An evolutionarily informed therapy for adolescents with prominent schizotypal traits: a pilot five case series

Background: There is a growing interest in the early assessment and treatment of maladaptive forms of personality traits in adolescents, though little is known about effective interventions. This case series aims to present the adaption of a therapy specifically tailored on schizotypal traits to adolescents. The treatment - Evolutionary Systems Therapy for Schizotypy - integrates evolutionary psychopathology, metacognitively oriented psychotherapy and compassion focused therapy. Methods: Five adolescents attended 6-months of individual psychotherapy. All participants were diagnosed with schizotypal personality disorder in accordance with the DSM-5 Alternative Model of Personality Disorders. Primary outcome was remission from diagnosis. Secondary outcomes were a reliable change in personality pathology and distress and the acceptability of the intervention. Results: Four out of five patients showed remission from diagnosis. All the participants showed reliable changes in personality pathology and distress whether comparing initial and final assessments or investigating monthly variations. Changes were maintained at 1-month follow-up. No adverse events were reported, and intervention was described as satisfactory and sustainable. Discussion: Further research is needed to confirm the feasibility of the proposed treatment. This study suggests the importance of developing effective interventions for adolescents with personality disorder, especially for those at risk for severe manifestations.