View metadata,Schizophrenia citation and Bulletin similar vol. papers 41 suppl. at core.ac.uk no. 2 pp. S436–S443, 2015 brought to you by CORE doi:10.1093/schbul/sbu185 provided by Serveur académique lausannois Schizotypy—Do Not Worry, It Is Not All Worrisome Christine Mohr*,1 and Gordon Claridge2 1Institute of Psychology, University of Lausanne, Lausanne, Switzerland; 2Department of Experimental Psychology, University of Oxford, Oxford, UK *To whom correspondence should be addressed; Faculté des Sciences Sociales et Politiques, Institut de Psychologie, Bâtiment Geopolis, Quartier Mouline, Bureau Geo – 4117, CH-1015 Lausanne, Switzerland; tel: ++41-21-692-37-53, fax: ++41-21-692-32-65, e-mail: [email protected] A long-standing tradition in personality research in psychol- thus assumed that knowledge acquired from schizotypy ogy, and nowadays increasingly in psychiatry, is that psy- research will also enlighten our knowledge of schizo- chotic and psychotic-like thoughts are considered common phrenia. Within this taxonomic tradition, it is no surprise experiences in the general population. Given their widespread that deficits and similarities with schizophrenia are high- occurrence, such experiences cannot merely reflect patholog- lighted.6 Sticking to a purely pathological perspective, ical functioning. Moreover, reflecting the multi-dimensional- however, seems one-sided when considering that scores ity of schizotypy, some dimensions might be informative for in such self-report questionnaires vary widely in the gen- healthy functioning while others less so. Here, we explored eral population.4,7 Moreover, in longitudinal studies, the these possibilities by reviewing research that links schizotypy large majority of so-called “psychosis-prone” individuals to favorable functioning such as subjective wellbeing, cogni- (high in self-reported schizotypy), will never experience tive functioning (major focus on creativity), and personality a psychiatric illness.4,5 Thus, it is possible that individu- correlates. This research highlights the existence of healthy als who score high in schizotypy might have some advan- people with psychotic-like traits who mainly experience tages, guaranteeing its persistence over generations and positive schizotypy (but also affective features mapping onto contributing to the richness of human experience and bipolar disorder). These individuals seem to benefit from a performance. Indeed, when taking that dimensional per- healthy way to organize their thoughts and experiences, that spective, grounded in individual differences research, one is, they employ an adaptive cognitive framework to explain can account for both the psychopathological and healthy and integrate their unusual experiences. We conclude that, personality potential of schizotypy.7 Our contribution to instead of focusing only on the pathological, future studies this special issue is, therefore, to provide a selective and should explore the behavioral, genetic, imaging, and psycho- brief overview on study domains in which schizotypy has pharmacological correlates that define the healthy expres- been considered advantageous. In particular, we review sion of psychotic-like traits. Such studies would inform on studies on health/social wellbeing, flexible and unconven- protective or compensatory mechanisms of psychosis-risk tional thinking (in particular creativity) and psychologi- and could usefully inform us on the evolutionary advantages cal styles, and personality features. To also account for of the psychosis dimension. the likely important role of the multidimensionality of schizotypy, we report on results as a function of schizo- Key words: health/creativity/reasoning/psychoticism/ typy subdimensions where possible. Alongside, we dis- bipolar/personality traits cuss the potential implications of these advantages and how they could influence and shape future studies on Introduction schizotypy, including its psychopathological expression. Schizotypy, in particular in a clinical context, is treated as a pathological condition. It is commonly assessed via Healthy Schizotypy self-report questionnaires comprising symptom dimen- The years preceding the introduction of the new DSM, sions known from schizophrenia, that is, positive, nega- now in its fifth revision, has seen numerous contributions to tive, and disorganized symptoms.1–3 Individuals who the debate as to whether dimensional models of mental ill- score very high in such self-report questionnaires were nesses (including psychosis) should be included.8 Decades found to have an enhanced risk for psychosis.4,5 It is of research within a clinical and personality tradition © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: [email protected] S436 Benefits of Schizotypy have focused on markers (eg, cognitive and behavioral) reported subdimensions.1–3 In the case of positive schizo- that are present in both patients with schizophrenia and typy, studies link this subdimension to pleasant and healthy schizotypal individuals from the general popula- enriching mental experiences. In a context in which par- tion.6,9–11 In most studies, the link between schizotypy and ticipants were exposed to experimental settings facilitat- the clinical condition is key. Markers are treated as indi- ing altered states of consciousness, those scoring high as cators of psychopathology rather than as indicators of compared to low on positive schizotypy reported higher mental health. Yet, one could argue that these markers are and more intense levels of altered perceptual experiences simple by-products of the psychosis dimension devoid of and visual imagery.20 Importantly, these authors hinted any clinical relevance. In the end, these markers are present that such settings (eg, shamanism) were associated with in completely healthy, fully functioning individuals from enhanced self-healing, raising the notion that positive the general population without a past, current, and future schizotypy in the right context would be beneficial. history of a psychotic or related psychiatric history.4,5 We Several additional examples support this position, as obviously appreciate the possibility that these markers shown by some recent studies on new religious move- could be clinically relevant, in particular when of a certain ments (NRM). Positive schizotypal traits in mem- magnitude. There is, however, a major caveat with this pos- bers of NRM (eg, Hare Krishnas, Druids) were higher sibility; we lack information as to the necessary magnitude than those in both Christians and nonreligious control of cognitive deficits for those to be clinically predictive or groups.21 In another study, higher delusional ideations selective. Commonly, we observe that deficits for given cog- were observed in members of NRM when compared nitive domains are evident in patients with schizophrenia with controls.22 This study also showed that NRM mem- as well as in the respective populations along the schizo- bers had comparable delusional ideations to deluded phrenia spectrum (including schizotypy). When taking a patients.22 Importantly, however, NRM members seemed dimensional personality research perspective, we do not less distressed and preoccupied by their experiences than need to focus on impairments and disadvantages. We can were patients.23 Yet another study showed that individu- focus on both potential psychopathological and beneficial als holding peculiar beliefs (eg, faith healing, angels, ESP) markers. This approach equally facilitates the discussion and who perceive them as being important to their lives of evolutionary advantages of the schizophrenia spectrum consider these beliefs to have a positive impact enhancing including schizotypy.12–14 their understanding of the world and themselves.24 The more this relationship was observed, the less individuals experienced psychological distress. Finally, Farias et al25 Schizotypy and Health/Wellbeing reported significant relationships between NRM and Several studies have reported on comparisons in health magical thinking (but not with paranoid ideation and and wellbeing between schizophrenia and schizotypy. perceptual ideation). NRM individuals reported a sense For instance, patients with schizophrenia as compared to of connectedness and holistic experiences and showed controls report a lower quality of life and life satisfac- an associative thinking style and emotional hypersensi- tion.15 In the healthy population, schizotypal traits are tivity. These authors suggested that such features offer a often accompanied by lower life satisfaction and higher healthy way to cognitively organize thoughts and expe- negative affect. Even when negative affect is accounted riences, that is, reflect on a cognitive framework within for, lower life satisfaction was most importantly asso- which magical ideation and unusual experiences are given ciated with negative and disorganized schizotypy, but meaning. not with positive schizotypy.16–18 Moreover, while all Being able to cognitively organize thought and expe- schizotypy dimensions (positive, negative, disorganiza- riences might indeed reflect a crucial factor in how tion) related to lowered life quality, the relationship was schizotypal features impact on mental health. Positive most relevant to negative schizotypy, in particular when schizotypal features themselves, especially when accom- related to social activity.16 In another