Borderline Schizophrenia: What Happens When BPD And Schizophrenia Occur Together?
While borderline personality disorder (BPD) and schizophrenia are considered distinct mental health disorders, they sometimes have significant features in common. Both can involve distorted perceptions of reality, as well as disturbances of emotion, social relationships, and self-concept. Could there be deeper connections between these conditions, and is it possible to have BPD and schizophrenia at the same time?
The available research suggests that the symptoms of schizophrenia and BPD can overlap in certain ways, such as the presence of hallucinations and paranoid delusions. There’s even some evidence for shared genetic risk factors. However, the core features of these mental illnesses are usually different, and some studies suggest that it’s relatively rare for them to occur in the same person. Understanding these similarities and differences can assist in the effective management of BPD and schizophrenia. If you believe you may be living with either of these mental health disorders, consider reaching out to a licensed therapist for support.
Classifying BPD and schizophrenia
Below, discover the characteristics of each of these mental illnesses.
Borderline personality disorder diagnosis
Borderline personality disorder (BPD) is considered a personality disorder, which can be defined as a deeply entrenched pattern of dysfunctional thinking and behavior. BPD is usually marked by a “pervasive pattern of instability” in several key areas.
- Emotions: People with this condition often experience extreme emotional reactions and shift rapidly and frequently between intense feelings.
- Relationships: Those with BPD often have difficulty maintaining interpersonal connections. Their views of other individuals may fluctuate between extreme positivity and negativity, with little room for a middle ground.
- Identity: An individual with BPD may have trouble holding onto a clear sense of who they are as a person.
- Behavior: Impulsive and reckless actions can be common in borderline personality disorder. Many patients also exhibit self-harming or suicidal behavior.
If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.
An exaggerated sensitivity to rejection can be a common feature of this condition, and this may partially predict the severity of interpersonal symptoms. Those with BPD often experience an intense fear of abandonment, and many of their counterproductive behaviors may be reactions to perceived rejection or attempts to avoid it.
Schizophrenia diagnosis
Schizophrenia, in contrast to BPD, is classified as a psychotic disorder. These illnesses usually involve difficulty separating reality from imagined perceptions or irrational ideas. A diagnosis of schizophrenia normally requires the presence of psychotic symptoms like hallucinations, delusions, or disorganized speech.
Other symptoms can include the following:
- Extremely disorganized behavior
- Catatonia (motor disturbances such as immobility or repetitive mimicry)
- “Negative symptoms” like a lack of emotional reactivity, motivation, or interest in activities
- Difficulties with social function
- Cognitive impairments
Auditory hallucinations tend to be particularly common in schizophrenia, especially the perception of external voices commenting on or directing the individual’s behavior. Bizarre delusions, such as the idea that alien machinery has secretly been implanted in the person’s body, can also be frequently observed in individuals living with schizophrenia.
Schizophrenia and borderline personality disorder: Similarities and differences
Although the central diagnostic features of these two illnesses can be considered quite different, they may resemble each other in certain ways.
Psychotic symptoms
In most cases, psychotic symptoms are more limited and temporary in borderline personality disorder than in schizophrenia.
Paranoia
Suspicious, distrustful attitudes and conspiratorial thinking can be warning signs for both disorders. Although paranoid thoughts and feelings can be popularly associated with schizophrenia, they also often occur in BPD and may be risk factors for this condition.
In schizophrenia, paranoid thinking may extend to persistent delusions, such as beliefs about being controlled or persecuted by powerful conspiracies.
Impulsivity
While impulsivity seems to be more common for those with borderline personality disorder, it’s also frequently observed in schizophrenia. Both conditions can involve seemingly unpredictable behavior and a lack of self-control, which can be a risk factor for aggression.
Despite this overlap, recklessness and risk-taking may be more common in BPD. Individuals with schizophrenia tend to be more averse to risk, and some may display persistent inactivity and apathy rather than impulsive behavior.
Limited self-identity
Individuals with BPD or schizophrenia often report experiencing a lack of selfhood or identity. “Chronic feelings of emptiness” are a recognized clinical sign of BPD, but people with schizophrenia may also describe themselves as “hollow,” “dead,” or “artificial.” Both disorders may involve a sense of detachment from the body or a sense of being somehow “unreal.”
In schizophrenia, these experiences may be linked to delusions of being controlled by other entities or having parts of themselves replaced by technology. People with BPD may also be more likely to try to distract themselves from their sense of emptiness through extreme behavior.
Comorbidity of borderline personality disorder and schizophrenia
There’s debate within the psychological community about how often borderline personality disorder and schizophrenia can occur together. One study examining 84 people with BPD noted that roughly 38% of those they evaluated also met the criteria for psychotic disorders. However, only 2% of them fulfilled the conditions for schizophrenia as opposed to other psychotic disorders.
Other studies have found conflicting results. A 2020 paper entitled “Exploring Schizophrenia Spectrum Psychopathology in Borderline Personality Disorder” reported that 20% of the people with BPD they examined could also be diagnosed with schizophrenia.
Some of these discrepancies may result from limitations in diagnostic tools. Under current clinical approaches, a diagnosis of a psychotic disorder often prevents an individual from being diagnosed with BPD as well. This may make it harder to assess how often the characteristic symptoms of these two types of mental illness occur together.
Could there be a connection between BPD and schizophrenia?
Though schizophrenia and borderline personality disorder are currently considered distinct diagnoses, this hasn’t always been the case. The term “borderline” in psychology originally referred to a state of mind that lay on the “border” between psychosis and neurosis.
Psychotic symptoms, such as delusions and magical thinking, were once considered a core part of the condition, and it was often seen as a mild form of schizophrenia. Some clinicians called it “borderline psychosis” or “borderline schizophrenia.”
This view began to change in the 1970s, as personality disorders were increasingly seen as a distinct type of mental illness. “Borderline personality disorder” was first officially adopted as a clinical term in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). The condition formerly called borderline psychosis was divided into two new classifications: BPD and schizotypal personality disorder (SPD), a disorder characterized by odd beliefs and quasi-delusional thinking.
Today, the term “borderline schizophrenia” is rarely employed in clinical practice. Some may use it to describe cases in which an individual has both BPD and a schizophrenia spectrum disorder.
Common risk factors for BPD and schizophrenia
Like many mental health disorders, schizophrenia and borderline personality disorder seem to result partly from genetic factors. A large-scale Swedish study from 2021 estimated that about 46% of the risk for BPD may be inherited along family lines.
Schizophrenia may be even more strongly influenced by genes, with some studies reporting a heritability of 73% to 79%.
Researchers have begun to find evidence that some of the same genes may be responsible for these disorders. For example, a 2017 genomic analysis of individuals diagnosed with borderline personality disorder found associations with two genes that appear to be involved in neurological development and neuronal signaling. These genes are also considered risk factors for schizophrenia, which could indicate that their genetic origins are partially shared.
Childhood trauma, such as abuse or neglect from caregivers, could also be a significant risk factor for both conditions. Traumatic experiences may negatively affect the development of brain structures involved in behavioral control, personal identity, and accurate perceptions of reality.
If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.
Treatment for borderline personality disorder and schizophrenia
Schizophrenia and BPD may be more difficult to manage when they occur together. The kinds of treatment that tend to be effective for each condition are often very different. For instance, there’s little evidence for the effectiveness of antipsychotic medication for BPD symptoms.
In addition, the presence of one of these illnesses might make clinicians more likely to overlook the other. Some studies suggest that people diagnosed with BPD who experience a psychotic episode might be less likely to receive the medication that could help.
If you think you’re experiencing symptoms of both BPD and schizophrenia, you may benefit from the help of a licensed psychiatrist. They can work with you to develop a treatment plan involving a combination of pharmacological treatment (to manage schizophrenia symptoms like hallucinations and delusions) and psychotherapy (to assist with cognitive, emotional, and behavioral challenges).
While you’re seeking psychiatric care, therapy may relieve some of your symptoms and improve day-to-day function. Seeking help online can be a fast and convenient way to get in touch with a licensed professional.
Research suggests that online interventions may provide similar benefits to in-person treatment in many cases. A 2016 trial found that internet-based cognitive-behavioral therapy could reduce depressive symptoms in schizophrenia, although those experiencing acute psychosis may need to seek care in person.
Other studies have found online skills training helpful for improving self-regulation and decreasing self-harm in people with BPD.
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