It is difficult to gain rapport with people with STPD due to the fact that increasing familiarity and intimacy usually increase their level of anxiety and discomfort.Group therapy is recommended for persons with STPD only if the group is well structured and supportive. Otherwise, it could lead to loose and tangential ideation. Support is especially important for schizotypal patients with predominant paranoid symptoms, because they will have a lot of difficulties even in highly structured groups. Comorbidity
Schizotypal personality disorder frequently co-occurs with major depressive disorder, dysthymia and social phobia. Furthermore, sometimes schizotypal personality disorder can co-occur with obsessive–compulsive disorder, and its presence appears to affect treatment outcome adversely. Some people with a clinical diagnosis of OCD have been found to also possess many schizotypal personality traits resulting in what can be called ‘schizotypal OCD’. Without proper treatment, STPD tendencies, such as magical thinking and paranoid ideation, could worsen the symptoms of OCD in an individual. There may also be an association with bipolar disorder. People with Gilles de la Tourette syndrome (GTS) can commonly possess some schizotypal traits.In terms of comorbidity with other personality disorders, schizotypal personality disorder has high comorbidity with schizoid and paranoid personality disorder, the other two Cluster A conditions. It also has significant comorbidity with borderline personality disorder and narcissistic personality disorder.Some schizotypal people go on to develop schizophrenia, but most of them do not. There are dozens of studies showing that individuals with schizotypal personality disorder score similar to individuals with schizophrenia on a very wide range of neuropsychological tests.
Technically speaking, schizotypal personality disorder may also be considered an "extended phenotype" that helps geneticists track the familial or genetic transmission of the genes that are implicated in schizophrenia pathogenesis. But there is also a genetic connection of STPD to mood disorders and depression in particular. Prediction of schizophrenia based on schizotypal traits has a higher accuracy for individuals with high genetic risk for STPD. Social and environmental
Unique environmental factors, which differ from shared sibling experiences, have been found to play a role in the development of STPD and its dimensions. There is now evidence to suggest that parenting styles, early separation, trauma/maltreatment history (especially early childhood neglect) can lead to the development of schizotypal traits. Neglect or abuse, trauma, or family dysfunction during childhood may increase the risk of developing schizotypal personality disorder. There is also evidence indicating insults in the prenatal environment could have an effect on development of STPD. Over time, children learn to interpret social cues and respond appropriately but for unknown reasons this process does not work well for people with this disorder.Schizotypal personality disorders are characterized by a common attentional impairment in various degrees that could serve as a marker of biological susceptibility to STPD. The reason is that an individual who has difficulties taking in information may find it difficult in complicated social situations where interpersonal cues and attentive communications are essential for quality interaction. This might eventually cause the individual to withdraw from most social interactions, thus leading to asociality.