Borderline personality disorder (BPD) and schizophrenia share similarities that might make them seem like the same condition. But they’re separate diagnoses and different types of mental health conditions.
Impaired relationships, symptoms of psychosis, and changes in emotional expression can happen in both BPD and schizophrenia. At first glance, these outward signs can make these conditions seem similar — even the same.
Current diagnostic guidelines list BPD and schizophrenia separately. In fact, the deeper you dive into their symptoms, the more differences emerge.
Both borderline personality disorder (BPD) and schizophrenia are mental health conditions outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), the primary clinical guidebook used for mental health diagnoses in the United States.
BPD was once merged with schizotypal personality disorder, but the two conditions were separated when the DSM-3 was published in the 1970s.
Some experts at the time disagreed with the decision. They claimed both conditions featured perceptual-cognitive symptoms and shared a genetic relationship that meant they should be considered one condition under the class of schizophrenia spectrum disorders.
They informally called the proposed disorder “borderline schizophrenia.”
The change was never made. BPD and schizophrenia were kept distinct from one another
BPD is a personality disorder. It features patterns of unstable interpersonal relationships, a distorted sense of identity, emotional instability, and impulsivity. It can involve secondary symptoms of psychosis.
Schizophrenia is a psychotic disorder. Hallucinations, delusions, and disordered thoughts must be present. It also includes prominent features of cognitive and functional loss.
Here are some of the most common symptoms:
Borderline personality disorder (BPD)
- a pattern of unstable relationships
- avoidance of real or perceived abandonment
- a persistent unstable image or sense of self
- reckless behaviors and impulsivity
- self-destructive behaviors
- recurrent suicidality or self-harm
- mood instability
- chronic feelings of emptiness
- frequent outbursts of inappropriate anger
- stress-related psychosis
- stress-related dissociation or paranoid thoughts
- hallucinations or delusions
- disorganized thoughts and speech
- disorganized motor function or catatonia
- negative symptoms, including reduced emotional expression, decreased speech output, and social withdrawal
- active and inactive periods of psychotic symptoms
- psychosis not related to mood
- impaired concentration, memory, and decision-making
- mood episodes, particularly depressive episodes or dysphoria
Possible overlapping systems
- relationship challenges
- mood shifts
- inappropriate anger
- paranoid ideation
It is possible to be diagnosed with both borderline personality disorder and schizophrenia at the same time. This is called comorbidity.
But because both of these conditions are uncommon, comorbidity is exceptionally rare. Small sample pools in research make it challenging to know the exact prevalence.
A small study in 2019 found a higher rate of comorbidity. Out of 30 people diagnosed with BPD, approximately 20% also met the criteria for schizophrenia.
Just as some symptoms of BPD and schizophrenia overlap, so do their treatment options.
To treat BPD, psychotherapy is the first-line treatment. Dialectical behavior therapy (DBT) is a framework specifically developed for BPD treatment. It focuses on emotional and situational awareness, as well as the development of skills to help:
Treating schizophrenia typically starts with medications. Antipsychotics help manage the core features of this condition, while psychotherapy assists with stress management, developing beneficial thought patterns, and adjusting to life with schizophrenia.
Cognitive behavioral therapy (CBT) is commonly used to treat schizophrenia and may also be used to treat BPD.
Your healthcare team will work together to develop a treatment plan that makes sense for your prominent symptoms.
Can BPD turn into schizophrenia?
Under current diagnostic guidelines, BPD is not considered an early form of schizophrenia. BPD won’t turn into schizophrenia, and schizophrenia won’t turn into BPD.
At one time, however, BPD was lumped in with schizotypal personality disorder, which is considered both a personality disorder and schizophrenia spectrum disorder in the DSM-5-TR.
It’s estimated that as many as 30% of people living with schizotypal personality disorder go on to develop a psychotic disorder, primarily schizophrenia.
Overlapping symptoms of psychosis, mood changes, and dissociation can make borderline personality disorder and schizophrenia seem like the same condition. At the core, however, these disorders are very different.
BPD won’t turn into schizophrenia or vice versa, but you can live with BPD and schizophrenia at the same time.
Like with symptoms, treatments can overlap. CBT, antipsychotics, and antidepressants might be part of a dual treatment plan. Not all BPD treatments are used for schizophrenia, and not all schizophrenia treatments will benefit someone with BPD.