What is Borderline Schizophrenia?

There is borderline personality disorder (BPD) and then there is schizophrenia. Since the publication of the DSM-3 in 1980, they have been classified as two separate disorders. However, at the time many felt that they should both fall under schizophrenia spectrum disorders.

Mental health professionals are divided on whether borderline schizophrenia should be considered an official medical diagnosis.

Is Borderline Schizophrenia a Medical Diagnosis?

No, borderline schizophrenia is not a medical diagnosis, but some professionals believe it should be. Some psychologists have launched campaigns to add it to the DSM, but they have all failed. Even though it isn’t considered an official diagnosis, studies suggest that there may be a connection between the BPD and schizophrenia. 

Even though it is not officially used medically, borderline schizophrenia is used to describe when both BPD and schizophrenia occur together. It includes a combination of symptoms from both disorders. 

This convergence of the two illnesses is characterized mostly by perceptual-cognitive abnormalities, meaning that a person interprets information differently than someone who is neurotypical. 

Defining BPD and Schizophrenia

BPD and schizophrenia are both serious and fairly rare mental health disorders. They share some similar characteristics, but the DSM-5 classifies them as separate disorders. 

To understand borderline schizophrenia, we need to understand borderline personality disorder and schizophrenia independently.

Borderline Personality Disorder (BPD)

BPD is a personality disorder with its largest defining factor being an inability to manage emotions. People with BPD can have intense and unstable emotions that cause serious behavior issues. Symptoms of BPD include: 

• Impulsive
• Viewing things in extremes 
• Having rigid ideas and perceptions
• Rapidly changing likes and dislikes
• Unstable relationships
• Quick changes in self-identity
• Suicidal ideation

Less often, someone with BPD can show symptoms of psychosis, such as:

• Paranoia
• Dissociation
• Hallucinations

Typically, these psychosis symptoms are relatively short-lived compared to the symptoms of a psychotic disorder. They’ll usually only last from a few hours to a few days.

BPD is often characterized by difficulty regulating emotions like anger. Like all personality disorders, these symptoms will vary from person to person. Generally, one of the biggest challenges for people with BPD is maintaining stable relationships with others.

Schizophrenia 

Schizophrenia, on the other hand, is a psychotic disorder, meaning it affects how a person perceives external stimuli. Essentially, it’s characterized by a skewed sense of reality. Again, the symptoms and the intensity vary case by case, but people with schizophrenia often struggle to discern what is real and what is not. 

Schizophrenia is often associated with delusions, hallucinations, and paranoia. While these are common symptoms, they can manifest in a lot of different ways. 

Schizophrenia can also be characterized by:

• An inability to feel or express some emotions
• Lack of motivation, interests in friendships, or hobbies
• Disorganized movement 
• Disordered speech
• Disorganized thoughts

All of these symptoms affect how a person feels, thinks, and believes, which in turn, affects how they behave.

Comorbidity of BPD and Schizophrenia

The co-occurrence of BPD and psychotic disorders is not well-studied, but the evidence we do have points to some kind of correlation. 

One study of BPD patients showed that 37% of participants also had schizophrenia. Another study showed that 38% of BPD patients had some form of a psychotic disorder, but only a small portion had schizophrenia. 

Common Borderline Schizophrenia Symptoms

Schizophrenia is a psychotic disorder, while BPD is a personality disorder. However, psychosis symptoms in rare cases of BPD do line up with those of schizophrenia. Inversely, the skewed reality of a person with schizophrenia can cause some of the same emotional turmoil and behavioral problems as a person with BPD. 

Symptoms of borderline schizophrenia include:

• Intense emotional instability
• Paranoid ideation
• Hallucinations (often voices)
• Dissociation
• Chronic emptiness
• Impulsivity
• Identity disruption
• Fear of abandonment

These symptoms range in intensity and are often distressing.

Treatment of BPD and Schizophrenia 

Though borderline schizophrenia isn’t an official diagnosis, it’s still a way to understand the link between BPD and schizophrenia. It’s important to treat both at the same time. 

Luckily, treatment looks similar for BPD and schizophrenia. They both respond well to therapy and medication.

DBT and CBT

Dialectical behavioral therapy (DBT) was originally created to treat BPD, though many therapists will use it in a variety of contexts. DBT’s keystone concept is mindfulness. DBT clients learn to use grounding techniques to improve emotional regulation.

Cognitive behavioral therapy (CBT) aims to help clients change their perceptions, beliefs, and negative behaviors associated with them. 

Both DBT and CBT can help clients:

• Regulate their feelings and emotions
• Find healthy coping mechanisms
• Reduce behaviors that are destructive
• Improve how they interact with others

Medication is often necessary for management and treatment as well. Antipsychotics, mood stabilizers, and antidepressants are all viable options depending on the situation.

Stress can worsen the symptoms of BPD and schizophrenia. Finding self-care strategies to relieve stress can help manage symptoms.

Medication

Medication may be an important part of treatment for schizophrenia. Remember that borderline schizophrenia is not a formal diagnosis, and therefore doesn’t have any medical treatment. However, people experiencing overlapping symptoms of schizophrenia and BPD may benefit from medication.

The best medication for your needs can be found with the help of your medical professional team. Only take medications as directed by your doctor.

Get Help Today 

BPD and schizophrenia can be intense, but one of the scariest parts is a lack of understanding. At Sequoia Behavioral Health, we use psychoeducation for our clients and their families as a part of treatment. Understanding why a person feels and acts the way they do is the first step to improving those feelings and actions. 

Even more serious disorders like BPD and schizophrenia can be treated. Your mental health matters. Talk to a professional to see how to improve yours.

Contact Sequoia Behavioral Health today for a free consultation to see what we can do for you, a family member, or a friend.