Leo Sher, M.D.

Our research work, “Clinical features of individuals with schizotypal personality disorder with and without suicidal ideation” has just been published in Psychiatry Research (1).

Schizotypal personality disorder (SPD) is classified in DSM-5 as a Cluster A personality disorder (2). Cluster A personality disorders are described as odd or eccentric conditions. Studies have demonstrated that SPD is associated with suicidal ideation (SI) and behavior (3-6).

This study compared demographic and clinical features in a sample of 384 participants: healthy controls (HC; n = 166) and individuals with SPD with (n = 50) and without (n = 168) SI to examine specific risk factors for suicidality in SPD. The three (HC, non-SI and SI) groups were demographically matched and there were no between-group differences in age, gender, race, or levels of education. We hypothesized there would be a spectrum of SPD individuals with SI being more abnormal on outcome measures than those without SI.

Compared to the non-SI group, the SI group showed significantly greater severity of depression, aggression, impulsivity, affective lability, schizotypal features, poorer social adjustment, and had fewer social contacts. Individuals in the SI group were also more likely to have a history of a suicide attempt and comorbid borderline personality disorder (BPD) in comparison to the non-SI group. Logistic regression analysis indicated that severity of depression and the number of social contacts drove the difference between the SI and non-SI groups. Compared with both SPD subgroups, the HC group was significantly less depressed, aggressive, impulsive, affectively labile, had fewer schizotypal features, was better socially adjusted, and had more social contacts.

This study indicates that overall, the SI group is a more severely impaired group of individuals with SPD compared to the non-SI group. Our findings indicate that depression, poor social integration, impulsive-aggressive traits, affective lability, high levels of schizotypy, a history of suicide attempt, and co-occurring BPD increase suicide risk in individuals with SPD. Better educating medical professionals about the diagnosis and management of SPD and its associations with suicidality is warranted.

References

1. Sher L, Challman KN, Smith EC, New AS, Perez-Rodriguez MM, McClure MM, Goodman M, Kahn RS, Hazlett EA. Clinical features of individuals with schizotypal personality disorder with and without suicidal ideation. Psychiatry Res. 2023 Apr;322:115132. doi: 10.1016/j.psychres.2023.115132. Epub 2023 Feb 23.
2. American Psychiatric Association, Diagnostic and statistical manual of mental disorders (fifth ed., text rev.), 2022.
3. Joiner TE Jr, Rudd MD.The incremental validity of passive-aggressive personality symptoms rivals or exceeds that of other personality symptoms in suicidal outpatients. J Pers Assess. 2002; 79:161-70.
4. Lentz V, Robinson J, Bolton JM. Childhood adversity, mental disorder comorbidity, and suicidal behavior in schizotypal personality disorder. J Nerv Ment Dis. 2010;198: 795-801. https://doi.org/10.1097/NMD.0b013e3181f9804c
5. O’Hare KJM, Poulton R, Linscott RJ. Psychotic Experiences and Schizotypy in Early Adolescence Predict Subsequent Suicidal Ideation Trajectories and Suicide Attempt Outcomes From Age 18 to 38 Years. Schizophr Bull. 2021; 47:456-464. https://doi.org/10.1093/schbul/sbaa151.
6. Sher L. Schizotypal personality disorder and suicide: problems and perspectives. Acta Neuropsychiatr. 2021 Oct;33(5):280-282. doi: 10.1017/neu.2021.19. Epub 2021 Jul 8.