Ep. 182-Schizoid & Schizotypal Personality Disorders: When You Believe In Magic
This episode explains what schizotypal and schizoid personality disorders are, how they're diagnosed, and what treatments may work.
Do you know anyone who marches to the beat of their own drum?...Even drums that no one else can hear? Most people with schizoid or schizotypal personality disorder are misunderstood, yet their unique traits can be seen as adaptive or even vital in the right context. Dr. Kibby challenges the negative stereotypes around these "odd" personalities. In this episode, she delves into the subtle yet profound distinctions between schizoid and schizotypal personalities.
She breaks down how schizoid individuals thrive off solitude, resembling the iconic Sherlock Holmes or Mr. Robot. Conversely, schizotypal personalities are more open to connection yet remain anxious and eccentric, exemplified by Luna Lovegood from "Harry Potter."
Dr. Kibby walks through key diagnostic traits like ideas of reference, magical thinking, unusual perceptual experiences, and social withdrawal. She discusses how these traits, often misunderstood, are shaped by early trauma, cultural influences, and evolutionary roles.You'll also learn about emerging, promising therapies that focus on social cognition and compassion, offering hope for better integration and self-understanding for those with schizotypal traits.
With stories from clinical practice and insights into neurodiversity, this episode invites you to rethink what it means to be "different."
Resources:
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Dr. Kibby McMahon (00:00)
Hey, little helpers. Today I'm gonna be talking about two related but different personality disorders, schizoid personality disorder and schizotypal personality disorder. And this is just to continue the conversation about cluster A disorders, because the last episode I talked about paranoid personality disorder, and then I'll talk about the other two in this cluster, schizoid and schizotypal. And this cluster A,
a personality disorder is called odd or eccentric. So these are the kind of people who have different beliefs, different thoughts, and are really socially isolated. So that's why I think they're clustered together. this is, talking about these disorders is kind of continuing conversation ⁓ from paranoid personality disorder. So this topic was also requested by a fan. So again, if any of you have requests for topics,
I love to hear them and I take them really seriously. So you can always write in the comments on Spotify, YouTube, wherever you're watching this and I will listen. this is for the person who requested the schizotypy personality disorders. So again, the same thing with paranoid personality disorder. Schizoid and schizotypal are really rare. So you're not going to hear a lot about them.
It's looking at the prevalence rates, and it's like 0 to 5 % of the population for schizoid, and about 0.6 to 4 % of schizotypal. So I want to talk about the really rare disorders in the community, but the symptoms and the traits might be something that are a little bit more common than that.
These two disorders, schizoid and schizotypal, they're in the category of schizophrenia spectrum disorders. So they're all related to schizophrenia in some way. I think it's also called schizotypy ⁓ dimension, meaning that there's all these different kind of manifestations of a similar kind of disorder of schizophrenia. ⁓ And these are the fun people. These are the people who think differently.
And I don't know, I think I have a soft spot for any individual who thinks differently. And so I've just been fascinated by these disorders. But I'll also fully disclose that I don't have an expertise in these disorders. what I have seen, I have seen ⁓ these kind skits a tippy traits when I was doing a lot of research, because when we were doing a lot of research, a lot of
clinical studies I was working on actually had to exclude for psychosis because it makes it hard to do research when someone ⁓ isn't really in touch with reality, right? So if someone is hallucinating, it's really hard to get them to like show up for therapy or to fill out the questionnaires we need to. So I'm much more familiar with these as like looking out for these symptoms as a way to say, I'm sorry, you're not a good fit for ⁓ our studies. And I saw a lot more.
schizotypy ⁓ disorders in the emergency room. So I've had a very limited and very specific view of these disorders. So take that with a grain of salt while I talk about this. ⁓ But it's fascinating. So I will go through the diagnostic criteria for schizoid and schizotypal, including just relatable or famous examples that you might know in like movies and TV and stuff like that.
And then since there's so little research on it, I will talk about a little bit of what I found in terms of the treatment.
But fair warning, there's not a lot of research on the treatment for either of these disorders. So I'll mention what I found, but you know, they're.
Definitely needs to be more. So let me just talk about the basic definitions of them, and I'll talk about the actual criteria. So schizoid personality disorder. This is, if you think of the extreme recluse, someone who's extremely isolated, who almost doesn't seem to want to be part of society, who is...
⁓ really socially withdrawn and a loner and not interested in relationships or any kind of like sensory rewarding experiences that you know people do. ⁓ It's almost like the schizoid pedies tend to be like the people who are off the grid. The people who don't want to be in society, right? They like to live on their own. Schizotypal, however,
a little different. It's also a little odd, also a little bit ⁓ kind of a person who is not, doesn't flow so easily with society, but they are a little bit more eccentric, have odd beliefs about supernatural, paranormal, or you know, other kinds of like, I'd say delusional thoughts, but just out of the ordinary and
They tend to feel very anxious in social situations, but they're more sad about it. They actually, I think that they tend to want, people with schizotypal personality disorder tend to want more connection and relationships and schizoid people. ⁓ So that's like, schizotypal is more like odd, but friendly and anxious. And schizoid is like, you know, people who are living off the grid.
and I'm very happy to do so. So I'll talk a little bit more about schizotypal personality disorder because I think the traits are just maybe more common in therapy, more common in what I've seen. Schizoid, of course, they're off on their own. They're not interested in coming in to interact with sighting anyway, so I have way less contact with them. But schizotypal, if you want to think about it,
Schizotypal personality disorder is really well illustrated by Luna Lovegood from Harry Potter, right? Like this kind of dreamy, kind of like faraway look in her eyes, friendly, but it's just kind of not in the group. She has like, she's like talking to, you know, beings that other people can't see and has funny beliefs. It is funny to think about having an odd and ⁓ like eccentric
a person within the wizarding world. Already it's like someone who's paranormal on top of the paranormal, but she's a really good example of what schizotypal tends to look like, which is perfectly harmless, like nice, but just a little bit odd, a little bit out there, a little bit, ⁓ I don't say woo woo, but woo woo is the work that comes up. Another example of schizotypal personality disorder, I think.
is Phoebe Buffay from Friends. So the show Friends, it's also so crazy. This must date me so much. Every time I bring up Friends as an example or something, I assume that people have already seen that show. ⁓ But I'm 40 and I'm talking to people who are like, what's Friends? I've never seen it, which is madness to me. So if you haven't seen Friends, go see it somewhere in your streaming. ⁓
It's just, it's like a cornerstone of millennial culture. So Phoebe Buffay is one of the friends in the group and it doesn't really make any sense why she's in the group. ⁓ She is really kind, really warm. She doesn't seem to have schizotypal personality disorder in the sense that she is anxious around her friends. In fact, she's quite confident and quite warm and extroverted, which people with schizotypal beauty does.
do not technically, but she is in her own world, right? She's like, there's some episodes where she gave a massage to a client. has a massage therapy. She gave a massage to a client and the client died and she was possessed by the spirit. And so she's good. There's a whole episode for going around to her friends like Monica and Chandler and everyone and saying like, you know, I'm being, possessed by this old woman who died on my table. And
The reactions of their friends are funny. They're usually like, okay, Phoebe, ha ha ha. You no one's really concerned about these thoughts or behaviors and they're very accepting of it. They might make fun of her a little bit, but they don't really react to how odd her beliefs are compared to theirs. So she just kind of exists as like the token schizotypal person, sort of person where she's walking around talking to spirits, believing in energy and you know, all these different kinds of paranormal beliefs and...
living a very happy life within that group. those, ⁓ Luna Lovegood and Phoebe Buffay are like the people I tend to think about when I think of schizotypal. But ⁓ I'm pulling up, as I do, the actual diagnostic criteria from the interview, the skid PD that I've used to diagnose people. And the...
The questions that we ask to diagnose Schizotypal Personality Disorder is very similar to the ones that at least I would use to diagnose schizophrenia. And it's a lot about trying to tap into the normal or the commonly held delusions or hallucinations, like these odd beliefs that people with Schizotypy disorders tend to have. So in order to have a diagnosis Schizotypal, ⁓ you need five or more of the following traits. One.
is ideas of reference. So this is, it's a weird way to, it's a weird name for it, but we assess this by asking about how, like are there any unusual beliefs about being targeted or the world being about them in a certain way that you wouldn't expect? So the questions that I ask are, know, ⁓ do you feel like when you're in public,
⁓ and see people talking, do you feel like they're talking about you? Again, people always say, yeah, I'm so self-conscious and they're, I'm so worried that they're talking about my, how silly I look or something. And instead of just self-consciousness, I have to clarify, ⁓ it's not that you're, not that you think like people are looking at you, but do you feel like if you go into a public area,
⁓ everyone is looking at you. Are they conspiring against you or even people you don't know and they'll go, no, not really.
Another example of this idea as a reference is ⁓ feeling that you're being watched or stared at, even by people you don't know, and get the feeling that words to a song or something in a movie or TV has special meaning for you in particular. So what this is is kind of like, they're looking at the world at kind of like public things and they think,
something is sending me a message or this was made for me. I remember when I was in a, example of this, when I was in an Uber driving to an airport in a city that I'm not familiar with. So it was kind of, it was kind of scary, but this guy, the driver, really friendly guy, older man, and just immediately gets in chatting with me. And he's like, I'm just having so much fun in life. I'm really,
I'm really doing well and I'm in touch with the universe and what the universe is telling me. I was like, cool man, that's wonderful. He was just so energizing. And then he started to say things like, yeah, I knew that looking at my house number and the house number next to me is like 22 and 23. And a couple of days later I saw a car with 22 and 23 in the license plate. So I knew that.
⁓ this deity, I forgot what he was saying, this deity, this spirit was talking to me and these numbers were meant for me and now I see those numbers everywhere as a message that I should do and I was like, huh. Like it went a little bit beyond a little superstition, like, well, that's my lucky number or, know, like, wow, it was so weird that I saw this number and this number at the same place. It was like,
There is a spirit talking to me through these numbers that could have been coincidental, I don't know. But that's an example of like ideas of reference of, know, ⁓ I saw a movie billboard and I think that they put that billboard outside of my home because they're trying, like the government's trying to tell me something, right? So it's like the idea that these public things in the world are specifically targeted to you ⁓ is one type of.
⁓ odd belief that is inskittable personality sort of ⁓ The other trait the other symptom is odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms Okay, this is really fascinating and this is an example of how context and culture make all the difference when it comes to diagnosing Person personality disorders if not all mental health disorders. So
The questions that tap into, that I've asked to tap into odd beliefs or magical thinking that's outside of cultural norms. I say, you're a superstitious person, tell me about your superstitions. ⁓ How have they affected what you say or do in your life? Do you know other people who believe these things? And of course there were, I'll give you an example of one person that I found it really, really hard to.
decide whether they met criteria for this. So I was doing this assessment in a research study context. And this person was from a culture that really did believe, it was more religious and did believe in like spirits and ⁓ supernatural things that I'm not familiar with. So.
They told me that they're like, yeah, I am superstitious. They have been some weird things. They said that ⁓ I went to a school trip to an old ⁓ abandoned, used to be a prison. And we're walking around and we're taking pictures. And when I developed those pictures, I saw that there were people in it. ⁓
like people hanging in the back ⁓ where the gallows were, where the places where people were hanged in like different cells where the pictures show people inside the cells, even though when they visited, it was completely empty and abandoned.
I was like, oh my, even as I'm doing the assessment, I'm trying to be professional, but I'm like, what? Oh my God, that's so scary. And she was like, I was like, what? And then what happened? Did other people see it? She was like, yeah, I showed it to my friends and they all got freaked out and we showed it to our teachers. And then they, since they believe in.
spirits, like we had to do a whole cleansing ritual, like a religious ritual with the school to cleanse the kids of like potential spirits. And I was like, okay, I don't even know if this counts for odd beliefs that is inconsistent with subcultural norms, like superstitiousness or belief in, you know, spirits or magic powers or something that was inconsistent with our culture because
Clearly ⁓ her community was believing it. So I like, I guess you have beliefs, but it makes sense in terms of ⁓ your culture, your community. So they didn't technically meet criteria for that, but it was like a little question mark. ⁓ So that's just when we talk about odd.
beliefs, it really is based on context. So there are other questions that tap into these odd beliefs, like ⁓ making things happen just because you made a wish or thinking about them. God, every time I've asked this question, everyone says yes, especially because in our culture, we have manifestation or the secret or trying to think the now book. It's all, it's all these different like beliefs that if you believe in something and think about it, it'll come true.
So a lot of people say yes, but then I really have to dig into it a little bit more. Usually people answer, oh, you know, it's, yeah, I really wanted to get into the school and so I worked really hard and I really prayed and wished really hard and then I got it. And I'm like, okay, well that's good for you and that's not really what I mean. it's...
in order to tap into like magical thinking that influences behavior, it's like, I have special powers, I'm telepathic, or I have telekinesis, clairvoyance, like special powers where I can think and it can all make it rain. Or I think something, one common one that's very distressing is I have these thoughts and then someone is harmed.
Like I have thought about something random and then someone dies, right? And so it's magical thinking in the sense that it's making connections that maybe they're not. Like if they have that thought and someone dies, they believe that they caused it. So again, you have to assess like how magical is your magical thinking? ⁓ And also questions about, have you had a personal experience with a supernatural? Do you believe you have a sixth sense?
⁓ Supernatural ones is really interesting because yeah, like there are a lot of people who when I've asked that question they say, yep, like I've had this weird thing happen. Like I walked into my childhood home and the picture of my late grandmother just like fell on the floor in this really particular way. And I'll also admit that I am more open in terms of
beliefs and so I used when I was a kid I used to love reading any books from the New Age section. Like I used to love reading about ESP and telekinesis and like mind reading and I don't know like astral astral projection like I find that stuff super fascinating and I really do believe that we don't have we have very rudimentary methods of research that
if we did have any of those abilities or supernatural abilities, then we don't really know how to study them yet. So I believe there's a lot of stuff that we don't know. And so when someone says, yeah, I saw something that made me think that my, you know, like someone who's passed away is like in the room, their spirit is in the room. I'm like, you know, I don't, great. I'm, I don't write those off as like.
you know, this person's weird and that's crazy. I'm like, maybe. So a lot of people have had, have like come up with really interesting stories that freaked me out. And there was one, there was one particular, one person in particular who definitely had Schizotypal Personality Disorder or like really intense traits. And this person ⁓ has very friendly, had that kind of vacant.
⁓ wide-eyed, vacant looking in their eyes. And I asked about the supernatural, like if you had any paranormal experiences. And they were like, yeah. Yeah, I see some weird things sometimes. I'm like, okay, yeah, tell me about the ghost story that you have, love them. And they said, well, I always see a little girl in rain boots and a rain jacket following me around. I was like, ⁓ like how often is this?
Another question is like, is it when you're sleeping or at night? Because sometimes people will have like dreams or like half dreams that are strange, right? And seem like there's a ghost in them but really is like part of their dreaming process. ⁓ Or they're not fully conscious. And they were like, no, all the time this little girl is following me all the time. She's here right now. And I was like.
And then the person looked at to the distance in the corner of my office and I was
I mean, at very least, I don't think this person qualifies for the study that I was working on. So they might have to leave, but also they might have to leave because they're haunted. if this person is telling the truth and they are followed by a little girl ghost, you know, I don't want to do it that, like I'm scared. So I got a little nervous, but they were really nice.
But yeah, they were they were saying some stuff about this little girl is just like, you know They'll look down the hallway and they'll see this little girl with rain boots and a raincoat wandering down the halls and I was like, my god, there's just I've seen too many horror movies for me to Not have nightmares after that So that's an example of what that trait would look like that odd and unusual beliefs ⁓ Another trait is unusual perceptual experiences including body illusions
⁓ So this is tough to assess. It's like a weird feeling of dissociation, like feeling detached from your body or mind, feeling like an outside observer. So there's some dissociation in schizotypal personality disorders, as well as all the schizotypy ⁓ disorders. ⁓ And not only is it like you feel something weird, but it could be like,
I feel bugs or electricity going through my body. ⁓ So it's like, I'm feeling things that are quote, not there. We also ask, do you see things that other people don't see? Do you hear things that other people don't hear? ⁓ And ⁓ like taste or smell, like do you sense anything regularly that is not actually there?
of course, a lot of people who have very high sensitivities go, yeah, I could smell something before anyone else can. And then we have to ask, like, how often does that happen? is it's, this is a tough question. This is why this is such a tough disorder to assess. we have to say, is it stuff, do you notice these things that aren't actually there? Like, are you,
Or were you convinced that they were real or is it not? And often people who have some kind of hallucinations will say like, yeah, I'm not exactly sure. I heard my name being called in the distance and I hear it a lot ⁓ and no one else seemed to hear it. So I'm not sure. I don't think it's real. So they might have some insight on that about whether they're sensing something that is part of everyone else's reality.
⁓ And then another question in that line of unusual perception.
Yeah, I hate this question. ⁓ So do you have the sense that some person or force is around you even though you cannot see anyone? So that, of course, is going to get a lot of yeses from people who are spiritual or religious. ⁓ But then again, it's taking, it's then listening to how they answer that. They're like, yeah, know, God's all around me and, you know, fine.
But if they go, God's all around me and he's talking to me through my drink. It's like, okay, like, or, or I'm hearing his voice through the, the air vent in my home. Okay. All right. So it's this idea that there's like a being that's doing something to them. ⁓ And then there's odd thinking and speech, suspicious or paranoid ideation, inappropriate constricted affect and behavior appearance.
that is odd or eccentric, peculiar. So all of those questions are just based on ⁓ observation. So it's just watching and noticing when you're talking to this person, do they have just kind of ⁓ different mannerisms? And usually when they said inappropriate constricted affect, what that means is, ⁓
that they're not showing emotion in the way that you would expect a lot of other, like neurotypical people to show. People in general in the schizotypy disorders and schizophrenia disorders, they have a different way of expressing emotion. It's more blunted often, or it's just a little detached from the normal responses. So usually the kind of look, know, like Luna Lovegood, she's like kind of blank in her face.
friendly, smiling, but she's blank, right? And it's not showing the normal range of emotions you would expect. And it's just like doing things that are a little odd compared to ⁓ personal space or how you would move around in a social setting. So the next questions that assess schizotypal personality disorder, they are more about the
the mechanisms around the social isolation. So there's one trait that's lack of close friends or confidants other than first degree relatives. And then there's social, the next one is excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about the self. So this is what often differentiates schizotypal personality disorder from schizoid or.
other disorders is that they're really isolated, they're socially withdrawn, they don't get along with a lot of people. ⁓ And when we say like no, like lack of close friends, I don't mean just like one or two, but like zero ⁓ or maybe one. That's why Phoebe Buffay's case is like, she has like five best friends as well as like a healthy dating life. So it's question mark.
But the sad part about Schizotypal Personality Disorder is that they might want to be connected, they want friendships, they want to get close to people, but they're really socially anxious. And it doesn't get a lot better with familiarity, meaning like the more they get to know someone, the closer they get, they still feel anxious. And looking at the research on this disorder,
It's interesting that it's really sad because for both of these disorders, there's a lot of ⁓ trauma. There's a lot of early trauma that ⁓ lead to the developing these disorders. a lot of, for example, people who have odd beliefs get bullied. So people with schizotypal personality disorders, they might...
say something weird or act a little bit weird and then they get bullied for it or they get judgment or whoa, that's weird. Why do you think that, right? And so they get this negative judgment and rejection from other people. And because of that, they might have a lot of like fear around their own thoughts or they might have a lot of shame or they aren't able to self-soothe. So they don't know how to connect to other people.
for that soothing and they don't know how to connect to themselves for soothing, which is so sad. Think about if, you know, when I talk about borderline personality disorder or narcissistic personality, these other disorders, there's often a way that people with those disorders connect to other people, right? With narcissistic personality disorder, they might feel insecure, they might feel lonely, but they're like, ⁓ if I'm the best, if I'm the most attractive, if I'm the richest, the...
the top dog, whatever. That's how I could get soothing. That's how I could get love. Schizotypal personality disorder, ⁓ there isn't that sense of like, I know how to connect to others, except that they connect with other people with similar viewpoints. So I read in the research that they tend to, ⁓ because their social skills might be...
so limited, they just withdraw into themselves and they get a little bit more maybe protective or into their odd beliefs. So instead of saying, yeah, I saw a ghost, like, know, who knows if ghosts are real? They're like, no, I believe in ghosts and you all don't see it and I do, right? So they kind of get more socially withdrawn into their quote oddities.
So what schizotypal personality disorder, ⁓ there's not a lot of research for either of these disorders, there's not a lot of research on the treatment, which is a shame, but I think that's often because these people might not seek out therapy as much or they might not, ⁓ they're just so rare that it's hard to actually do research on just schizotypal personality disorder.
So the study by Shelley, Shelley, I don't know, Chilai, who knows, 2023, tested a new psychotherapy for schizotypy disorders, and it's evolutionary systems therapy for schizotypy. And it's cool because it combines, I think, some evolutionary theory, but with metacognition and compassion focused.
approaches. So what does that mean?
in general, something that I found very fascinating about schizotypy ⁓ disorders is that there is a real social cognition deficit. I love that so much. That was my obsession for so many years. social cognition is a big term for people's ability to think and understand.
⁓ cues in social interactions. It's really about understanding social interactions. So that is empathy, that is theory of mind, perspective taking, right? To be able to go, ⁓ I have a mind and you have a mind and it's different and I'm gonna, I'm making guesses about what you're thinking and I know it's different than what I'm thinking, but we have different minds and I'm just trying to make sense of it, right? So one example of a...
of a social cognitive skill is being able to tell what other people are feeling, right? Just being like, that person's sad, that person is happy, which is all of what I did my research on at Duke. And I'm so obsessed with like empathy and social cognition. And people with schizophrenia, schizotypal, schizoid, they all have these deficits in social cognition. They have a hard time being aware of their own thoughts and feelings and also...
understanding what's going on in social ⁓ interactions. So metacognition is ⁓ basically it's a cool term for your thoughts about your thoughts, like your awareness of your own mind, of your own cognitive processes, your own thoughts, your own beliefs, your own mental ⁓ activity. And as you can imagine, that's really useful, right?
meditation and self-awareness and all those practices boost our metacognition, being like, I'm having a thought right now. Ooh, I'm having a thought and I'm angry, right? This is all metacognitive skills. And this ⁓ evolutionary systems therapy teaches people, let's get to Tippie, these metacognitive skills, like being reflect on themselves, like reflecting on other people's minds. ⁓
And what I really love about it, I think everyone should get this therapy now that I'm thinking about it, but they really, this therapy also targets a big problem with people with Schizotypal Personality Disorder, which is what they say, a poor ability to experience interpersonal and intrapersonal safeness, which is another crazy word for a crazy way to describe underdeveloped soothing system.
So they don't know how to feel safe within themselves and with other people. So that's where the compassion part comes in. so this therapy says, well, people with schizotypal personality disorder probably, whenever they are aware of their thoughts, they probably have gotten a lot of judgment or bullying from that, maybe some trauma. ⁓ And so they've learned to not trust themselves. And then they also have learned that other people don't like what they're thinking.
not only is like developing this meta awareness, metacognition, but it's also adding compassion and being able to self soothe like the way the different techniques that they teach in this therapy.
Like some of the techniques they use to, you know, boost compassion and really take a compassionate approach to their own thoughts and feelings is soothing breathing, compassionate imagery, or compassionate chair work, which I imagine is like the empty chair exercise where you're looking at an empty chair and you say, you know, like imagine yourself as a little kid in that chair. What would you say? How can you be compassionate to that?
into that person. So it's like an experiential exercise where you're there, they're learning how to be compassionate to themselves in these like creative ways. And I just think that I really love this kind of ⁓ therapies where they're really thoughtful about how do we help and work on the parts of the disorders that are that
Basically like the areas that they need better skills in this like skills based approach and it's and it's interesting thing of schizotypy and schizotypal personality disorder as a problem of ⁓ In of too much openness meaning that they're so open that they have odd behaviors thoughts or emotions that is just ⁓ Is like too open is like too
⁓ far away from the norm and doesn't really conform to like, you know, normal ⁓ social thinking, ⁓ as well as low extraversion. So this is a personality trait that's like, they're not as warm, they're not as agreeable, they're not as good as connecting to others. So they're like isolated, but also ⁓ are like really open to thoughts to the point where they're like almost impressionable and kind of like make connections that other people don't.
I mean, as I'm saying this, I'm kind of like, what's wrong with that, right? I think the part about being open and having these different thoughts, that's really interesting and lovely. I always love hearing when people just think differently. That's why I love personality disorders. ⁓ I love the idea that people have a totally different perspective on things that we take for granted, like social interaction, or do we believe in spirits?
But the problem here with this disorder is that they might not have the awareness or the flexibility to be able to say, yeah, I have this belief in this supernatural, superpowers, but I know that not everyone does. So I will choose when to talk about it. So the... ⁓
I don't know, maybe I just have a soft spot because I remember these people that I met in ⁓ the research context and I've also been myself into many ⁓ meditation and spiritual ⁓ retreats and meditation retreats and things like that, like silent meditation retreats. And there's sometimes a couple people in that category that are just like out there.
that just believe in their own thing and march to the beat of their own drum and they are happy. And if they're happy and they're enjoying and they found their people, then great, this is not a disorder. But if they feel like it gets in the way of them getting a job or in the way they want or ⁓ making friends or feeling comfortable around other people, then it's something that is very painful for them. ⁓
But this is one of those disorders that's really contextual because ⁓ there's research to show that people with schizophrenia tend to do better, ⁓ their clinical outcomes are better in smaller villages and towns than big cities. And a lot of that is because like there's...
in a small community, there's a place for them, right? There's always like the village shaman or like the ⁓ psychic reader, you know? There's just someone who's just like tapped into another way of living and seeing the world and the universe. And there are some cultures that make them a very big part of society, right? Like the shaman or the religious leader.
of ⁓ the soothsayer or whatever, ⁓ anyone who would like to have like psychic or like mediums would be in this category. So if they found their groove, if they found their place and found like a role in society that celebrates their odd thinking and they're able to make it work, then great. So the more I'm talking about this, more I'm like, schizotypal is awesome. But.
It's really that social anxiety that's really the hard part. I did see a number of these ⁓ people with different kind of traits in the emergency room. a lot of them, so schizoid and schizotypal, they don't often ⁓ become full-blown schizophrenia. There's some, and they're probably more at risk than the general population, but they don't always ⁓ move to full-blown psychosis. It's just kind of like a stable, ⁓
personality, like they're a little odd, right?
And what I learned, because the emergency room is usually where people bring people who are having a particular episode, like mania or self-harm or psychosis, like there's something really wrong and the loved ones don't know what to do, so they bring them to the emergency room to help them stabilize, figure out what's going on and refer them to the appropriate treatment. So when I was working in the emergency room, there was... ⁓
there were a lot of people coming in with like psychotic symptoms. Some of them were just from smoking weed or doing some kind of drug. Like many people I saw like in their 20s or 30s, they like were doing some drugs and then they started to, you know, have a psychotic episode. And then it, so,
And what was interesting too, I'm hesitating right now because I don't want to say something false, not based on the research, but anecdotally, something that I saw was that when people had some kind of skits, a tip be traits, like they're a little odd to begin with. had like, you know, they're, kind of have the blank look. They're kind of, you know, not connected to reality, so to speak. And then they did a lot of drugs.
like smoked a lot of weed or something like that, then it would kind of exacerbate the psychotic symptoms. So I don't want to say that certain drugs create psychosis, but what I saw is like people who had that tendency that did a lot of drugs often ended up in the ER with like full blown psychotic, you know, full hallucinations. I was also surprised that I thought that people with psychotic, like hallucinations would just be like what you would
think in the movies, like people screaming down the hallways. Like thought it would be really obvious, but there were a lot of people who came in who were just quiet, know, looked scared, but everyone looked scared in the hospital. ⁓ They can answer questions. They seem like normal. know, there's a couple people who said, yeah, my friends or my family told me to come here and they were really worried about me. So I wanted to just make sure everything is okay. And they could...
name what they do and you know, just a normal conversation. But then when you get a little bit into the meat and then they go, yeah, I was I was in a show and everyone started clapping and I thought they were clapping at me to scare me. And I looked around and I thought everyone was was out to get me. And so I I jumped up and screamed at them and ran out of the show. And I was like, ⁓ OK. And then you have more of those stories and thoughts when you pull on that thread. Right. So.
I was just surprised that there are many people with kind of these psychotic symptoms that can seem like they're healthy, they're coherent, ⁓ they're not dangerous, they're really just scared and confused. ⁓ And then when you ask about what's going on, then you get like, wow, there's a whole thing going on in your mind, right?
This reminds me of a conversation that we had on this podcast with Lauren Schow, who was the star of the new movie, Rosemead with Lucy Liu. And he was, he did a lot of research on schizophrenia. He played a character with schizophrenia and what he said really resonated. was like, these are, you know, people with these odd beliefs or hallucinations or delusions are more common than you think.
They're scared and confused by their own what's going on inside, but a lot of them aren't dangerous. A lot of them are just like living with these thoughts and there might be some kind of escalation with a big stressful moment, a trauma or drugs, ⁓ which can kind of dysregulate someone. But there's a lot of people who are just like, you know, harmlessly having odd thoughts, odd beliefs.
So that's just skits a typical personality disorder. There's there's more I there's more I actually could say about skits a typical than skit soyed because skit soyed As you can imagine is it's just It's just real loners like real loners. The question I do have about it is How is it different than forms of autism? So if any actually experts know
like neuroscientists or we're experts on schizoid personality disorder or autism, please let me know. I'm really curious about this. So I'll briefly go through the criteria, but there's not a lot of research on the treatment, but the criteria is four of the following traits. One is that ⁓ doesn't desire, doesn't want or enjoy close relationships, including being part of a family. So
These are really odd questions that I have to ask, but it's like we assess that with, is it important to you to have friends or romantic relationships or to be involved with your family? Most people say yes or no, or it's good to be independent, blah, blah. But we're talking about like, I do not care about having relationships. They make no difference to me. ⁓
And then another trait is almost always chooses solitary activities. So do things alone than with other people. get jobs that are like, they don't have to talk to anybody. They're just like by themselves, like technical roles and things like that. And treat true both work and at home. So it's just like, I like to be alone no matter what. Not just introverted, but just like I am indifferent to any human interaction. ⁓
And then there is the trait has little if anything interest in having sexual experiences with another person. And the other trait is takes pleasure in few if any activities. So this is really, those traits are about ⁓ pleasure seeking, about reward seeking. So people with schizoid ⁓ personality disorder are, really afraid of harm, but they're also like not interested or not seeking.
sensory experiences in the same way as like most people would and so they have no interest in sex. They, ⁓ you know, I might ask questions like, you know, how do you feel about eating a good meal or watching a good movie or something and it's just like, nope. you know, of course you're have a lot of people who are just like more stoic, like they're like, I'm not really a sensation seeking person.
But this is really like, I do not care about sex. a good meal doesn't make a difference to me. It's the same anyone. And I just don't like sensory experiences. ⁓ And then the other question is, the other traits are lacking close friends or confidants other than first degree relatives. Similar to schizotypy, but it's like, it's not just how many friends you have. I have like,
I don't have that many friends, just three. It's like no close friends. I don't spend time with people. ⁓ other traits really funny. Just every time I ask these questions.
A lot of people say yes, and then I really have to tease apart. No, no, no. Is this really what I'm looking for? This is how you diagnose people. It's like, you know, do you think that people are talking about you? But like even strangers on the street. ⁓ Anyway, so this trade appears indifferent to the praise or criticism of others. The question I have to ask to assess this is, does it matter to you what people think of you? ⁓ How do you feel when people praise or criticize you? Now,
Most people would say a range of what you imagine like, I hate criticism. It really hurts my feelings. But then you have the people like, yeah, it doesn't matter what people think of me. I'm confident in myself and praise or criticism doesn't make a difference. And I'm like, no, no, no. mean, like really not make a difference. you do not, like other people's judgment or responses to you.
do not affect you at all. Not just like, are you able to cope with the ups and downs of social reactions. And then the other trait is show emotional coldness, attachment or flattened affectivity. So we're trying to think of this like very different than schizotypal personality disorder, but schizoid is really like.
blank, like stony face. ⁓ That's like the stereotype that they're rare. They really have strong feelings like being angry or joyful. It's very flat, very stony. ⁓
And I think it's a little bit more, schizotypal is a little bit, there's more anxiety, like schizotypal personality disorder, there's a lot more depression and social anxiety and anxiety. So there's a lot more feelings, ⁓ even though the feelings or the facial expressions of those feelings might be different than like the norm. But schizoid is really like, I have none. I have no feelings. I don't like sex. I don't like people. I just want to be by myself.
That's it. those are the traits of schizoid personality disorder.
So I was thinking about really who has schizoid personality disorder in you know, in our culture. And it's interesting, there was some suggestions that I saw that was Sherlock Holmes. So especially in the Benedict Cumberbatch series, which I love, I love the Sherlock series. They call him in the show as a high functioning sociopath.
I don't think I agree with that, ⁓ there is some hypothesis that maybe the character himself, but the way they portrayed him ⁓ in the, I think it was the HBO show, it was BBC, the HBO show, is more close to schizoid. Where you could kind of see the traits, he like...
does not have facial expressions. He doesn't seem to have strong emotion, even when really crazy things are happening, like things being shot at or he's just like blank. ⁓ Doesn't seem to be interested in being nice to people or getting along with them, or
He pulls in Watkins more like an assistant, like doesn't seem to, you know, I think in the show they show a little bit more of a relationship, but like doesn't seem to care about social connection. ⁓ And sociopath is when people say sociopath, they mean antisocial personality disorder. And that is also ⁓ related to, you know, antisocial tendencies, like not really caring if someone's sad, not having as much empathy. ⁓
doing things just for their own goal, right? Not caring if it actually hurts other people or they just don't have the same regard for other people. Sherlock Holmes in that show definitely shows that. He will do things and be rude and bulldoze over people just because he's interested in a goal. But it doesn't seem malicious, right? It doesn't seem to ⁓ be for the sake of harming someone else. It's just like he's involved in his puzzle. So that's what feels more schizoid.
I also saw that an example of someone with schizoid personality disorder is Mr. Robot. I think it's on Netflix, it is ⁓ Rami Malek, who I love, ⁓ plays a cybersecurity engineer and is kind of like a vigilante by night. ⁓
When I first watched it, I've only seen a couple of episodes, but when I first watched it, I was like, this is clearly someone with autism because they're portraying someone who's like a very technical person. But it does make sense that it is more schizoid personality disorder because I don't know the neurological underpinnings that really differentiates schizoid and autism, but something that I know about just
people on the spectrum in general, is that there is interest to connect to others. There is interest in love and joy and emotions and making friends and getting closer to people and sex. There's social desire that might be a little different from someone with schizoid personality disorder. The profile, if you wanna watch them in TV, might look the same, like someone who's like...
very technical and just focus on the details and blank and kind of socially odd, but schizoid personality disorder, it's like, they don't care about people. They just don't care. So Mr. Robot is a good example because it's someone, even if you Google it or watch it, like his face is really stoic. Like there's no emotion, almost like a robot, like Mr. Robot. that's it.
That's an interesting example. And then I haven't seen this movie, but Ad Astra is a movie with Brad Pitt, who is an astronaut. And he is, I think that character is supposed to have schizoid personality disorder. The fascinating thing about that is in evolutionary theories, people with autism and people maybe with schizoid personality disorder, the theory is that they,
⁓ survived even a little bit, ⁓ because there are certain roles in society that require certain people to be alone for long periods of time. And for the majority of people, that's like not tolerable. I mean, we as a, as a species have, ⁓ developed and grown and, you know, become like the masters of, of the world because of our social
Because our ability to collaborate with each other, to live in complex societies, to make relationships, to share responsibility and work together, that is a huge reason why we've survived. But there might be some people that were selected because they can go on long hunts for like days, months, whatever, and being alone and not go crazy, right? There's some people who are like, great, this is my happy place. Bye, bye society, I'll go hunt.
and I'll be back later. So, I think the character in Ad Astra, Brad Pitt's character, the point is that sometimes astronauts might have been selected for these getzoid traits because they're doing a lot of technical work and they're alone and separated from society. They're literally off the grid and for people to have to be able to cope with that.
you have to be a little bit different socially. You have to be okay with being that alone. So I think it's just fascinating to think about how these, I don't wanna say abnormal, because that's negative, like different neurodivergent, I suppose, like these neurodivergent people who don't think like everyone else in society and have a hard time being in community with people.
but they are special. They're special in their different ways, whether it's like schizoid, they love just whatever interests them and their tasks and living their own life by themselves, or schizotypal who just are just like open to broader ideas about the paranormal or psychic abilities or I don't know. and I just love that.
there are these people who like are on the fray, are on the fringe of society and there's a place for them too, right? There's a role for them. Whether it's like the shaman of the local village or if it's our astronaut, right? There's certain people who are suited for these unusual roles. So I love to think about personality disorders, especially, you know, these odd eccentric ones as not like...
How are these people broken or bad or sad, but how are they special and how are they fit for a social context or environment that is unusual? And they just got to find their place. Schizoid personality disorder unfortunately doesn't have a lot of research on the treatment because honestly, they might not be seeking treatment as much, right? The idea of someone who loves being on their own
You know, to sit in front of someone like me, very social, Talking about their feelings on themselves and connecting with a therapist is not in their interest whatsoever. But also, as I said, the difference between schizotypal versus schizoid is that schizotypal is like, they feel this anxiety of being disconnected, right? They're like, they might even want a little bit more of that connection or feeling more at ease, whereas schizoid...
people are like, I'm fine. I'm fine the way I am. ⁓ As long as they're able to figure out how to survive being ⁓ so socially isolated.
I think these disorders are fascinating and it does, I'm always interested in what makes certain people have difficulty connecting to others because I think that connecting to others and reading social information and social cognition is so complex. If you think about it, if you're sitting in a room full of people,
we're reading information all the time, right? Like someone's tiredness or their interest or body language and their tone of voice. They're like how close or far you sit with someone, how do you express emotion in this group versus another group? Like there's so much calculation going on that we just take for granted. So it's fascinating to see certain people who are just like, they're just, they just don't have that language. They're like blind to it. And.
Both of these disorders, unfortunately, ⁓ do develop. There's a lot of genetic influence. ⁓ Usually, ⁓ you find this kind of schizotypy ⁓ gene in the family. ⁓ what also influences the risk of developing these disorders are, as you imagine, childhood trauma, childhood neglect. ⁓
So it's really an attachment trauma that can lead to these disorders. So for schizoid personality disorder, there's a lot of childhood emotional neglect or abuse as risk factors, which actually kind of makes sense if it's very hereditary, then maybe the parents have something going on. And so they're like not emotionally attending or just not being emotionally connected or.
safe with their with the children. ⁓ And for schizotypal personality disorder, there's early trauma and PTSD are common in that. that might be because of bullying or because of being harmed or treated badly or abused because they are quote odd or think differently. So just like any disorder, ⁓ it comes it
is usually there's a lot of like trauma that influences it. So I am fascinated by this topic. I wish I knew so much more. If you have had experiences with these people or these thoughts, I would love to hear about it. So please write in the comments, either in Spotify or YouTube, wherever you're watching this. And I think that like we should
just have the spirit of celebrating neurodiversity where some of these people are a little bit different. They don't fall in line with everyone else's thinking and belief system. And the disconnect that that leads, the social isolation that can lead to can be painful for some of those people and not painful for others. But I really hope that the messages
letting them find their groove, right? Like letting them find their people, letting them find the life that ⁓ they want and makes them comfortable. ⁓ So if you have any other questions or thoughts or requests for topics, again, leave in the comments.
And if you enjoyed this, please leave a five star rating on Apple Podcasts or Spotify and we'll see you next week. Thanks guys.