A 40-year-old man has a lifelong pattern of odd beliefs, magical thinking, peculiar speech, ideas of reference, and social isolation but maintains contact with reality and has no frank psychosis. He does not meet criteria for schizophrenia. The DSM-5 Cluster A personality disorder best describing this presentation is:

• A Paranoid Personality Disorder
• B Schizoid Personality Disorder
• C Avoidant Personality Disorder
• D Schizotypal Personality Disorder ✓

Explanation

Schizotypal Personality Disorder (Cluster A) is characterised by a pervasive pattern of social and interpersonal deficits combined with acute discomfort in close relationships, cognitive or perceptual distortions (magical thinking, ideas of reference, unusual perceptual experiences), and eccentricities of behaviour and speech. It is genetically and phenotypically linked to schizophrenia spectrum (often found in first-degree relatives of schizophrenic patients). It differs from Schizoid PD (which lacks the cognitive-perceptual oddities and magical thinking) and Paranoid PD (which is dominated by suspiciousness without perceptual distortions). In ICD-11, Schizotypal Disorder is classified within the schizophrenia spectrum, not as a personality disorder.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.