What Even Is Borderline Schizophrenia?

Borderline personality disorder (BPD), also referred to as “borderline,” and schizophrenia are two separate and distinct mental health conditions. However, they can share common symptoms and features. In some cases, BPD and schizophrenia can occur together—a phenomenon once referred to as “borderline schizophrenia.” Although borderline schizophrenia is no longer an accepted psychiatric diagnosis, understanding the differences and similarities between the two conditions can be helpful when seeking treatment, especially if they co-occur. Below, we delve into what you need to know about the defunct diagnosis, the causes of BPD and schizophrenia, and how to cope with both conditions.

What is borderline schizophrenia?

“Borderline schizophrenia is an obsolete term used to describe the occurrence of both borderline personality disorder and schizophrenia in a client,” says Charlie Health Clinical Supervisor Tracye Freeman Valentine, LPC-MHSP. Borderline schizophrenia has not been recognized as a diagnosis since 1980 and is not part of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). People may now use the defunct diagnosis informally to refer to someone diagnosed with both BPD and schizophrenia. 

BPD and schizophrenia share some common symptoms, but the two are very different diagnoses. Importantly, BPD is classified as a personality disorder, while schizophrenia is a psychotic disorder. The former is marked by rigid and unhealthy patterns of thinking and behaving, whereas the latter is characterized by a loss of contact with reality.

The conflation of the two conditions may also come from the fact that BPD was once linked with schizotypal personality disorder, which is now considered a schizophrenia spectrum disorder—a class of conditions characterized by disturbances in thought, emotion, perception, and behavior. These disorders include schizophrenia, schizoaffective disorder, schizotypal personality disorder, delusional disorder, and others. BPD is not considered a schizophrenia spectrum disorder. 

Differences between borderline personality disorder and schizophrenia

In order to better understand the difference between BPD and schizophrenia, it’s helpful to define each condition independently. 

Borderline personality disorder (BPD)

BPD is a personality disorder affecting a person’s emotions, behavior, and sense of self. People with BPD often have intense and unstable relationships, struggle with self-image and identity, and experience extreme mood swings and impulsivity. They may engage in risky behaviors such as substance abuse, self-harm, or suicidal behavior (however, if these behaviors happen primarily during times of elevated mood or energy, they may be symptoms of a mood disorder, like bipolar disorder, not BPD). BPD usually develops in early adulthood and is more common in women than in men. With therapy and, in some cases, medication, managing BPD symptoms is possible, and people with BPD tend to show improved well-being. 

Schizophrenia

Schizophrenia is a severe mental health condition that affects the way a person thinks, feels, and behaves. People with schizophrenia often experience hallucinations, delusions, catatonia, disordered thinking, and behavior, as well as difficulty with social interactions and communication. Schizophrenia usually develops in the late teenage years or early adulthood, and it affects both men and women equally. The first line of treatment for schizophrenia is typically antipsychotic medication, though therapy may also be incorporated into treatment in the long term.

How are borderline personality and schizophrenia similar? 

Both BPD and schizophrenia can cause disturbances in a person’s thinking, perception, and behavior. Common BPD symptoms include intense anger, impulsivity, paranoia, dissociation, and hallucinations—symptoms also seen in clients with schizophrenia. Additionally, both disorders can result in difficulties in social relationships and emotional regulation. 

Individuals with BPD may experience psychotic symptoms under intense stress or in severe cases. These symptoms can include visual or auditory hallucinations (seeing or hearing things that aren’t there) and delusions (firmly held beliefs that are not based on reality). 

However, experiencing psychotic symptoms does not mean that someone with BPD has a psychotic disorder, such as schizophrenia. Psychotic symptoms in BPD are typically brief and occur in response to intense emotional stress. By contrast, these symptoms are a common and enduring feature of schizophrenia.

The conditions are also similar because their probable causes aren’t entirely clear. No single factor exists, but a complex combination of multiple factors, like genetics, physiology, and environment, all play a role in the development of these conditions. 

How common is it for someone to have schizophrenia and borderline personality disorder at once? 

According to Valentine, research shows that BPD and schizophrenia may occur at the same time; however, additional research is needed to confirm definite comorbidity. 

While research from a 2014 study indicates that people with BPD often experience co-occurring psychiatric conditions, the exact rate of schizophrenia and BPD comorbidity is not yet apparent—and is often conflicting in the research. For example, a 2010 study found that 17.6% of people diagnosed with schizophrenia also met the criteria for BPD, while research from 2018 illustrates that schizophrenia was present in only 2% of female clients surveyed with BPD. 

Treatment for borderline personality disorder and schizophrenia

BPD patients and schizophrenic patients may both be treated with a combination of therapy and medication. Commonly used treatment modalities include cognitive behavioral therapy (CBT) for managing and reframing thoughts and dialectical behavior therapy (DBT) for managing behaviors. Antipsychotic medication and mood stabilizers may also be used to treat both BPD patients and those with schizophrenia. Valentine notes, though, that coordinated medical and therapeutic care is more often needed for clients with schizophrenia. 

Support for borderline personality disorder and schizophrenia at Charlie Health 

If you or a loved one are struggling with borderline personality disorder or schizophrenia, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for young people dealing with complex mental health conditions, including personality disorders, mood disorders, and more. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing borderline personality disorder and schizophrenia is possible. Fill out the form below or give us a call to start healing today.