what constitutes a personality disorder?

ideas of reference - STPD.
odd beliefs and magical thinking - what you said you have fits magical thinking, not ideas of reference or intrusive thoughts, so...STPD.
unusual perceptual experiences, including bodily illusions - dissociation doesn't cause bodily illusions, neither does autism. STPD.
odd thinking and speech - could be autism, could be STPD.
suspiciousness or paranoid ideation - more than likely, STPD, not OCD, given what you described.
behavior or appearance that is odd, eccentric, or peculiar - they generally mean things that go above and beyond "I'm autistic". for instance, I wear the same hoodie year-round, which is considered 'eccentric' and not autism-related. there's other examples but I can't think of them right now because it's early and my brain is useless this early.
lack of close friends or confidants other than first-degree relatives - you can have 'lack of close friends or confidants other than a few very close non-relative people', which is what I have. not having many friends but trusting them explicitly is an STPD thing, particularly since you don't trust your family.
social anxiety that doesn't diminish with familiarity and is associated with paranoid fears - not likely to be OCD or autism, probably STPD.

based on this, I'd say STPD.

 

I would like to point out that as far as I know (and @chaoticArbiter probably knows about this more than me), beliefs of magical powers/divination/whatever that are Because Religion aren't counted. (Which is a really awkward line to poke at, because it leads to What If I Only Believe This Because Crazy, but it is better than not accounting for religion at all, I guess.)

 

oh, yeah, I totally forgot that. @Lib is right--if the belief of magical powers is religious, then it's not STPD.

 

What I meant in the "magical thinking" bit was that I felt intrusive thoughts and compulsions could explain both magical thinking and ideas of reference. Anyway, while it's kind of a spiritual thing, my spirituality is based around my magical thinking and not the other way around.
So... Welp. I guess I won't have to feel guilty about relating to STPD feels posts anymore.

 

@palindromordnilap admittedly this is a little late, but here, have what the DSM-5 has to say about STPD. hope it's helpful! I know you've got an accurate rundown of the diagnostic criteria, but there's some additional information in here that might be helpful as well. from what you've said so far I think it's definitely a possible diagnosis, but I'd need a little more information to say so assuredly.

Spoiler: diagnostic criteria

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”: in children and adolescents, bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.

Spoiler: diagnostic features

The essential feature of schizotypal personality disorder is a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. This pattern begins by early adulthood and is present in a variety of contexts.

Individuals with schizotypal personality disorder often have ideas of reference (i.e., incorrect interpretations of casual incidents and external events as having a particular and unusual meaning specifically for the person) (Criterion Al). These should be distinguished from delusions of reference, in which the beliefs are held with delusional conviction. These individuals may be superstitious or preoccupied with paranormal phenomena that are outside the norms of their subculture (Criterion A2). They may feel that they have special powers to sense events before they happen or to read others' thoughts. They may believe that they have magical control over others, which can be implemented directly (e.g., believing that their spouse's taking the dog out for a walk is the direct result of think ing an hour earlier it should be done) or indirectly through compliance with magical rituals (e.g., walking past a specific object three times to avoid a certain harmful outcome). Perceptual alterations may be present (e.g., sensing that another person is present or hear ing a voice murmuring his or her name) (Criterion A3). Their speech may include unusual or idiosyncratic phrasing and construction. It is often loose, digressive, or vague, but with out actual derailment or incoherence (Criterion A4). Responses can be either overly concrete or overly abstract, and words or concepts are sometimes applied in unusual ways (e.g., the individual may state that he or she was not "talkable" at work).

Individuals with this disorder are often suspicious and may have paranoid ideation (e.g., believing their colleagues at work are intent on undermining their reputation with the boss) (Criterion A5). They are usually not able to negotiate the full range of affects and interpersonal cuing required for successful relationships and thus often appear to interact with others in an inappropriate, stiff, or constricted fashion (Criterion A6). These individuals are often considered to be odd or eccentric because of unusual mannerisms, an often unkempt manner of dress that does not quite "fit together," and inattention to the usual social conventions (e.g., the individual may avoid eye contact, wear clothes that are ink stained and ill-fitting, and be unable to join in the give-and-take banter of co-workers) (Criterion A7).

Individuals with schizotypal personality disorder experience interpersonal relatedness as problematic and are uncomfortable relating to other people. Although they may express unhappiness about their lack of relationships, their behavior suggests a decreased desire for intimate contacts. As a result, they usually have no or few close friends or confidants other than a first-degree relative (Criterion A8). They are anxious in social situations, particularly those involving unfamiliar people (Criterion A9). They will interact with other individuals when they have to but prefer to keep to themselves because they feel that they are different and just do not "fit in." Their social anxiety does not easily abate, even when they spend more time in the setting or become more familiar with the other people, because their anxiety tends to be associated with suspiciousness regarding others' motivations. For example, when attending a dinner party, the individual with schizotypal personality disorder will not become more relaxed as time goes on, but rather may become increasingly tense and suspicious.

Schizotypal personality disorder should not be diagnosed if the pattern of behavior occurs exclusively during the course of schizophrenia, a bipolar or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder (Criterion B).

Spoiler: associated features supporting diagnosis

Individuals with schizotypal personality disorder often seek treatment for the associated symptoms of anxiety or depression rather than for the personality disorder features per se. Particularly in response to stress, individuals with this disorder may experience transient psychotic episodes (lasting minutes to hours), although they usually are insufficient in duration to warrant an additional diagnosis such as brief psychotic disorder or schizophreniform disorder. In some cases, clinically significant psychotic symptoms may develop that meet criteria for brief psychotic disorder, schizophreniform disorder, delusional disorder, or schizophrenia. Over half may have a history of at least one major depressive episode. From 30% to 50% of individuals diagnosed with this disorder have a concurrent diagnosis of major depressive disorder when admitted to a clinical setting. There is considerable co-occurrence with schizoid, paranoid, avoidant, and borderline personality disorders.

Spoiler: development and course

Schizotypal personality disorder has a relatively stable course, with only a small proportion of individuals going on to develop schizophrenia or another psychotic disorder. Schizotypal personality disorder may be first apparent in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, hyper sensitivity, peculiar thoughts and language, and bizarre fantasies. These children may appear "odd" or "eccentric" and attract teasing.

Spoiler: differential diagnosis

Other mental disorders with psychotic symptoms. Schizotypal personality disorder can be distinguished from delusional disorder, schizophrenia, and a bipolar or depressive disorder with psychotic features because these disorders are all characterized by a period of persistent psychotic symptoms (e.g., delusions and hallucinations). To give an additional diagnosis of schizotypal personality disorder, the personality disorder must have been present before the onset of psychotic symptoms and persist when the psychotic symptoms are in remission. When an individual has a persistent psychotic disorder (e.g., schizophrenia) that was preceded by schizotypal personality disorder, schizotypal personality disorder should also be recorded, followed by "premorbid" in parentheses.

Neurodevelopmental disorders. There may be great difficulty differentiating children with schizotypal personality disorder from the heterogeneous group of solitary, odd children whose behavior is characterized by marked social isolation, eccentricity, or peculiarities of language and whose diagnoses would probably include milder forms of autism spectrum disorder or language communication disorders. Communication disorders may be differentiated by the primacy and severity of the disorder in language and by the characteristic features of impaired language found in a specialized language assessment. Milder forms of autism spectrum disorder are differentiated by the even greater lack of social awareness and emotional reciprocity and stereotyped behaviors and interests.

Personality change due to another medical condition. Schizotypal personality disorder 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 differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more personality disorders in addition to schizotypal personality disorder, all can be diagnosed. Although paranoid and schizoid personality disorders 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 relationships are limited in both schizotypal personality disorder and avoidant personality disorder; 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 having 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 symptoms that may worsen under stress but are less likely to be invariably associated with pronounced 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 desire for intimacy. Furthermore, individuals with schizotypal personality disorder do not usually demonstrate the impulsive or manipulative behaviors of the individual with borderline 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 enduring personality disorder.

 

Yeah, the thing about autism spectrum disorders is why I really wasn't sure about STPD. But apparently, magical thinking and stuff is definitely a schizotypal thing when associated with the other stuff?

 

I do think the whole 'autism cannot coexist with schizo-spectrum disorders' is nonsensical, and probably left over from when autism was thought to be childhood schizophrenia - because, like, I can see confusing the negative symptoms, but magical thinking/psychotic features/etc aren't autistic.

edit: what are ideas/delusions of reference?

 

There was a short while where my brain went into panic mode with "No, no, you're not psychotic, you can't be psychotic, that's Bad, also They'll lock you up", which is actually kinda funny because, before that, one of my recurring intrusive thoughts was "Yeah, but what if you're actually delusional and everything you think is wrong? Also They'll lock you up". So, uh, yeah.
Besides, STPD is not, AFAIK, full-blown psychosis, right?

 

@palindromordnilap oh yeah, magical thinking and ideas of reference are basically STPD's "thing," as it were. mildly psychotic stuff, basically. 's why it's called schizotypal. the differential diagnosis thing isn't very helpful with distinguishing between autism and STPD, but I'd say that the fact you have magical thinking, etc. means you probably have STPD, not autism. although I guess you could have autism and a psychotic disorder... do you experience full-on psychosis, do you think? also, do you experience the sensory issues, stimming, and perseveration commonly associated with autism, or is it just the social stuff?

@Lib I think that qualification is there because five of those STPD traits could be present in a purely autistic person, and five is the number needed for diagnosis, so someone with autism could technically be diagnosed with STPD. but that wouldn't be correct, so they added that "STPD isn't autism" qualifier. it's poorly phrased, though. probably a better thing to do would be to split the diagnostic criteria into two groups—like, 1, 2, 3, & 5, and 4, 6, 7, 8, & 9—and say that you gotta have at least one in both groups and a total of five. but I'm not a psychiatrist, so I don't get to design these things. :P

 

I think I don't experience full-on psychosis? Though one of my obsessions/intrusive thoughts is, as I just said, "Yeah but what if you're psychotic". And yeah, I do stim and have sensory issues and all that, I've actually got a professional diagnosis of autism (It was Asperger's at the time).

 

@Lib ideas of reference are "the feeling that causal incidents and external events have a particular and unusual meaning that is specific to the person," which I take to mean something like someone believing that a shopping cart rolled across the parking lot because they pushed it with their mind. or that a dead bird on the sidewalk is an omen of doom. I'm pretty sure that the distinction between ideas and delusions of reference is that the person full-heartedly and despite evidence to the contrary believes the latter, whereas ideas of reference are less strong and can be reasoned with.

 

@esotericPrognosticator thanks for clarifying! and yeah, that makes sense, but as you say it could be designed much better, because you can definitely be autistic and have some sort of psychosis/psychotic features/whatever going on (hi), so you could just like... require positive symptoms as well as negative???

 

I've always liked the shitborderlinesdo-style checklists because they're classed in different categories and it would definitely solve that problem.

 

@palindromordnilap well, would you say you're delusional? because delusions are a feature of full-blown psychosis, not STPD; if your beliefs are fixed enough to be delusions, you're psychotic. it seems like a difficult distinction to make. if you want I can copy-paste the DSM's definition of delusions? also, have you ever experienced hallucinations or disorganized speech, not just autistic nonverbal episodes?

@Lib I'm curious, where are you getting the positive/negative symptom classification? the only time I've seen terminology like that used is in describing the negative symptoms usually associated with schizophrenia.

 

Exactly from that - there, positive symptoms seemed to be psychotic features/etc, and negative symptoms seemed to be, well, all the stuff that could also get confused with autism/depression/basically most mental illnesses. So I figured since these were related disorders and we're discussing a related concept, the terminology might still be useful.

 

My ideas of reference are pretty close to being delusions as I completely believe them most of the time, but there have been several times when I managed to rationalize them away and I'm sure I can do it every time with effort. It's a bit easier with magical thinking.
I don't get actual hallucinations so much as vague feelings of something being there, sometimes knowing what the thing is (Fuck you, shadow entity behind the bathroom's glass door that only shows up in the mirror), but I don't actually see it.
Disorganized speech is... IDK, it's not as much of a problem with writing, but when I'm speaking, it's like all my ideas are put into a blender and vaguely regurgitated. But I think that's probably an autism thing?

 

you can also have psychosis and STPD! because I have psychotic depression, but some of my symptoms didn't stop when on medication, so they also dx'ed me schizotypal.

 

@Lib huh, do you know if that terminology's in use elsewhere? it does seem useful. but I'm afraid that the categories don't quite line up in this case. the thing about negative symptoms is that they are psychotic. by definition, they are a symptom of psychosis. and they consist of diminished emotion expression (which could look autistic), avolition (a decrease in wanting to do things, which could look depressive), alogia (not talking as often, also could look autistic), anhedonia (decreased enjoyment, a symptom of depression), and asociality (also autistic-looking). which are kind of like the personality traits associated with STPD, which is what we're discussing, but only in that they're "personality" sort of things present in a schizophrenia spectrum disorder. the thing is, since they are psychotic, they'll come and go with psychotic episodes of delusions and hallucinations, whereas the personality traits of STPD are present all of the time. and as for what you're calling "positive traits," I guess what you meant by "psychotic" is "demonstrating a belief in something contrary to reality," as in hallucinations, delusions, magical thinking, etc., but as I pointed out psychosis also includes several other symptoms, including negative ones. also I have never seen the term "positive traits" used anywhere else. tl;dr I understand the categories you're setting up with those terms and agree that there should be a distinction, but my pedantry takes affront at the misusage of an already-defined term.

 

Oh, and yeah, I know for a fact that antipsychotics don't work on me or any of my symptoms. So, I'm assuming I'm not psychotic.

 

I have seen 'positive traits' used elsewhere, I'm fairly sure (I'd thought it was the DSM, but presumably not), but overall you get my point.