The heterogeneous structure of schizotypal personality disorder: item-level factors of the Schizotypal Personality Questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality

A. Raine et al.'s (1994) 3-factor scheme is currently the most widely accepted model of schizotypal personality disorder (SPD). Factor analytic studies of the Schizotypal Personality Questionnaire (SPQ; A. Raine, 1991) subscales, which represent the 9 Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for SPD, have provided the model's primary support. The use of only 9 modeled variables, however, limits the number of factors that can be extracted. To explicate this structure more fully, the authors conducted item-level factor analyses of the SPQ in a large student sample that completed the instrument twice within a 2-week interval. The authors' analyses failed to support either the 3-factor model of SPD or the 9 existing DSM-based subscales of the SPQ. Instead, 5 replicable dimensions emerged that capture recurrent symptom pairings found in the broader SPD literature: Social Anhedonia, Unusual Beliefs and Experiences, Social Anxiety, Mistrust, and Eccentricity/Oddity. These factors are only weakly correlated with each other and show differential correlational patterns with the Big Five personality traits, dissociative tendencies, and symptoms of obsessive-compulsive disorder. Moreover, they are congruent with dimensional models of personality psychopathology. Implications for SPD in DSM-V are discussed.     

Using the structural analysis of social behavior (SASB) to differentiate young adults with borderline personality disorder features.

The present experiment investigated the ability of the Structural Analysis of Social Behavior (SASB) Intrex questionnaires to differentiate nonclinical samples of young adults with features of either borderline personality disorder (BPD), schizotypal personality disorder (SPD), or no personality disorder (no PD). A number of significant differences were demonstrated on the SASB Intrex questionnaires when comparisons were made between the BPD and no PD samples. These results are consistent with those reported in an earlier investigation of BPD using SASB in a clinical sample. Few differences were found between the SPD features sample and the other two samples. These results are not consistent with previous findings that have differentiated BPD and SPD in clinical samples. The results are discussed in terms of the possible implications for SASB to differentiate BPD, the use of nonclinical samples in personality disorder research, and dimensional models for conceptualizing personality disorders.     

Gender differences in the frequency of personality disorders in depressed outpatients

We examined gender differences in the frequency of DSM-III-R personality disorder diagnoses and symptomatology in a sample of 225 depressed outpatients. This research partially replicates and extends one of the first studies in this area by Golomb et al. (1995). Males were significantly more likely than females to meet diagnoses for schizotypal, paranoid, narcissistic, antisocial, obsessive compulsive, and borderline personality disorder. Compared to females, males were also significantly more likely to have schizoid, schizotypal, narcissistic, antisocial, and obsessive-compulsive personality disorder symptomatology. Females did not predominate in any personality disorder symptomatology or diagnoses. A possible explanation for these findings is discussed. The results of this study challenge traditional assumptions about gender differences in the frequency of personality disorders, and confirm the need for future studies to investigate the relation between gender and personality disorders in specific Axis I samples.     

Comorbidity in compulsive hoarding: a case report

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.     

Positive schizotypal symptoms predict treatment outcome in obsessive-compulsive disorder

Previous research has suggested that the presence of schizotypal personality disorder may represent a risk factor for treatment failure in obsessive-compulsive disorder (OCD). Relying on a dimensional approach, the present study investigated whether the predictive importance of schizotypal personality is shared by all of its features to the same extent or whether it is confined to a subset of symptoms. Fifty-three patients underwent multi-modal cognitive-behavioral therapy with or without adjunctive antidepressive medication. Therapy response was defined as a 35% decline of the Y-BOCS total score. At baseline assessment, patients were asked to fill out the schizotypal personality questionnaire, the perceptual aberration scale and the Beck depression inventory. Stepwise regression analysis and group comparisons conducted with the schizotypal and depression scales revealed that elevated scores in the positive schizotypal scales, especially perceptual aberrations, were highly predictive for treatment failure. Responders to treatment and non-responders did not significantly differ on other variables or on scores in two scales which measured response biases. The study provides evidence that positive schizotypal symptoms are antecendents for treatment failure in OCD. It needs to be evaluated whether these at-risk individuals benefit from additional intervention, such as the adminstration of low-dose atypical neuroleptics and specifically tailored behavorial intervention.     

Relationships between anger, symptoms, and cognitive factors in OCD checkers

The purpose of this study was to examine whether individuals diagnosed with obsessive-compulsive disorder (OCD) with primary checking compulsions report higher levels of trait anger and anger expression compared with a student control group, and whether trait anger and anger expression are correlated with specific beliefs and interpretations that are common among individuals who compulsively check. A group of individuals with OCD reporting significant checking compulsions (n=33) and a group of undergraduate students (n=143) completed a questionnaire package that included measures of trait anger and anger expression, as well as measures of obsessive-compulsive symptoms and beliefs. The compulsive checking group reported greater trait anger, though not greater anger expression, than the student control group. Furthermore, beliefs concerning perfectionism and intolerance of uncertainty were positively correlated with anger expression and trait anger among compulsive checkers but not among the student control group. The implications of these findings are discussed in terms of cognitive-behavioural treatments for and models of compulsive checking in OCD.     

Relationship between schizotypal and borderline traits in college students

The main objective of the present investigation was to analyze the relationship between self-reported schizotypal and borderline personality traits in a sample of 759 college students (M = 19.63 years; SD = 2.03). For this purpose, the Schizotypal Personality Questionnaire-Brief (SPQ-B; Raine and Benishay, 1995) and Borderline Personality Questionnaire (BPQ; Poreh et al., 2006) were administered. The results showed that schizotypal and borderline features are partially related at subclinical level. The exploratory factor analysis conducted on the subscales revealed a three-factor solution comprised of the following factors: Identity/Interpersonal, Lack of Control and Schizotypal. The canonical correlation analysis showed that schizotypal features and borderline personality traits shared 34.8% of the variance. The data highlight the overlap between schizotypal and borderline personality traits in nonclinical young adults. Future studies should continue to examine the relationship and the degree of overlap between these traits in community samples.     

Context-processing deficits in schizotypal personality disorder

Research suggests that schizotypal personality disorder (SPD) is a part of the spectrum of schizophrenia-related illnesses. This article hypothesizes that a deficit in the representation and maintenance of context is a core cognitive disturbance in schizophrenia and that SPD individuals should demonstrate context-processing deficits. To test this hypothesis, the authors administered 3 versions of their AX-CPT task, designed to assess context processing, to 35 healthy controls and 26 individuals with DSM-IV SPD. They also administered working memory and selective attention tasks. SPD individuals displayed context representation deficits similar to those found in schizophrenia but did not show the same additional deficits in context maintenance. Context processing was strongly associated with working memory and selective attention performance in the SPD individuals.     

Subtyping obsessive-compulsive disorder: neuropsychological correlates

We administered neuropsychological measures considered sensitive to prefrontal dysfunction (both orbitofrontal and dorsolateral prefrontal neocortex) to obsessive-compulsive disorder (OCD) patients and control subjects. OCD subjects exhibited performance deficits, in comparison to community controls, on three measures sensitive to orbitofrontal neocortex dysfunction. Contrary to expectation, OCD patients also exhibited performance deficits on measures sensitive to dorsolateral prefrontal neocortex dysfunction. However, distinct neurocognitive profiles emerged when we examined the impact of comorbid schizotypal personality features on neuropsychological test performance. Primary OCD patients displayed impaired performance on measures sensitive to orbitofrontal dysfunction; however, they did not differ from control subjects on tests of dorsolateral function. OCD subjects presenting with schizotypal personality features performed poorly not only on tests sensitive to orbitofrontal dysfunction, but also on tests sensitive to dorsolateral dysfunction. Findings suggest that OCD can be subdivided into clinical subtypes, and distinct prefrontal subsystems may be differentially involved in these subtypes.     

Comparing borderline definitions: DSM-III borderline and schizotypal personality disorders

Compared the two types of borderline disorder formally defined by DSM-III, borderline personality disorder and schizotypal personality disorder, at the diagnostic category and individual criterion level. Unlike previous research in this area, which has focused on inpatient and outpatient populations, the sample was a psychometrically defined, nonpatient sample including Ss meeting DSM-III criteria for each disorder. The results indicated that the two diagnostic categories each define a type of borderline with distinctive combinations of features. Perceptual and cognitive distortion, however, seem to be present in both and define an area of overlap between the two disorders. The implications of these findings for the revision of the SPD diagnostic criteria in DSM-III-R are discussed, and the theoretical separation of two subtypes of borderline personality is affirmed.     

Neuropsychological impairment associated with compulsive hoarding

A group of patients with compulsive hoarding (n=30) was compared to a mixed clinical group (n=30) and a nonclinical community group (n=30) on laboratory tests of information-processing features hypothesized to be central to hoarding (memory, attention, and decision-making). Hoarding patients demonstrated slower and more variable reaction time, increased impulsivity, greater difficulty distinguishing targets and nontargets, and worse spatial attention relative to comparison groups. Multiple regression analyses demonstrated that slower reaction time and increased impulsivity were significantly related to hoarding symptoms over and above the effect of depression, schizotypy, and other obsessive-compulsive disorder (OCD) symptoms. There were no group differences on a test of emotion-based decision-making. Results are discussed in terms of previous findings and theoretical models of compulsive hoarding.     

Thought-action fusion and its relationship to schizotypy and OCD symptoms

Thought-action fusion (TAF) is a cognitive bias that has been linked to obsessive-compulsive disorder (OCD). Preliminary evidence suggests schizotypal traits may be associated with some types of OCD obsessions but not others. We examined the relationship between each of the two major types of TAF (i.e., likelihood and moral), schizotypal traits, and OCD symptoms in 969 nonclinical undergraduate students. We hypothesized that likelihood TAF would be associated with schizotypal traits; whereas moral TAF would not. Consistent with prediction, schizotypal-magical thinking was significantly associated with likelihood TAF even after controlling for the effects of OCD symptoms, general anxiety, and depression. Moreover, the relationship between likelihood TAF and OCD symptoms was significantly attenuated after controlling for schizotypal traits. In contrast, moral TAF demonstrated negligible association with OCD symptoms, depression, or schizotypal traits. These findings provide preliminary support for the linkage between likelihood TAF and schizotypal traits.     

Sex-specific clinical correlates of hoarding in obsessive-compulsive disorder

Little is known about whether the clinical correlates of hoarding behavior are different in men and women with obsessive-compulsive disorder (OCD). In the current study, we evaluated the association of hoarding with categories of obsessions and compulsions, psychiatric disorders, personality dimensions, and other clinical characteristics separately in 151 men and 358 women with OCD who were examined during the OCD Collaborative Genetics Study. We found that, among men but not women, hoarding was associated with aggressive, sexual, and religious obsessions and checking compulsions. In men, hoarding was associated with generalized anxiety disorder and tics whereas, among women, hoarding was associated with social phobia, post-traumatic stress disorder, body dysmorphic disorder, nail biting, and skin picking. In women but not men, hoarding was associated with schizotypal and dependent personality disorder dimensions, and with low conscientiousness. These findings indicate that specific clinical correlates of hoarding in OCD are different in men and women and may reflect sex-specific differences in the course, expression, and/or etiology of hoarding behavior in OCD.     

Recognition of nonverbal affect and schizotypy

The authors assessed the degree to which schizotypal characteristics in a nonclinical population were associated with impairments in the ability to correctly identify emotions as expressed in facial, paralinguistic, and postural cues. Participants completed the Schizotypal Personality Questionnaire (SPQ; A. Raine, 2005), and the 3 receptive subtests of the Diagnostic Analysis of Nonverbal Accuracy-2 (DANVA2; S. Nowicki Jr., 2005). The SPQ subscales No close friends and Suspiciousness were correlated with impaired ability to correctly identify postural affective cues on the DANVA2. Unusual perceptual experiences were correlated with deficits in the ability to identify emotions on the DANVA2 paralinguistic measure. Impairments in the ability to correctly perceive and respond to expressions of affect may be part of a deficit in social cognition that contributes to development of schizotypal traits.     

The representation of four personality disorders by the schedule for nonadaptive and adaptive personality dimensional model of personality

This study examined the relationships of the Schedule for Nonadaptive and Adaptive Personality (SNAP) model of personality to 4 targeted personality disorders (PDs) in a large multisite sample of patients. Data were examined from 529 patients, who were assigned 1 of 5 primary diagnoses: borderline, schizotypal, avoidant, and obsessive-compulsive PDs and major depression without PD. Patients were administered the SNAP questionnaire and results were compared among diagnostic groups and between patient groups and nonclinical norms. Results indicated that the dimensions of the model appear to have considerable promise in differentiating normal from abnormal personality, particularly in the propensity of individuals with PDs to manifest negative affects and interpersonal detachment. Furthermore, the model appeared to successfully distinguish specific PDs, a property that represents a particular challenge for dimensional models of personality.     

Lateralized perceptual organization deficits on the global-local task in schizotypal personality disorder

Right and left hemisphere contributions to perceptual organization functions were examined using a divided-attention version of the global-local task in a sample of 21 unmedicated participants diagnosed with schizotypal personality disorder (SPD) and 20 controls. The SPD participants showed an abnormal global processing advantage. When the visual angle of the hierarchical stimuli was increased from 3 degrees to 9 degrees, the controls showed an increasing local processing advantage, but the SPD participants continued to show an abnormal global processing advantage. These findings suggest a local processing deficit on divided-attention versions of the global-local task in schizophrenia spectrum disorders. Female SPD participants, who had less severe interpersonal deficit symptoms, showed a more abnormal global processing advantage. Hemispheric and processing resource mechanisms that might explain these findings are discussed.     

Screening for obsessive and compulsive symptoms: validation of the Clark-Beck Obsessive-Compulsive Inventory

The 25-item Clark-Beck Obsessive-Compulsive Inventory (CBOCI) was developed to assess the frequency and severity of obsessive and compulsive symptoms. The measure uses a graded-response format to assess core symptom features of obsessive-compulsive disorder (OCD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria and current cognitive-behavioral formulations. Revisions were made to the CBOCI on the basis of psychometric and item analyses of an initial pilot study of clinical and nonclinical participants. The construct validity of the revised CBOCI was supported in a subsequent validation study involving OCD, nonobsessional clinical, and nonclinical samples. A principal-factor analysis of the 25 items found 2 highly correlated factors of Obsessions and Compulsions. OCD patients scored significantly higher on the measure than nonobsessional anxious, depressed, and nonclinical samples. The questionnaire had strong convergent validity with other OCD symptom measures but more modest discriminant validity.     

Mood, personality disorder symptoms and disability in obsessive compulsive hoarders: a comparison with clinical and nonclinical controls

Hoarding is a symptom of obsessive compulsive disorder (OCD), as well as a diagnostic criterion for obsessive compulsive personality disorder (OCPD). One recent study suggests that people who suffer from compulsive hoarding report more general psychopathology than people who do not [Frost, R.O., Krause, M.S., & Steketee, G. (1996). Hoarding and obsessive compulsive symptoms. Behavior Modification, 20, 116-132]. The present study addressed whether persons with OCD hoarding exhibit more depression, anxiety, OCD and personality disorders symptoms than community controls, OCD nonhoarders, or other anxiety disorder patients. Disability was also examined. Hoarding subjects were older than the other three groups, but age did not account for any of the differences observed among the groups. Compared to controls, OCD hoarding, nonhoarding OCD and anxiety disorder patients showed elevated YBOCS scores, as well as higher scores on depression, anxiety, family and social disability. Compared to nonhoarding OCD and anxiety disorder patients, OCD hoarding patients scored higher on anxiety, depression, family and social disability. Hoarding subjects had greater personality disorder symptoms than controls. However, OCD hoarding subjects differed from OCD nonhoarding and anxiety disorder subjects only on dependent and schizotypal personality disorder symptoms. The findings suggest that hoarding is associated with significant comorbidity and impairment compared to nonhoarding OCD and other anxiety disorders.     

Visual event-related potentials in schizotypal personality disorder and schizophrenia

Schizophrenia (SZ) occurs among a spectrum of disorders with similar characteristics, including schizotypal personality disorder (SPD). Visual processing disturbances have been reported in both disorders, but it is not yet clear which processes are disturbed in both SZ and SPD, suggestive of a common endophenotype, and which appear only in SZ. In order to address this question, the authors evaluated visual event-related potentials (ERPs) elicited during a line-orientation discrimination task in control, SPD, and SZ participants. Visual ERPs allow specification of both the time course and physiological correlates of visual perception and cognition. SZ patients had smaller P100 and P300a amplitudes and prolonged P300b latency compared to the control group. SZ patients also had smaller N160, N200, P300a, and P300b amplitudes compared to the SPD group. SPD participants did not differ from control participants on any ERP measure. These data documented pervasive abnormalities in visual perception and attention in SZ but not in SPD, suggesting that these visual ERP disturbances may not represent a common endophenotype.     

Emotional correlates of the different dimensions of schizotypal personality disorder

Two studies explored which different dimensions of schizotypal personality disorder (SPD) were associated with negative affect, attention to emotions, clarity of emotions, and emotional intensity/instability. Study 1 included 247 college students, and questionnaires were used to measure SPD. Study 2 included 225 community residents, oversampling for individuals with elevated levels of SPD, and semistructured diagnostic interviews were used to measure SPD. In both studies (a) higher levels of negative affect were associated with higher levels of both cognitive-perceptual and interpersonal symptoms, (b) cognitive-perceptual disturbances were associated with greater attention to emotion, whereas interpersonal disturbances were associated with less attention to emotion, and (c) lower levels of emotional clarity were associated with higher levels of suspiciousness.