Schizotypal Disorder: A First-Person Perspective

We’ve previously written about various mental health disorders, but somehow the topic of schizotypal disorder has remained largely unexplored. It’s also hard to find accessible information about it online. Most resources are either copy-pasted, inaccurate, and full of myths, or the opposite—overly technical texts written by doctors for other doctors. According to the DSM, schizotypal disorder is a pervasive pattern of social and interpersonal deficits marked by acute discomfort, reduced capacity for close relationships, cognitive or perceptual distortions, and eccentric behavior, beginning in early adulthood and present in various contexts. If none of that made sense to you—welcome. Today, I’ll share what it’s like from the inside.

A Note on Perspective

Since this is a self-analysis, it’s inherently subjective. I’m not a doctor. Not everything I describe may be accurate from a clinical perspective, and my attempt to explain my state may not match what a psychiatrist or psychologist would see. Many statements here are simply “how I see it.” This article is for those interested in a first-person view.

Who Am I?

Since this article may reach a new audience, let me introduce myself. My name is Ivan. I won’t go into too much detail, but I used to be a typical student—attended art school and a math-focused high school, participated in competitions, got into programming, became interested in computer security, and pursued a related degree. I also developed as a musician. But gradually, things started to fall apart—studies, hobbies, and life in general slipped away from me.

The Illness

So, schizotypal disorder. If several independent psychiatrists agree on the same diagnosis, it’s unlikely they’re all wrong. It crept up on me and hasn’t let go for years—and probably never will. In the past, this was called “sluggish schizophrenia” in my country. The name has changed, but the essence remains. The classification of “schizo-” disorders is broad, and drawing lines between them is difficult. Wikipedia says schizotypal disorder affects about 3% of the population, but it’s hard to estimate. Many people with such conditions drop out of public life and become “invisible.” Given the general mood in my country, where many people seem gloomy and depressed, it’s hard to say who’s more affected than others.

There’s a belief that schizotypal disorder, unlike schizophrenia, isn’t a disabling diagnosis, but in practice, disability status is sometimes granted, especially with severe social dysfunction and loss of ability to work.

There are many myths about schizophrenia-spectrum disorders: that all patients are violent, have constant hallucinations and delusions, or experience split personalities. In reality, many patients are calm—sometimes eerily so—and pronounced positive symptoms aren’t required. Negative symptoms alone are more than enough. In this sense, schizotypal disorder is close to simple schizophrenia, just less severe, and some self-awareness remains. But when doctors say “not severe,” that’s from their perspective, not the patient’s.

Apathy

Psychiatrists often mention the “apathetic-abulic syndrome.” In practice, I’ve never heard them use these words with patients, but they imply it. This is usually where complaints start: apathy, fatigue, sleepiness—these are the main obstacles to functioning. From talking to doctors, I’ve gathered that disability is often granted for these reasons—people simply can’t work.

Some think people with this disorder are just lazy and can spend hours doing nothing. But it’s more like a complete lack of desire or motivation, combined with fatigue. A lazy person might not want to do chores but would still enjoy a walk, a tasty meal, a movie, or games. Here, you don’t even want to turn on a movie. And if you do, you might realize halfway through that you weren’t even watching or can’t remember what happened. Or you get tired just watching. Meanwhile, you weren’t doing anything else—just lost in thought.

Sometimes, there are no thoughts at all. The mind “doesn’t think.” It’s hard to gather your thoughts, and even simple daily tasks take a long time. You can lie there, not thinking or doing anything, for hours. You don’t even want to toss a pebble against the wall (you know, when it bounces back into your hand). On some forums, people describe racing thoughts in other disorders, but here it’s the opposite—too few thoughts, moving very slowly.

People often say this is a lack of willpower, that you just need to force yourself to do things and not be “weak.” That’s nice in theory, but the main problem isn’t willpower—it’s the absence of emotions and the ability to feel pleasure. When you can’t enjoy anything, it’s hard to motivate yourself. The end goal isn’t clear, and the process brings no joy. The only real motivation I’ve found is the desire to leave something behind.

Absence of Emotions

Judging by old photos, I used to have emotions. Now, I can’t remember when or how that was. A few years ago, things started to change: first, positive emotions disappeared, then the ability to enjoy things, leaving only anxiety, fear, anger—and then even those faded. It happens slowly, and you only realize after the fact that your feelings are gone. What’s left? Hard to say. When a psychiatrist asks, “How would you describe your mood?” the best answer is “none.” It’s neither good nor bad—it just isn’t there. I tried to find ways to change it, but eventually gave up.

The only thing that changes is internal tension under stress. Sometimes it’s so strong it feels like you’ll burst. Doctors call this anxiety, and maybe that’s accurate—vague unease. But these feelings have no emotional color; it’s more physiological: increased pulse, breathing, blood pressure, dizziness, or “hammers in the head” if it’s really bad. Maybe this is the “splitting” they talk about, where opposite emotions cancel each other out, leaving strong tension with no color.

Reactions to good and bad events are the same. Everything is filtered through logic, and judgments are made only on practical grounds. Tasty food? Good. If it were bad, that would be worse. Nice weather? Good, rain would be worse. Slipped on ice? Bad, could get hurt. Car splashed your pants? Bad, now you have to wash them. No emotions.

The instinct for self-preservation dulls. To a healthy person, this might look like self-harm, but it’s more a loss of the boundary where the risk of harm increases. Under stress, internal tension interferes with logical thinking, and there are no feelings to back you up.

Without feelings as a guide, you start to relate to things differently. Fear of many things disappears. Combined with thought disturbances, this leads to odd reactions to external stimuli. This is where incompatibility with cultural norms begins. For example, a healthy person might be disturbed by the TV show “Hannibal” (not for the faint of heart, with constant boundary-crossing), but for me, it’s total indifference. I’m more interested in the plot, dialogue, details, and visuals, and the characters (especially Will Graham) seem more relatable than real people.

Empathy

It’s hard to empathize with others when you lack the emotions they feel. But logic can help. That’s why I mentioned the TV character—I really do relate to him. His “empathy” is familiar to me. Where others feel, we think and notice details others miss. We see everything: the lies, the manipulation, the tricks. You can really see another person’s point of view—or at least it feels that way. Psychiatrists call this “magical thinking,” saying patients think they can “read minds.” That’s not it—it’s just that attention is focused differently, creating that effect. It’s often hard to explain your conclusions, but they’re always based on details.

Avoiding eye contact is a way to filter out secondary information and focus. You see too much and too little at the same time—that’s a good description of eye contact. A burst blood vessel, eye color, cat hair on a hat—the brain gets distracted by details and loses focus. It’s hard to look someone in the face and think at the same time. And if you don’t think, there’s nothing left.

Emotional Expression

Since there’s little to express, people like me may seem cold or detached. Facial expressions are limited, the voice is flat and monotone. Combined with a certain appearance and clothing, it can create a monk-like image.

Sometimes there are smiles—or more accurately, grimaces. Involuntary reactions unrelated to emotions. These can make others feel uneasy, since they often don’t match the situation. Like creepy clown stories—it messes with your head and creates mixed feelings. Not everyone knows these grimaces aren’t signs of friendliness or good mood, and this can lead to the thought, “no one understands me.” Indeed, people often misinterpret appearances, and it’s hard to know what to do about it. Strangely, dogs understand me better than people do.

Memory and Thinking Disturbances

After taking a battery of psychological tests and reading the psychologist’s report, I was puzzled. There was a whole paragraph about my thought disturbances. It’s interesting—my intelligence, in terms of “problem-solving,” is intact, but overall thinking is impaired. Perception, attention-switching, memory, and associations all work incorrectly.

By “problem-solving,” I mean intelligence as measured by things like Raven’s Matrices. I hadn’t seen them in a while, but recently scored 130 on the test. I’m usually skeptical of such tests, but at least it shows there’s no major problem there.

Sometimes I feel very forgetful. I have to write down what groceries to buy, for example. Or I might exit the subway and forget how I got there. I know where I am, but the process is gone from memory. Thinking about it causes tension. It feels like you’re going crazy, like you weren’t yourself for a while and can’t be sure what happened.

But tests show my memory is okay—or at least not too bad. Last time, my word recall curve was 5-7-9-10-9. Delayed recall—6. Remembering words with pictures—11 out of 13 correct, and another close in meaning. Memory lapses aren’t due to memory itself, but because the brain is busy with something else—philosophical thoughts, obsessions, or irrelevant details. Attention is focused in the wrong place. After doing a simple task, I might not remember how I did it. I can’t trust myself. Doubts linger, and associative chains can go very far. This is one example of obsessive thoughts that are hard to shake, even when you know why they happen.

Associations work in an odd way, probably due to focusing on secondary details. This is what others often call “creativity.” But it’s not creativity—just that thought chains drift to minor details and then continue as if nothing happened. This helps with odd tasks, yes. Helps find patterns others miss, yes. But it makes focused work difficult. The brain keeps drifting. I have to monitor myself and keep returning to the main point—but it doesn’t always work. Especially hard is finding the right words. If I forget a word, I’ll remember everything but the one I need. That’s probably why people like me invent neologisms or use words oddly, trying to express themselves.

This focus on details and constant drifting is clear in picture categorization tests—I immediately group things by irrelevant criteria, and only later (if at all) adjust to the “normal” answer. The line between important and unimportant blurs. It’s hard to self-diagnose this; I wouldn’t have known if the psychologist hadn’t told me.

Also, sometimes the brain starts noticing weird patterns in daily life—like always seeing 11:11 or 13 minutes on digital clocks. Day after day, you notice this and feel like you’re losing it, as if you only look at the clock when it’s 13 minutes past the hour.

Thinking disturbances are an interesting topic. The illness creates “blind spots,” and it’s hard to know what’s happening, or if anything is happening at all. Apathy is easy to spot in yourself, but thinking issues are not. This raises the question: should you try to fix these problems, as some psychologists do, if they help you be creative or solve unusual problems? That’s a rhetorical question. No one has fully learned to fix thinking problems yet.

Misunderstanding

I often draw conclusions based on observations and details, but others (even some doctors) see my conclusions as anxiety or paranoia. Meanwhile, they’re focused on emotions and, in my view, are blind. Sometimes I have to find documentary proof to convince them—and often I do. Just because you think someone is paranoid doesn’t mean they’re not being watched. With my background in information security, I know not just what can be done, but how. The line between sanity and madness is thin—don’t lump everyone together.

People often misunderstand me. Because I lack emotions, I just seem calm. Others might think I’m sad and try to cheer me up—but I’m not sad, they just made that up. Talking to psychologists is a whole other story. They start manipulating, and I see it all. It’s like knowing how a card trick works and watching someone else perform it—you can’t be surprised, you know how it’s done, and can’t unsee it. So the psychologist thinks one thing, I think another, and it leaves a feeling of “the psychologist just made something up.” I’ve stopped seeing psychologists after the first session—not because I’m “running from my problems,” as they see it, but because I “almost fell asleep at that boring show.”

Isolation and Masks

I don’t need social interaction—at least not constantly. I’m fine alone; my inner world is big enough that I don’t need to fill holes with other people. Intellectual or professional communication is fine—it doesn’t touch emotions. Everyday interaction is harder, and you can’t always avoid it.

To fit in, I have to put on emotional masks, learned from watching others. They’re not always appropriate or natural, and I think it shows. If everyone smiles, you should smile too; if everyone is sad, you should be sad too. That’s how it looks. But it’s exhausting, and I need lots of rest. It’s like being an actor—a hard job. You have to play someone else, someone foreign to you. Maybe this is where the myth of “split personality” in schizophrenia comes from. But it’s not that. It’s one person, with and without the mask.

Dereality and Illusions

The world loses perspective, sounds are muffled, colors fade, time slows down… It’s like you’re dreaming but can’t wake up. You understand what’s happening, but lose the “sense of reality.” Everything feels wrong. This is one of the harshest symptoms. It can happen anywhere, for no reason, and lasts a short time, but feels endless because of distorted time perception.

Some think derealization means objects change shape or color, or other bizarre things. But really, it’s the feeling that everything is just “off.” I’d describe it as feeling like you’re asleep and can’t wake up, but you’re actually awake. It’s very hard to bear.

Illusions are less scary but still interesting. Unlike hallucinations, illusions are based on lack of information. The brain fills in gaps, so you might see a person in a bush, a cat in a flying bag, or hear words in the sound of a printer. Sometimes there are taste or smell illusions—or maybe hallucinations, I’m not sure where the line is. You might suddenly smell crab salad when there’s none, or taste lemonade while eating meat. It’s brief, but makes you suspicious. I think it happens because the brain breaks down complex smells and tastes, and sometimes one component dominates. But maybe I’m wrong.

Treatment at the Psychiatric Dispensary

At some point, it became clear I needed medication. I went to the local psychiatric dispensary. Treatment started at the main branch, then I was transferred to another at a city clinic, but they were similar. Some might be interested in what goes on inside, so I’ll describe it.

The dispensary has two parts: the general department, where psychiatrists and psychologists see patients, and the day hospital. The general department is like a regular clinic—lots of people, long lines, noisy, confusing. The registration desk is the same as in any clinic. Records get lost. No procedures are done here—just consultations, referrals for psychological testing, doctor meetings, diagnoses, prescriptions, and certificates.

The day hospital is on another floor. In the new branch, it’s more like a psychological help center than a hospital—quiet, clean, with plants. People are mostly calm, probably due to medication. The old branch felt more oppressive, but that was due to the old building—narrow, dark halls, small offices. Interestingly, there are no mirrors anywhere—not in the halls, bathrooms, or offices.

The day hospital doesn’t require you to stay all day. Formally, you can be there all morning—they serve breakfast and lunch, and you can attend various sessions. They now offer psychoeducation lectures for patients and families, training, and consultations. It’s surprising that something is done well in our country. But attendance is voluntary.

You’re only required to visit two offices: your psychiatrist, who prescribes medication, and the pharmacy, where you get your meds. You see the doctor, get a prescription, pick up your pills, and can go home. At first, you come daily, then every other day. As your dosage is adjusted, you might only need to come once a week.

There’s no clear understanding of the causes of these disorders, so treatment is symptomatic. In my case, apathy and depression dominate because I can’t do anything. Atypical antipsychotics and antidepressants help a bit, but full recovery isn’t possible. These meds are free at the dispensary—covered by insurance.

There are a couple more offices: one for blood tests and injections, and a room with beds for IVs. I never used those, just walked by.

That’s what it’s like. Nothing scary happens at the dispensary, unlike the psychiatric hospital I once ended up in via the military draft office. The hospital was terrifying. I’m talking about the First Alexeev Hospital (aka Kashchenko), where some people say “there’s nothing to fear.” It’s a deserted park with old buildings, ambulances, police forcibly hospitalizing people, missing doors, others locked, bars on windows, searches at the entrance, patients’ belongings confiscated, and doctors who seem crazier than the patients. The ward I was sent to felt like a mix of prison and communal apartment. I used my sanity to refuse admission. I wouldn’t recommend anyone go there if they can avoid it. The regular dispensary is much better, and the meds are the same everywhere.

What Else Do I Do for My Condition?

I had to find activities to distract from bad thoughts and gradually return from total helplessness to a more functional state. Cooking turned out to be a good option. It’s a short task—you can force yourself to do it, and it requires focus. You have to cut things carefully, watch the time, gather ingredients, and then plate the food. The reward is a nice dish. It doesn’t bring joy, but it’s better than store-bought pasta. Cooking something new every day helps with discipline and motivation. It really helps with apathy.

Over time, I added web development. Returning to information security after being out of it was hard, and getting access to certain places is tough when you’re registered as a patient. I started learning web design and building unusual websites. I didn’t study 8–10 hours a day—started with half-hour sessions, then an hour a day. Gradually, I got side jobs. After a couple of years, I got pretty good and started making things that surprised people. Before I started writing about it, people didn’t believe I made my own portfolio.

During treatment, I developed a slight hand tremor from antipsychotics. Playing musical instruments—guitar and piano—helps with that. I’m not sure why, but it works. If I don’t play for a few days, the tremor gets worse. So I added an hour of music practice daily. Step by step, I wrote a flamenco guitar guidebook and started composing etudes—first short, then longer. If anyone’s interested, you can listen to synthesized recordings. I haven’t managed to record live yet, but I’ve published printed collections.

The point is, even with serious problems, you can achieve something. Working an hour a day, you can slowly but surely make progress. I’m amazed when healthy people say they can’t achieve anything. You all can.

Conclusions?

I’m not sure what conclusions to draw. I hope someone found it interesting to read about what it’s like to live with this disorder. Maybe it will give someone hope that partial recovery is possible. In any case, draw your own conclusions.