal personality disor- der must be distinguished from personality change due to another medical condition, in which the traits that emerge are attributable to the effects of another medical condition on the central nervous system.
Substance use disorders. Schizotypal personality disorder must also be distinguished from symptoms that may develop in association with persistent substance use.
Other personality disorders and personality traits. Other personality disorders may be confused with schizotypal personality disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differ- ences in their characteristic features. However, if an individual has personality features that meet criteria for one or more personality disorders in addition to schizotypal person- ality disorder, all can be diagnosed. Although paranoid and schizoid personality disor- ders may also be characterized by social detachment and restricted affect, schizotypal personality disorder can be distinguished from these two diagnoses by the presence of cognitive or perceptual distortions and marked eccentricity or oddness. Close relation- ships are limited in both schizotypal personality disorder and avoidant personality dis- order; however, in avoidant personality disorder an active desire for relationships is constrained by a fear of rejection, whereas in schizotypal personality disorder there is a lack of desire for relationships and persistent detachment. Individuals with narcissistic personality disorder may also display suspiciousness, social withdrawal, or alienation, but in narcissistic personality disorder these qualities derive primarily from fears of hav- ing imperfections or ﬂaws revealed. Individuals with borderline personality disorder may also have transient, psychotic-like symptoms, but these are usually more closely related to affective shifts in response to stress (e.g., intense anger, anxiety, disappointment) and are usually more dissociative (e.g., derealization, depersonalization). In contrast, individuals with schizotypal personality disorder are more likely to have enduring psychotic-like symp- toms that may worsen under stress but are less likely to be invariably associated with pro- nounced affective symptoms. Although social isolation may occur in borderline personality disorder, it is usually secondary to repeated interpersonal failures due to angry outbursts and frequent mood shifts, rather than a result of a persistent lack of social contacts and de- sire for intimacy. Furthermore, individuals with schizotypal personality disorder do not usually demonstrate the impulsive or manipulative behaviors of the individual with bor- derline personality disorder. However, there is a high rate of co-occurrence between the two disorders, so that making such distinctions is not always feasible. Schizotypal features during adolescence may be reﬂective of transient emotional turmoil, rather than an endur- ing personality disorder.
Diagnostic Criteria 301.7 (F60.2)
A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
Impulsivity or failure to plan ahead.
lrritability and aggressiveness, as indicated by repeated physical fights or assaults.
Reckless disregard for safety of self or others.
Consistent irresponsibility. as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
93.01:“?
. The individual is at least age 18 years.
. There is evidence of conduct disorder with onset before age 15 years.
. The occurrence of antisocial behavior is not exclusively during the course of schizo- phrenia or bipolar disorder.