Borderline Personality Disorder (BPD) vs. Schizophrenia: What’s the Difference?

“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.

• 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)
• Stress-related paranoid thoughts
• Psychotic episodes (in times of severe stress)
• Self-harm and suicidal thoughts or attempts

• 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

• 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.

• 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.

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  After several sessions, many report improved symptoms.

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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.

• 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 the 988 Suicide & Crisis Lifeline, available 24/7. If you need immediate help, call 911.