Models of Schizotypy: The Importance of Conceptual Clarity

Abstract

The observation of psychosis-like traits that resemble symptoms of schizophrenia and bipolar disorder, both among healthy relatives of psychotic patients and among the general population, can be traced to the early 20th century.1,2 These traits have since been described within various models of illness and health (ie, normal/abnormal personality, abnormal psychotic continua), each giving rise to concepts such as "schizotypy," "psychoticism," and "psychosis-proneness" that are not necessarily interchangeable, although their subtle distinctions are often overlooked. Historically, there have been 3 major models of schizophrenia-/psychosis-proneness, one of which is referred to as "taxonic" or "quasi-dimensional,"3,4 and 2 models that can be regarded as "fully dimensional,"5,6 as distinguished by the relationship that is proposed to exist between psychosis-proneness and the risk of clinical schizophrenia or other psychotic disorder. In this review, we outline the key assumptions of each model and its implications for research of psychosis in relation to mental illness and health and for the alternative models. We integrate historical concept development with current findings from various fields of research (eg, personality, neurobiology, and behavioral genetics) and highlight the remaining questions each model poses in relation to understanding the development of psychotic illness and the distribution of psychotic-like traits in the general population.

Figures

Fig. 1.

Schematic of Meehl’s, Eysenck’s, and Claridge’s continuum models of risk for psychosis spectrum disorders, mapped on 2 axes representing separate dimensions of illness-health and the psychosis-mood spectrum. Within Meehl’s schizotypy model (solid line), the discrete taxon of schizotypy exists as 10% of the general population and is underpinned by an inherited, integrative neural defect (schizotaxia). Within Eysenck’s model (dotted-and-dashed line), risk for schizophrenia is seen as a monotonic function of the personality dimension of Psychoticism; extreme values in Psychoticism represent psychotic disorder, and individual variation in an independent dimension of cyclothymia/schizothymia is said to explain differences within the group of psychotic disorders. Within Claridge’s fully dimensional model (dashed line), schizotypy is seen as a set of behaviors and characteristics distributed normally in the general population, with the potential for illness arbitrarily distinguished at the extreme end of the health-illness spectrum. Like Eysenck, Claridge proposes that variance within the psychotic disorders (ie, within the psychosis spectrum) would be explained by other dimensions of personality (not shown here).