Borderline Personality Disorder (BPD) vs. Schizophrenia: What’s the Difference?
Although the two conditions have a few symptoms in common, they have several important differences.
Schizophrenia and borderline personality disorder (BPD) have several symptoms in common. For instance, both schizophrenia and BPD can cause symptoms like psychosis, relationship difficulties, and paranoia. Although these conditions are alike in some ways, there are key differences between them.
“Both can involve psychotic episodes, but in BPD, these are usually short and triggered by stress, while in schizophrenia, they tend to last longer,” says Joel Frank, PsyD, a clinical psychologist and neuropsychologist at Duality Psychological Services in Sherman Oaks, California. They also tend to be more severe in schizophrenia than BPD.
“Treatment for both is a series of attempts to teach appropriate social behaviors and challenge distorted views, with the end goal of living a more fulfilling life with a higher frequency of neurotypical behavior,” says Tirrell De Gannes, PsyD, a licensed clinical psychologist based in New York City. But although similar goals drive treatment for schizophrenia and BPD, the exact approaches differ, which is why it’s important to know the difference.
BPD is a psychiatric condition that makes it hard to regulate emotions, causing intense emotions for long periods. BPD can make you see yourself in a negative light, act impulsively, and create problems in relationships.
Symptoms of BPD may include:
Severe mood swings
Feelings of instability and insecurity
Extreme efforts to avoid real or perceived abandonment
Tumultuous personal relationships
Splitting (swings between strong declarations of love or hate for another person)
Impulsive behavior, like unsafe sex or reckless driving
Periods of severe depression, anxiety, or irritability
Frequently feeling bored or empty
Distorted self-image
Outbursts of anger followed by guilt or shame
Dissociation (disconnecting from your thoughts or having “out of body” experiences)
The most common psychosis symptom in BPD is auditory hallucinations, or hearing sounds or voices that aren’t there.
Schizophrenia is a psychiatric condition that affects how you feel, think, manage emotions, make decisions, and behave. If you have this complex, long-term illness, you may have trouble understanding what’s real and what isn’t.
Hallucinations: Hearing, seeing, smelling, tasting, or feeling things that aren’t present
Delusions: Strong false beliefs that are clearly untrue to everyone else
Disorganized thinking and speech: Thinking or speaking in ways that are jumbled and don’t make sense to others
Disorganized movements: Movements that range from agitation and seemingly purposeless repetitive movements to catatonia (little movement or response to one’s surroundings)
Negative symptoms: Flat facial expression, speaking in a dull voice, little interest in activities or relationships
Some people with schizophrenia don’t know they have it, which can make treatment more difficult. This is a symptom called anosognosia.
As mentioned, BPD and schizophrenia have several overlapping symptoms, including:
Difficulty maintaining close relationships
Feelings of paranoia
Episodes of psychosis
“Borderline personality disorder can consist of extreme emotional distress that appears like paranoia, which is very similar to the paranoia of schizophrenia,” says Ciara Bogdanovic, a licensed marriage and family therapist based in Los Angeles.
But as mentioned, BPD and schizophrenia have distinct differences, says Dr. De Gannes. The core symptoms of BPD center on emotional disturbance, while schizophrenia symptoms come from the disturbance of reality and thought, adds Bogdanovic.
“BPD often involves intense emotions, while schizophrenia can lead to pulling away from others,” Frank adds. “Emotional ups and downs and cognitive challenges are typical in both, though they stem from different causes.”
Although both conditions can lead to fractured relationships, the “why” varies by condition. In schizophrenia, confusion and hallucinations cause the most issues in relationships, says De Gannes. But in BPD, it’s the frequent switch between affection and anger, he adds.
Psychosis in BPD usually arises from extreme stress and is less common and severe than in schizophrenia, notes De Gannes.
BPD and schizophrenia have similar treatment goals: symptom management and appropriate social behavior, says De Gannes. But the approach for each condition is different.
People with BPD are primarily treated with psychotherapy and may take medications for specific symptoms. But to treat schizophrenia, healthcare providers turn to medication first, followed by psychotherapy to support daily functioning, says Frank.
Psychotherapy (talk therapy): Therapies like dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), and psychodynamic psychotherapy can help you learn ways to cope with emotional dysregulation. “The most common evidence-based treatment for BPD is dialectical behavior therapy (DBT),” says Bogdanovic. “Treatment focuses on addressing emotional disturbances including the impulsivity that comes with intense emotions and the behaviors that result from heightened emotions.”
Medication: Although there are no FDA-approved medications specifically for BPD, drugs like mood stabilizers, antidepressants, and antipsychotics can help with mood changes and other individual symptoms.
Hospitalization: During periods of extreme stress, self-harm, or suicidal ideation, hospitalization allows for close supervision to keep you safe.
Support: Family, peer, and group support can help you feel less isolated.
Antipsychotic medication: Medications like aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) can manage symptoms of psychosis, like hallucinations and delusions.
Psychotherapy: CBT, family therapy, or group therapy can help you retrain your thought patterns and cope with stress.
Social skills training: This treatment teaches communication and social interaction strategies to help you participate in daily activities more successfully.
Vocational rehabilitation: This specialized counseling teaches you how to prepare for, find, and keep jobs.
Hospitalization: During periods of crisis or severe symptoms, hospitalization offers a safe space to try new medication and other treatments.
Electroconvulsive therapy (ECT) For those whose symptoms don’t improve with medications, ECT may be an option. Done under anesthesia, this treatment applies small amounts of electricity to the brain. This causes a one- to two-minute therapeutic seizure. After several sessions, many report improved symptoms.
If you have schizophrenia or BPD, you may not always know when it’s time to see a healthcare provider. So it’s important to listen to your support system of family and friends when they suggest it, says De Gannes.
Some common reasons to seek medical help with schizophrenia or BPD include:
Suicidal thoughts
Hallucinations (hearing or seeing things that aren’t there)
Feelings of paranoia
Harmful behaviors
Isolating from others
Lack of personal hygiene
Not making sense while speaking
Trouble thinking clearly
Difficulty with your job, school, or relationships
Impulsive, risky behavior
“The sooner you reach out for help, the better,” says Frank. “Catching things early makes a big difference, and getting the proper support can stop symptoms from getting worse.”
Schizophrenia and BPD have some similar symptoms, like paranoia, psychosis, and trouble maintaining relationships.
BPD symptoms concern emotional dysregulation, whereas schizophrenia symptoms involve disturbances in perception of reality and thoughts.
Both conditions are treated with different types of medications and psychotherapy.
If you or a loved one is experiencing significant distress or having thoughts about suicide and need support, call or text 988 to reach the988 Suicide & Crisis Lifeline, available 24/7. If you need immediate help, call 911.
