Is Schizophrenia a Personality Disorder?

Health Line

a day ago

Key takeaways
Schizophrenia is not a personality disorder but rather a type of psychotic disorder listed in the Diagnostic and Statistical Manual of Mental Disorders under 'schizophrenia spectrum and other psychotic disorders.'
Symptoms of schizophrenia include hallucinations, delusions, disorganized thinking, disorganized motor function, and negative symptoms like decreased self-motivation, diminished emotional expression, decreased speech output, social disinterest, and reduced ability to experience pleasure.
Unlike personality disorders, which involve long-standing patterns of interactions that impact behavior, schizophrenia involves altered perceptions of reality. It typically presents with psychotic symptoms in adulthood, during the 20s or later in life, with varying frequency and severity of symptoms and episodes mixed with symptom-free periods.
Many symptoms associated with mental health conditions can create social isolation, pressure, and a deterioration of relationships.
Stigma and fear of judgment may keep you away from peers. Sometimes, the symptoms you're experiencing may contribute to low emotional expression or decreased ability to experience joy through others.
Living with schizophrenia can present a number of these challenges, but it doesn't mean you're living with the rigid, long-term patterns of behavior that accompany a personality disorder.
Is schizophrenia a personality disorder?
Schizophrenia is not a personality disorder. It's a type of psychotic disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, 5 th edition, text revision (DSM-5-TR), under 'schizophrenia spectrum and other psychotic disorders.'
Psychotic disorders involve altered perceptions of reality. These experiences make up the symptoms of psychosis, which are key features in all psychotic disorders.
Psychotic symptoms include:
hallucinations
delusions
disorganized thinking
disorganized motor function
negative symptoms
What are negative symptoms?
Negative symptoms are those indicating a loss of function. They include:
avolition (decreased self-motivation)
diminished emotional expression
alogia (decreased speech output)
asociality (social disinterest)
anhedonia (decreased ability to experience pleasure)
Symptoms of psychosis are primary features of schizophrenia. To receive a formal diagnosis, you must be experiencing delusions, hallucinations, or disorganized thinking for the majority of a 1-month period.
According to the DSM-5-TR, schizophrenia typically presents with psychotic symptoms in adulthood, during your 20's, or later in life, depending on your circumstances.
Symptoms can vary in frequency and severity and often come in episodes mixed with periods of time where you have no symptoms at all.
Unlike schizophrenia, personality disorders don't have to include a component of psychosis. They're identified by long-standing patterns of behavior that impact how you interact with the world around you.
Personality disorder characteristics tend to be more long-term and constant. They're often noticed in childhood and become enduring, rigid patterns of thought and action throughout life.
Is schizophrenia a multiple personality disorder?
In 2008, a survey from the National Alliance on Mental Illness (NAMI) found the greatest misconception surrounding schizophrenia was that it involved multiple or 'split' personalities.
According to the report, 64% of Americans believe this to be true.
Schizophrenia isn't a multiple personality disorder, but symptoms of psychosis can make it seem like someone has morphed into a completely different person.
Hallucinations, for example, can mean hearing voices or seeing people who aren't actually there. Talking out loud at a hallucination might make it seem like you're talking with another 'self.'
Similarly, delusions can change aspects of your personality. You might have been a long-term advocate of something only to suddenly cast it aside, due to delusion.
Schizophrenia can make you — and those around you — feel as though your personality shifts during symptom episodes.
In schizophrenia, however, you're experiencing psychosis, not dissociation, which is the mechanism underlying dissociative identity disorder (previously known as multiple personality disorder).
It is possible, however, to be living with both schizophrenia and dissociative identity disorder.
What's dissociation?
Dissociation is a mental escape mechanism that separates you from reality, often brought on by traumatic experiences. Dissociation is one way your brain tries to protect itself by distancing you from overwhelming memories and circumstances.
Schizophrenia vs. schizotypal personality disorder
Schizotypal personality disorder is considered a schizophrenia-spectrum disorder. You may have an increased chance of developing this condition if you have a family history of schizophrenia.
Despite this link and some overlapping symptoms, these conditions aren't the same.
Schizotypal personality disorder in the DSM-5-TR is a Cluster A personality disorder that involves overarching eccentric behaviors and beliefs.
Like all personality disorders, schizotypal personality disorder features an inner experience different from cultural norms. It emerges in childhood and contributes to challenges in maintaining close interpersonal relationships.
The uncommon behaviors and thoughts in schizotypal personality disorder can be similar to hallucinations and delusions in schizophrenia.
Delusions are unwavering beliefs in something that can be proven otherwise. When you're experiencing a delusion, no evidence to the contrary will sway your belief, not even seeing, hearing, or participating in undeniable proof.
Schizotypal personality disorder involves nontraditional beliefs; however, they're often related to intangible concepts, like clairvoyance, the paranormal, or superstitions. They're not necessarily rigid or untrue, though they can be.
You may also experience unusual sensory perceptions or 'bodily illusions' when living with schizotypal personality disorder. Unlike hallucinations, these sensory distortions involve real stimuli — just misinterpreted.
Schizotypal personality disorder symptoms
According to the DSM-5-TR, symptoms of schizotypal personality disorder can include:
a persistent belief that everything happening is directly related to you
magical thinking that influences behavior and decisions
preoccupation with paranormal phenomena
bodily illusions
atypical perceptual experiences
uncommon, sometimes metaphorical, speech patterns and thinking
paranoid ideation
suspiciousness
atypical emotional responses (or lack thereof)
eccentric behavior
unkempt appearance
persistent social anxiety even in familiar company
Living with schizotypal personality disorder may come with transient or passing psychotic episodes. These reality lapses can last minutes to hours and tend to be in response to stress. If they occur, the DSM-5-TR states they rarely meet the criteria for an additional psychotic disorder diagnosis.
Treatment options of schizophrenia vs. schizotypal personality disorder
Both schizophrenia and schizotypal personality disorder are lifelong conditions that can involve psychotherapy and medications to help lessen their impact.
Medications may be used for both disorders. You may be prescribed:
antipsychotics
antidepressants
anxiolytics (anti-anxiety medications)
The medications your healthcare team recommends will be based on your symptoms, but antipsychotics are considered a first-line treatment approach when psychosis is present.
Psychotherapy can also help you cope with a schizophrenia spectrum condition, though research is limited on how effective it is for schizotypal personality disorder.
Common therapies include:
cognitive behavioral therapy (CBT)
group therapy
compliance therapy
meta-cognitive training
mindfulness therapy
narrative therapy
Coordinated specialty care (CSC) might also make a difference in your quality of life. CSC involves a multidisciplinary support network to help you adjust to living and working with schizophrenia.
Delusions and skewed perceptions, however, can make it difficult to recognize the need for treatment when living with schizophrenia or schizotypal personality disorder.