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Oddity, Schizotypy and Evolution?

Oddity, schizotypy, evolution, evolutionary theory

My paper on an evolutionary model of schizotypy is finally out! New Ideas in Psychology has published it. As I anticipated in a previous post here, this study aims to summarize existing kowledge about proximate and evolutionary factors involved in schizotypy and oddity, and propose an integrative model.

Such a model suggests how schizotypy may be better understood by looking at the role of social brain in the evolution of our species and the neurodevelopment of those with prominents openness to experience and introversion.

The paper is also the foundation of the the shared conceptualization of newly developed treatment for schizotypal personality disoder, namely Evolutionary Systems Therapy for Schizotypy (ESTS). In the next few months the paper – figers crossed! – about a preliminary randomized controlled trial should be pulished.

Cheli, S. (2023). An evolutionary look at oddity and schizotypy: How the rise of social brain informs clinical practice, New Ideas in Psychology, 68, 10099, https://doi.org/10.1016/j.newideapsych.2022.100993

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European congress on personality disorders

I’ve attended at the 6th International Congress of the European Society (10-12 October) for the Study of Personality Disorders (ESSPD). Several very interesting keynotes and symposia were presented.

I was impressed by two relevant, innovative and recurring themes. First, something has finally changed in the way we discussed personality disorders. Even if this change has been long waited, many studies were focused on the search for a positive outcome, a recovery and personal growing rather than just discussing about reduction in symptoms or remission from a categorical diagnosis. This was evident since the first two keynotes on positive psychology (Meike Bartels) and borderline personality (Mary Zanarini). Second, there were three symposia exclusively dedicated to adolescence and early onset of personality disoders. Carla Sharp was present almost in all of them, as a leading expert in the field. I was very happy to see this new interest in adolescence, and I hope for more and more studies especially on clinical applications of a personality-informed approach.

Finally, I presented two researches: our RCT on schizotypal personality disoders and the longitudinal study on the relationship between narcissism and perfectionism. I previously presented here the results.

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Adolescence and severe psychopathology

The dataset of our recently concluded cases series on adolescents with prominent schizotypal traits is available on OSF. In the study we extended the clinical utility of Evolutionary Systems Therapy for Schizotypy (ESTS) by applaying it in treating five adolescents diagnosed with schizotypal personality disorder.

The results were encouraging: 4 out of five remitted from diagnosis at the end of the 6-month intervention and all the adolescents reported reliable changes in symptomatology.

Personality pathology in adolscence is an understudied area of psychotherapy, even if researchers are publishing more and more studies on that. We know that personality and its disorders emerge during adolescence, but the “straighforward” approach to psychiatry seemingly generates a paradox by not allowing a diagnosis in adolescence!

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The link between narcissism and perfectionism

I am ready for the upcoming congress of the European Society for the Study of Personality Disoders (ESSPD) where I join a symposium chaired by Elsa Ronningstam (Harvard Medical School) on recent advances in narcissism.

My team and I just concluded a study on the interwined path of narcissism and perfectionism. In a sample of healthy young adults we explored over time wheter perfectionistic traits and strategies explained the relationship between narcissim and psychopathology.

We found that the higher the perfectionistic strategies the higher the psychopathology associated with narcissistic traits. But perfectionism did not predict variation of narcissism over time. We interpret these results through an evolutionary perspective. Those with prominent narcissistic traits are often triggered by a social rank motive. We hypothesize that perfectionistic strategies are the “tools” used to pursue or recover a desidered social rank. This would be consistent with a common fluctuation of mental states in narcissism and with weak or non significant mediating role of perfectionism in the relationship between past and present narcissism.

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An evolutionary look at oddity

I’m extending the genetic background of my new paper on an evolutionary look at schizotypy. I have to thank the reviewers we asked me to improve this part of the research. The paper represents the theoretical foundation of my clinical work with those struggling with schizotypal psychopathology.

The idea at the core can be traced back to the long-standing debate about the evolutionary paradox of schizophrenia. In short, we know how schizophrenia hugely impact on quality of life, but it has always been present in our history. Or better we know how it is a very species-specific disoder. I was really surprised by discovering how those with high prevalence of Nehandertal genes were reporting a lower risk to been diagnosed with schizophrenia and if they were so they showed less severe symptoms!

In my paper I focus on schizotypy, that is a broad organization of personality that is reputed to range from healthy states (such as creativity) to severe manifestations such as schizophrenia. The hypothesis that I discuss in the submitted manuscript is that oddity (a core clinical manifestion of schizotypy defined by odd behaviors, emotions, thoughts) would represent the failure in socializing one’s own openess to experience. The latter trait is a healthy side of human personality allowing creativity and discovery, whereas oddity is a defensive stance often leading to emotional suffering and isolation.

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European congress of EABCT

The 2022 European Congress of the EABCT (European Associations of Behavioral and Cognitive Therapy) has just concluded in Barcelona.

EABCT is the most important umbrella association of cognitive behavioral therapy (CBT). Each and every year different scholars and clinicians meet up and discuss about trends and advances in CBT. During 2020 event several experts such as Todd Farchione, Emily Holmes and others discussed how transdiagnostic approaches are getting more and more relevant in daily practice and research.

Personally I presented the preliminary data of a recently concluded RCT where I teseted a new integrative therapy for schizotypal personality disorder. Evolutionary Systems Therapy for Schizotypy is a new treatment integrating evolutionary approaches, compassion focused therapy and metacognitively oriented psychotherapy. The RCT compared ESTS with a combination of CBT for personality disorders and standard psychopharmacotherapy. The protocol is described in a previous post.

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A new RCT on schizotypal personality disorder

RCT on schizotypal personality disorder

Fingers crossed for a recently submitted paper on our randomized controlled trial, RCT, on Schizotypal Personality Disorder!

In the last two years my team and I have dedicated so many efforts to this challange. We have tried to outline and test a new treatment for those diagnosed with Schizotypal Personality Disorder. The intervention was a 6-month therapy compared with a stardard treatment comprising of Cognitive Behavioral Therapy (CBT) for personality disorders plus psychopharmacological treatment. The RCT has been registered on ClinicalTrials.gov and the paper submitted in July.

We defined the intervention as Evolutionary Systems Therapy for Schizotypy (ESTS) since it integrates different approaches: an evolutionary look at schizotypy, a systemic framework in understanding self-to-self and self-to-other relationships, a metacognitively oriented approach to in session conceptualization, and finally a compassion focused approach to experiential tecniques.

The results of our RCT on Schizotypal Personality Disorder

were really good! We confirmed (as desidered and hypothesized) a non superiority of the control group (CBT + drugs) and in the secondary outcomes (metacognitife functioning and general symptomatology) we found a superiority of ESTS.

Preprint of the paper can be read on OSF!

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