#icd10

[schizotypaldisciple]

The WWWWW&H? of Schizotypal Personality Diorder -or- S✝PD

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What is S✝PD?

S✝PD is a classified schizophrenia-spectrum disorder, as well as a classified personality disorder.

The 2025 ICD-10-CM describes Schizotypal Personality Disorder as:

Diagnostic Code F21:

"A disorder characterized by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies occur at any stage. The symptoms may include a cold or inappropriate affect; anhedonia; odd or eccentric behaviour; a tendency to social withdrawal; paranoid or bizarre ideas not amounting to true delusions; obsessive ruminations; thought disorder and perceptual disturbances; occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation. There is no definite onset and evolution and course are usually those of a personality disorder."

The 2022 DSM-V-TR describes Schizotypal Personality Disorder as a Cluster A ("unusual & eccentric") personality disorder, and states:

Diagnostic Code 301.22:

"(S✝PD..) is characterized by a pervasive pattern of social and interpersonal deficits, marked by extreme discomfort with close relationships, cognitive and/or perceptual distortions, and eccentric behaviors; often including odd beliefs, magical thinking, and unusual perceptual experiences, all beginning by early adulthood."

Personality disorders are a specific class of mental health conditions - characterized by long-lasting maladaptive patterns of behavior, thinking, and internal experience, which are present across many contexts, and which deviate from what is usually deemed acceptable by the individual's culture.

According to the DSM-V-TR, to receive a Diagnosis of S✝PD, patients must present with:

A persistent pattern of intense discomfort with, and decreased capacity for, close relationships.

Cognitive or perceptual distortions and eccentricities of behavior.

This pattern is shown by the presence of ≥ 5 of the following:

Ideas of reference (notions that everyday occurrences have special meaning or significance personally intended for or directed to themselves) but not necessarily delusions of reference (which are similar but held with greater conviction).

Odd beliefs and/or magical thinking (ex: believing in clairvoyance, telepathy, or a sixth sense; being preoccupied with paranormal phenomena).

Unusual perceptional experiences (ex: hearing a voice whispering their name).

Odd thought and speech (ex: that is vague, metaphorical, excessively elaborate, or stereotyped).

Suspicions or paranoid thoughts.

Incongruous and/or limited affect.

Odd, eccentric, or peculiar behavior and/or appearance.

Lack of close friends or confidants, except for 1st-degree relations.

Excessive social anxiety that does not lessen with familiarity, and is related primarily to paranoid fears.

(Also, to recieve a Dx, these symptoms are required to have begun by early adulthood.)

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Who experiences S✝PD?

The lifetime prevalence of S✝PD in the United States (US) has recently been estimated to be just under 4%, with slightly higher rates among men (4.2%) than women (3.7%)

Likelihood of S✝PD is greater among black woman, among those with a low income, and among those who have experienced separation, divorce, or have been widowed.

The odds of being Dx with S✝PD are lowest in Asian men.

After adjusting for sociodemographic parameters and comorbidities, S✝PD remained significantly associated with:

Bipolar I & II Disorders

Post Traumatic Stress Disorder

Borderline Personality Disorder

Narcissistic Personality Disorder

Additionally, even after adjusting for sociodemographic parameters and Axis I and II comorbidities:

Patients with S✝PD had significantly greater disability than those without S✝PD.

Patients with S✝PD have been shown to be less likely to live independently or have obtained a Bachelor's degree, than even patients with Avoidant Personality Disorder (AvPD), as well as healthy control participants. (both patients with S✝PD and AvPD earn a lower hourly wage compared to healthy control participants, however)

S✝PD patients demonstrated lower functional capacity than patients with AvPD, as well as healthy control participants.

Similar to the role of cognitive dysfunction (working memory, processing speed, executive function) as a major determinant of functional outcomes in schizophrenia, functional capacity in patients with S✝PD is shown to be significantly correlated to a composite measure of cognitive function.

Cognitive function among S✝PD patients is shown to be poorer than among healthy control participants, and even patients with AvPD.

While a diagnosis of S✝PD is associated with less likelihood of employment than in patients without, this difference is found to be primarily determined by cognitive impairment.

Even after adjusting for cognitive function, however, a diagnosis of S✝PD was associated with employment at jobs involving less social contact.

Identifying S✝PD and associated traits in the clinical setting can be challenging, as manifestations overlap with many other more well-known psychiatric conditions, or may simply be qualified in colloquial terms (ex: "loner") without further diagnostic attribution.

Common complaints of patients with S✝PD or schizotypal traits are related to attentional/cognitive difficulties, social anxiety, difficulty “connecting” to others, and longstanding interpersonal complications related to suspiciousness/paranoia.

Superficially healthier S✝PD patients may present with characteristic anxieties or ‘neurotic conflicts’ that are, in a more latent manner, determined or exacerbated by underlying magical ideation, odd beliefs, or overvalued ideas.

S✝PD patients are not uncommonly first diagnosed with ADHD (inattentive type); Social Anxiety Disorder; Autism-Spectrum Diorder; Dysthymia.

Additionally, the role of an underlying odd/magical belief as an aggravating factor of a concurrent symptom disorder (ex: Anorexia, OCD..) may be overlooked, as well as what appears to be anxiety-related complaints or other symptom-related disorder complaints, may be overlooked.

Many of the cognitive/perceptual disturbances that schizotypal patients can bring to a clinician's attention can be quite dramatic or alarming, and even though these phenomena are not associated with a patient that has a fair degree of intact reality testing, these patients may nevertheless receive a diagnosis of a formal psychotic illness.

Clinically significant schizotypy can exacerbate the treatment of other clinical syndromes that may be the primary area of focus.

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When & Where was S✝PD first recognized/recorded as a disorder?

"Schizotypy" wasn't officially recognized until the latter half of the 20th century, however it's associated symptomology was first observed in the early 1900's, where common behavioural characteristics in relatives of schizophrenics were observed.

S✝PD is a recent psychiatric nosological concept developed by Spitzer at the end of the 1970s, based on the analysis of the characteristics of relatives of schizophrenic subjects included in the adoption studies carried out in the same decade (by Kety, Wender and Rosenthal). However, this entity is based on older observations at the beginning of the past century.

The status of S✝PD within our current nosography remains dubious, sometimes classified among personality disorders, sometimes in the schizophrenia spectrum disorders.

It is interesting to present the origins of this concept that stem from two complementary approaches: a family approach, and a clinical approach of sporadic cases; then to redefine the framework within, which the diagnostic approach was based, and its continuity, up until our current classifications.

Basically, the historical origins cannot summarize S✝PD, and it is apparently important to more precisely redefine the multidimensional characteristics of this disorder.

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Why & How do humans develop S✝PD?

Etiology: the cause, set of causes, or manner of causation of a disease or condition.

Etiology of S✝PD is thought to be primarily biological, because it shares many of the brain-based abnormalities which are characteristic of schizophrenia. However, studies have provided evidence that S✝PD is determined by both familial-genetic and unique environmental factors.

The COMT Val158Met polymorphism is one of the best studied candidate schizotypy genes.

S✝PD is more common among 1st-degree relatives of people who experience schizophrenia or another primary-psychotic disorder.

Unique environmental factors (i.e., those not shared among all siblings) are strongly suggested to be involved in the development of S✝PD, schizotypy, and specific schizotypal dimensions.

Similar to findings in schizophrenia, prenatal insults, such as influenza exposure during the 6th month of gestation (specifically, week 23) have been associated with higher scores of schizotypal traits in an adult male population.

A number of forms of psychological trauma and chronic stress have been associated with S✝PD. The effect of trauma on the development of schizotypal symptoms, however, appears to be dependent on genetic background.

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I will continue to update this post with relevant information as it is made known to me. I welcome submissions, suggestions, and information from both personal and professional sources.

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S✝PD

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(Sources: google.com - https://icd.who.int/browse10/2016/en#F21 - https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/schizotypal-personality-disorder-stpd - https://www.icd10data.com/ICD10CM/Codes/F01-F99/F20-F29/F21-/F21#:~:text=F21%20is%20a%20billable%2Fspecific,ICD%2D10%20F21%20may%20differ. - https://pmc.ncbi.nlm.nih.gov/articles/PMC4182925/ - https://www.researchgate.net/publication/5337114_The_schizotypal_personality_disorder_Historical_origins_and_current_status)

[writing-tics]

getting diagnosed with a tic disorder

I just wanted to try out talking about that experience. maybe someone will relate, or find it useful.

i don't really remember how my tics started. i have a tendency of not acknowledging my feelings and brushing things off. i have always been a little jumpy, so I just blamed my weird shrugs and other weird unwanted movements on being easily scared.

they got really bad after my 18th birthday. and soon i asked my parents to see a neurologist.

before that we had conversations about me seeing a specialist, but i didn't want to hear about it. i wanted to pretend that everything was normal.

i went to the neurologist privately. which means that i didn't have to wait too long for the visit but I had to pay for it. my school needed a confirmation that i do have that disorder for my final exams.

i was very stressed, but the doctor was super nice. i had prepared a whole document in which i described all my symptoms, with dates if i could remember them, what my tics feel like, what makes them worse, what makes them better, family history of tics, or similar conditions, etc.

she was really nice and understanding. i don't remember the specific questions that she asked, but something about what is distracting/difficult about them. stuff like that.

she asked me to close my eyes and touch my nose, or left ear, stuff like that. also she had a little stick (like the ones doctor use to look into someones throat) and she would lead it from my fingertips up to my shoulders. she also checked my knee jerk reaction.

over all it was more of a chat, than an actual physical test.

she gave me a prescription for a brain scan (magnetic resonance, which i couldn't do due to having braces, and we switched to an MRI with contrast) - nothing wrong with it, thank fuck. and she prescribed me medication. i fucking hated those meds. they were Awful.

I never got a diagnosis from her. She gave me meds, and reassurance that this is probably psychological, which was enough at the time. Even tho she was a really good neurologist, tics were not her speciality, so i tried another guy.

AND BOY O BOY

he was supposed to be the lead specialist on tic disorders in my country. and maybe he was.

i spend 4h traveling from my city to the capital, just so i could see him.

i knew that he would probably asked my father my childhood, so i was prepared that my dad would be present for a while during the visit. but no, the doctor ever asked him to go out of the room, after the conversation about my childhood ended (it was brief, i had no symptoms in childhood). the doctor would ask my dad about other stuff as well, stuff i could have easily have talked about myself.

and then he asked me about my self harm, and depression, and suicidal thoughts (with my father still present in the room). i answered truthfully, even tho I REALLY wanted to lie. i came out of that visit with my F95.9 diagnosis, and a bunch of other diagnosis like anxiety and stuff. and a prescription for anti-anxiety drugs that i never bought.

i am not sure if the F95.9 is my disorder, but it does fit my symptoms somewhat, so that's why i use it. it's definitely not TS, and at this point idc anymore. the guy saw me one time, and with my dad present, so the diagnosis is very questionable imo, but hey. whatever.

[pseudospectre]

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[mariamagdalenaposting]

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[kingofkingsschizo]

F20.9 Schizophrenia unspecified ❤️🙏😎

[aspd-culture]

I'm so sorry if you've gotten this question a thousand times, but do you have any non-biased list of ASPD symptoms or things people with ASPD tend to do/think? I've been questioning if I have it but I can't find any list of symptoms that isn't extremely ableist

Well, part of that is because the diagnostic criteria's phrasing is pretty ableist. I can give you a quote from the most recent DSM (DSM-V TR, 2022) which is the book that professionals in the USA diagnose out of. I cannot give you the current criteria for ASPD outside of the US, because the ICD-11 has gotten rid of individual personality disorders in favor of a general "Personality Disorder" diagnosis with 3 severities but no clusters or individual disorders. I can give you the previous criteria from ICD-10, however.

(From DSM-V TR, 2022 - "Antisocial Personality Disorder, Diagnostic Criteria")

"A. A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest 2. Deceitulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3. Impulsivity or failure to plan ahead 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. 5. Reckless disregard for safety of self or others 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. 7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder."

The important thing to remember is that the DSM specifically states it is not meant to be used like a cookbook, where a list of ingredients makes a final outcome. That is to say, having ASPD isn't as simple as having 3/7 of the numbered criteria and fitting the lettered criteria. There is nuance to understanding what ASPD looks like and feels like, the diagnostic and associated features sections, development criteria that must also make sense (aka what, as far as we currently know, are either genetics and/or environments that cause ASPD) within your life experience, as well as differential diagnosis to make sure the symptoms don't fit better elsewhere.

The associated features section of the DSM-V TR section on ASPD is fairly long, so I am unable to put all of that here.

The differential diagnosis section of the DSM specifically mentions a few types of disorders to look out for that may appear to be ASPD based on symptoms alone, which I can list here.

Substance Use Disorder: If someone would also qualify for a substance use disorder diagnosis, then ASPD is only diagnosed if ASPD symptoms were present from young childhood and to present day. Both can be diagnosed, even if both were present in childhood and adulthood, but it is not ASPD if no ASPD traits were shown in childhood prior to the use of substances.

Schizophrenia and Bipolar disorders: If ASPD symptoms are only present during episodes associated with Bipolar disorder (manic episodes) or Schizophrenia (psychosis), then that isn't considered ASPD.

Other Personality Disorders: ASPD *can* co-occur with other personality disorders, but you want to research all of them to be certain that it a different PD doesn't fit better than, rather than in addition to, ASPD.

(From ICD-10 Dissocial Personality Disorder)

"Personality disorder characterized by disregard for social obligations, and callous unconcern for the feelings of others. There is gross disparity between behaviour and the prevailing social norms. Behaviour is not readily modifiable by adverse experience, including punishment. There is a low tolerance to frustration and a low threshold for discharge of aggression, including violence; there is a tendency to blame others, or to offer plausible rationalizations for the behaviour bringing the patient into conflict with society."

(It is worth noting the word "gross" used in the phrase gross disparity is referring to a secondary definition of gross, meaning large/important/marked/prominent. They are not being bluntly ableist on main in the ICD).

In the ICD, they note exclusions, which I believe is similar to the differential diagnosis section in the DSM, for Emotionally Unstable Personality Disorder (BPD) and Conduct Disorders.

Overall, this criteria has its own serious issues for both versions, but it is the diagnosing criteria (current for the DSM and recent but not current for the ICD, as mentioned above) for Antisocial/Dissocial Personality Disorder and therefore needs to be a part of any research into self diagnosis.

I would highly recommend looking into the DSM entry itself for ASPD as it is lengthy but thorough (and yes, somewhat stigmatizing) in its explanation of how ASPD tends to present itself. Putting the term PDF after DSM-V TR definitely does (cough) not (cough) produce some results that would aid you in this, and idk why anyone would do that when there is a perfectly legal way to buy the DSM for over $100 for a PDF version.

I hope this helps!

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