It’s rare for borderline personality disorder (BPD) and schizophrenia to occur together, but it is possible.
Mental health conditions aren’t usually cut-and-dry conditions. It’s common for some people to have multiple mental health conditions that might be connected, such as living with depression and anxiety, or post-traumatic stress disorder (PTSD) and substance use disorder (SUD).
The same is true for some people with schizophrenia and borderline personality disorder (BPD), which can occur together.
To understand what the co-occurring disorders of borderline personality disorder and schizophrenia might look like, it can be helpful to familiarize yourself with what each disorder looks like separately.
And despite the seriousness of each condition, managing symptoms is possible with the right treatment plan.
You won’t find the term “borderline schizophrenia” in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5). It hasn’t been a recognized disorder since 1980.
Borderline schizophrenia — or “pseudoneurotic schizophrenia” — is an outdated term once used interchangeably with “borderline psychosis.” Later on, this was split into the current classifications of schizotypal personality disorder and borderline personality disorder (BPD).
But there are some overlapping symptoms between BPD and schizophrenia.
Can you have BPD and schizophrenia together?
It is possible for someone to have both disorders at the same time, though it is rare. But more research is still needed on the comorbidity of BPD and schizophrenia.
If you or a loved one has both BPD and schizophrenia, learning the similarities and differences of these conditions can be helpful in understanding how they may interact.
Borderline personality disorder (BPD)
BPD is classified in the DSM 5 as a personality disorder, which is generally characterized by:
- rigid thinking
- atypical behavior
- difficulty maintaining stable relationships
Schizophrenia falls within the schizophrenia spectrum class of disorders in the DSM 5.
According to the
Psychosis refers to a severe disconnection from reality. Psychotic episodes include hallucinations or delusions.
Psychosis can occur in both schizophrenia and borderline personality disorder, but psychotic episodes in BPD are, by definition, short, fleeting, and related to stress.
A significant but smaller percentage of people with BPD experience hallucinations than people with schizophrenia. According to research from 2021, an estimated 29% to 50% of people with BPD report hallucinations.
This is compared to an estimated 60% to 80% of people with schizophrenia who report experiencing these symptoms, based on a 2021 review.
And unlike schizophrenia, BPD psychotic episodes are generally
While it’s rare for BPD and schizophrenia to cooccur together, some symptoms may overlap.
Knowing the differences in how each condition’s symptoms can look and feel can be helpful.
Schizophrenia symptoms generally fall under three categories:
- Positive symptoms: this includes psychosis (including hallucinations and delusions), disordered thinking and speech, altered sensations
- Negative symptoms: these symptoms include reduced motivation, difficulty planning, suppressed emotions, social withdrawal
- Cognitive symptoms: this can include trouble withattention or concentration, memory loss, difficulty absorbing information, trouble making decisions
Some of the most common symptoms of borderline personality disorder include:
- sweeping shifts in mood and behavior
- varying perceptions of self and others
- emotional instability, including episodes of anger
- depression and anxiety
- unstable relationships with friends, family, and romantic partners
- feeling a lack of purpose or emptiness
- suicidal ideation
A significant but smaller percentage of people with BPD may also experience:
If you’re considering acting on suicidal thoughts, please seek professional support immediately.
Calling or texting a crisis helpline will connect you with a trained counselor 24/7, any day of the year, completely free of charge:
The causes of both BPD and schizophrenia aren’t entirely clear to experts at this time, and more research is needed. It’s believed that genetics, physiology, and environment all play a role in the development of these conditions.
No single factor is likely to lead to the development of these disorders but rather a complex combination of multiple sources.
Though no single gene has been identified as a cause of BPD or schizophrenia, it’s clear that family history may play a role in their development.
Family members of those with BPD also have a higher chance of developing the condition, according to
But this doesn’t mean that having a family member with one of these conditions guarantees that you will develop it, too.
Experiencing trauma early in life can be a contributing factor to developing BPD.
A 2021 review indicates that up to 90% of people living with BPD experienced childhood trauma, including:
- physical, verbal, or sexual abuse
A different 2021 review suggests that environmental sources may account for between 15% to 40% of the chance of developing schizophrenia, but those sources are believed to be more diverse than those that contribute to BPD.
This may include:
- complications at birth
- certain infections during pregnancy
- season of birth
- social factors, such as migration and living in cities
- adverse childhood experiences (ACEs), like abuse and neglect
- drug use, especially cannabis
Differences in neurotransmitter levels — especially serotonin and dopamine — may impact the development of both schizophrenia and BPD.
And, it’s not just your brain chemicals. Regions of the brain in charge of emotion regulation and impulse control — including the amygdala and hippocampus — may look and function differently in people with BPD.
- language functioning
Working with a doctor or therapist on designing an effective treatment plan can help you manage symptoms.
Treatment plans for both conditions may consist of a combination of:
Finding the best treatment plan for your symptoms can take time. You may have to try multiple strategies before finding what works for you.
Psychotherapy is considered a first-line treatment for BPD and is often used to treat schizophrenia in combination with medication.
Specific types of therapy used for BPD include:
Though research on how well transference-focused therapy performs is mixed.
For those with schizophrenia, therapy may focus more heavily on developing skills for managing everyday life.
Types of therapy commonly used include:
- cognitive behavioral therapy (CBT)
- social skills training
- assertive community treatment
- acceptance and commitment therapy
Currently, there are no FDA-approved medications available to specifically treat BPD. But some people with BPD may have overlapping mental health conditions and may be prescribed medications for those conditions, such as:
For people with schizophrenia, antipsychotic medication is commonly prescribed to help manage hallucinations and delusions, including:
Stress can impact both BPD and schizophrenia, and lifestyle changes centered on self-care can be essential for managing symptoms of these conditions.
Some examples of self-care strategies include:
If you or someone you know is experiencing symptoms of BPD and schizophrenia, you’re not alone. It’s possible to manage the symptoms of these conditions with the right treatment plan.
Consider talking with your doctor or therapist as a first step. Being curious and educating yourself on what these two conditions can look like — as well as possible treatment options — can be a helpful place to start your mental health journey.
If you’re ready to get help but don’t know where to begin, you can check out Psych Central’s hub for finding mental health support.