There are several misconceptions in diagnosing borderline personality disorder vs. schizophrenia. It can be a complex process to delineate between the two because of the instability they can cause. However, it’s essential to distinguish between these two disorders for effective treatment.
Understanding BPD and Schizophrenia
Schizophrenia is defined by having at least two or more of the following for a minimum of one month, one of which must be the first three:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
Borderline personality disorder is defined by a pervasive pattern of instability in self-image and interpersonal relationships, marked by impulsivity. Individuals must have five or more of the following:
- Frantic efforts to try and avoid abandonment, either real or imagined
- A pattern of unstable or intense interpersonal relationships
- Identity disturbances with an inability to maintain a stable self-image
- Impulsivity in at least two areas that are self-damaging, such as binge eating, substance abuse, reckless driving, reckless spending, or dangerous sex
- Recurrent suicidal behavior, threats, gestures, or behavior
- Effective instability because of reactivity of mood
- Chronic feelings of emptiness
- Inability to control anger with inappropriate and intense anger
- Stress-related paranoid ideation or dissociative symptoms
Overlapping Symptoms
Many of the overlapping features have to do with problems in relationships, as both disorders can hinder interpersonal relationships. Other overlapping features extend to problems with emotional regulation.
People with borderline personality disorder who have psychotic symptoms can have the same disorganized thoughts and speech, delusions, or auditory hallucinations as someone with schizophrenia. One of the key differences between BPD psychosis vs. schizophrenia is that BPD psychosis is often more limited, and it doesn’t occur in as many people with BPD.
Some studies have found that 71% of people with schizophrenia have auditory hallucinations compared to only 40% of people with BPD.
Distinguishing Features
Someone struggling with schizophrenia will have a wide range of behavioral, emotional, and cognitive dysfunctions. Schizophrenia involves significant impairment in at least one major area of functioning, and many signs persist for at least six months or more.
Someone with schizophrenia might experience delusions, which can take a variety of themes like referential, religious, grandiose, or persecutory, and that individual will not change those fixed beliefs no matter what conflicting evidence is presented to them.
It’s also common to experience hallucinations, which are experiences that don’t have any external stimulus but are just as vivid and clear as if they did. These are not within the individual’s control, and it’s quite common for people to experience auditory hallucinations, hearing voices that are not their own.
Disorganized speech can be loose associations or derailment where an individual switches from one topic to another or answers questions that are not directly related to what is being discussed. They might even struggle with incoherence, speaking in an incomprehensible and disorganized fashion.
By comparison, when looking at schizophrenia vs. borderline personality disorder, BPD has a pervasive pattern of instability in terms of how individuals use themselves and how they have interpersonal relationships. Someone with borderline personality disorder will, for example, have a severe fear of separation, rejection, or abandonment and go to frantic lengths to avoid this, whether real or imagined. They are also highly sensitive to any environmental changes, and if there is something like an individual being a few minutes late to an appointment, they will react with unrealistic or inappropriate anger.
Tools and Techniques for Accurate Diagnosis
If you are concerned about whether you or someone in your family has schizophrenia vs. BPD, a professional psychiatrist can use tools and techniques from the DSM-5 as well as other diagnostic tests to rule out other possible explanations.
For example:
- Both separation anxiety disorder and borderline personality disorder are characterized by a significant fear of abandonment and lead to problems with impulsivity and interpersonal functioning, so someone who is showing signs of BPD might work with a psychiatrist to rule out separation anxiety or to rule out a depressive disorder.
- Major depressive disorder, schizoaffective disorder, or bipolar disorder with psychotic features can have the same types of delusions or hallucinations and have a significant impact on psychosis. As such, a medical team would work hard to rule out any other potential explanations in order to help confirm an accurate diagnosis.
An initial assessment will help determine any risk or prognostic factors that might confirm whether something is likely BPD psychosis or schizophrenia. This might include a history of genetic and physiological backgrounds, particularly whether first-degree biological relatives have similar conditions.
Treatment Strategies for BPD
The primary treatment strategies for Borderline Personality Disorder center on psychotherapy as well as the potential use of medication and holistic care.
Psychological Therapies
Psychological therapies are the most common form of treatment for BPD. This includes dialectical behavioral therapy, where individuals have an opportunity to change their relationship with symptoms of BPD and recognize factors that contribute to negative cycles of symptoms.
Medication
In some cases, medication might be prescribed, but this is based on individual needs.
Integrative and Holistic Approaches
Integrative and holistic approaches like music therapy and art therapy can help individuals who have difficulty expressing their thoughts verbally find another outlet. Working with trained therapists can help provide access to integrative treatment that better controls certain symptoms, particularly through activities like meditation and exercise.
Treatment Strategies for Schizophrenia
Treatment strategies for schizophrenia involve antipsychotic medications, psychosocial interventions, and long-term management.
Antipsychotic Medications
Antipsychotic medications are the most common recommendations as initial treatment for acute schizophrenia symptoms. Antipsychotic medications work by blocking the effect of certain chemicals on the brain, like dopamine, so this can help reduce feelings of aggression or anxiety within the first several hours and, over the span of several weeks, start to reduce symptoms of delusions or hallucinations.
Psychosocial Interventions
Psychosocial interventions can help individuals cope with symptoms of delusions or hallucinations, addressing things like the negative symptoms of schizophrenia. The most common involve art therapy, family therapy, and cognitive behavioral therapy, all three of which are more effective when combined with antipsychotic medications.
Long-Term Management
At present, schizophrenia does not have a cure, and as such, long-term management focuses on helping individuals live with symptoms, manage the condition, and cope with the effects that occasional relapses can have on daily life. This includes healthy living strategies for good diet and exercise, taking medication as prescribed, and reporting any changes in symptom development.
Challenges in Treatment Adherence and Management
There are some challenges when it comes to treatment adherence and management for BPD vs. schizophrenia.
For BPD:
Some of the biggest challenges for borderline personality disorder have to do with emotional dysregulation. Emotional dysregulation can complicate adherence to treatment plans as individuals may not feel obliged to follow certain regimens based on issues with mood.
For Schizophrenia:
For schizophrenia, the challenges namely have to do with cognitive impairment and lack of insight into the condition. When individuals don’t have good insight into their condition, that can impact treatment adherence as they may see no need to follow certain rules or take medication.
Conclusion
If you are struggling with symptoms of borderline personality disorder vs. schizophrenia or you see schizophrenia vs. BPD symptoms in another person, it’s important to get an accurate diagnosis from a qualified psychiatrist. With an accurate diagnosis, you can start to develop an individualized treatment approach. What matters most is continuing to learn more about schizophrenia vs. borderline personality disorder and advocating for improved outcomes for individuals with both.