“Borderline Schizophrenia” is not an already established diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition as Schizophrenia Spectrum and other Psychotic Disorders are.
This term is used for an individual who partially but not completely meets the criterion for schizophrenia and has symptoms which are the characteristics of borderline personality disorder. In this article, we will discuss Borderline Schizophrenia.
What is Borderline Schizophrenia?
Borderline Schizophrenia is a chronic disorder which is closely associated with schizophrenia and borderline personality disorder not only in symptomatology but also it has a close genetic relationship with schizophrenia.
The term “schizotypal personality” is sometimes used as an alternative for borderline schizophrenia, but because of its strong genetic relationship with schizophrenia, the term borderline schizophrenia is the preferred.
A vast body of research has been conducted on both schizophrenia and BPD.
A recent research was conducted to compare differences and similarities in symptoms and prior experiences of schizophrenia, borderline personality disorder and borderline schizophrenia.
A total of 111 took part in the study out of which 59 suffered from schizophrenia, 33 from BPD and 29 had symptoms of both schizophrenia and borderline personality disorder.
The results of the study showed that the groups did share some symptoms of their perception of audio hallucinations but differed in the frequency of these symptoms.
Those with a BPD diagnosis reported more cases of childhood abuse and trauma than the group with only a schizophrenia diagnosis.
Schizophrenia is a psychological disorder characterized by having delusions, hallucinations, thought disorder, disorganized speech, catatonic movements, and negative symptoms including blunted affect, lack of motivation etc. It is estimated to affect approximately 1% of the US population. In American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V) schizophrenia is placed in the chapter called Schizophrenia Spectrum and other Psychotic Disorders and a patient to be diagnosed with schizophrenia must at least have the psychotic symptoms for 6 months. Although schizophrenia is a challenging disorder but with the right therapeutic interventions, it can be improved or in some cases completely cured.
Borderline Personality Disorder
Borderline personality disorder is a psychological disorder that affects the way an individual think and feels about him and others, resulting in the problems related to daily functioning in life. It includes issues related to self-image and self-esteem, difficulty in regulating emotions and controlling behavior, and problems in forming stable relationships. With borderline personality disorder, a person has to suffer from intense fear of abandonment or instability, and finds it extremely difficult to be alone. People suffering from borderline personality disorder have issues, they are impulsive and have frequent mood swings which may push others away, even though they want to have loving, stable and loving relationships. Borderline personality disorder usually begins by early adulthood. The condition seems to be worse in young adulthood and may gradually get better with age. There are many psychological treatments which help in reducing or curing the disorder.
Prevalence of Borderline Schizophrenia
Since borderline schizophrenia is not an established term in DSM V, its prevalence rate is hard to calculate, however the statistics of borderline personality disorder and schizophrenia are shared here. Borderline personality disorder (BPD) is common in both the general population and in clinical settings. It is estimated that the point prevalence of BPD is 1.6 percent and the lifetime prevalence is 5.9 percent. Studies in clinical settings found BPD was present in 6.4 percent. One the other hand, about 1 percent of the world population suffers from schizophrenia.
Symptoms of Borderline Schizophrenia:
As borderline schizophrenia is not an established diagnosis, it is sometimes hard to define the exact symptoms. Following are the symptoms of borderline schizophrenia.
- Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (e.g., blunted effect, lack of motivation etc.,)
In addition to these, following symptoms of BPD also exist.
- An extreme fear of abandonment, taking extreme measures to avoid real or imagined separation or rejection.
- Unstable intense relationships, for instance liking someone one moment and then suddenly believing the person doesn’t like you or is cruel.
- Sudden changes in self-identity, self-image and self-esteem which includes changing goals and values, and viewing yourself as not enough and worthy or as if you don’t exist at all.
- Prolonged periods of stress-related paranoia and loss of contact with reality, varying from a few minutes to a few hours.
- BPD patients also exhibit suicidal ideation, give threats and display behavior of self-harm often in response to fear of separation or rejection.
- Extreme mood swings ranging from periods of intense happiness, irritability, shame or anxiety lasting from a few minutes to many days.
- Patients of BPD also display anger related issues such as inappropriate, intense anger, resulting in frequently losing temper, being sarcastic or bitter, or having physical fights.
If any two symptoms of schizophrenia are accompanied by the symptoms of Borderline Personality Disorder, persist for a month then the patient will be diagnosed as borderline schizophrenic.
These symptoms cause some impairment in level of functioning for example problems in professional and personal life which is causing significant distress for a particular period of time and this disturbance is not caused by any drug or some other medical condition. A person will also be diagnosed bipolar schizophrenia if other disorders such as schizoaffective and depressive or bipolar disorder with psychotic features have been ruled out.
Borderline Schizophrenia Diagnosis
Borderline schizophrenia is diagnosed based on a:
- Detailed clinical interview with doctor or mental health professional
- Psychological assessment that includes self-report questionnaires.
- Medical history
- Discussion of patient’s signs and symptoms
- Information provided by family, friends and coworkers.
Usually the diagnosis of borderline schizophrenia is not made in children or teenagers because the symptoms usually fade away as they grow older. In adults however such a diagnosis is made when the symptoms of schizophrenia and borderline personality disorder co-occur but are not severe enough to be diagnosed as either schizophrenia or BPD.
Treatment of Borderline Schizophrenia:
Borderline schizophrenia is usually treated using psychotherapy, but in some cases the use of medication may become necessary. In some extreme cases, a patient might get hospitalized. Psychotherapy can help the patient learn new skills to manage and cope with his/her condition. With treatment, one can feel better about yourself and live a more stable, rewarding life.
Psychotherapy also sometimes called talk therapy (usually in psychodynamic school of thought is one of the basis treatment approaches for borderline schizophrenia. The therapists often use techniques which are best suited to clients’ needs and conditions. The common goals of psychotherapy are to:
- Evaluate the current level of functioning
- Help the client to identify the causes of distress
- Help the client to identify the faulty cognitions
- Learn to manage emotions that feel uncomfortable
- Help client in reducing impulsiveness by observing feelings rather than acting on them
- Work on improving relationships by being aware of feelings and those of others
Types of psychotherapy that have been found to be effective in treating borderline schizophrenia include;
Dialectical behavior therapy (DBT).
DBT is an important psychotherapy designed specifically to treat symptoms of BPD. Both individual or group sessions are used to help the client in eliminating the symptoms. DBT focuses on teaching skill based approaches to teach the clients about how to manage their emotions, tolerate distress and improve relationships.
Schema-focused therapy can be done individually or in a group to treat borderline schizophrenia and focuses on changing the negative schemas into the positive ones. It helps the client to identify unmet needs that have led to negative life patterns, which at some time may have been helpful for survival but now cause distress in daily life. Therapy focuses on helping the client to get the needs met in a healthy manner to promote positive life patterns.
Mentalization-based therapy (MBT).
MBT is a type of talk therapy that helps the client identify their emotions, and thoughts at any given time and create an alternate perspective on the situation. MBT stresses on thinking before reacting. It is also very helpful with people having symptoms of schizophrenia.
Systems training for emotional predictability and problem-solving (STEPPS).
STEPPS is a 20-week treatment program which is conducted in groups of family members, caregivers, friends or significant others. STEPPS is often used in CBT.
Cognitive Behavioral Therapy
CBT for schizophrenia includes the formation of collaborative therapeutic alliances between the therapist and the client. The alliance is established by understanding the problem, setting short term and long-term goals and teaching the person techniques or strategies to reduce or manage their symptoms. Cognitive behavioral Therapy is usually conducted in individual sessions and consists of 8-12 weeks of weekly sessions for borderline schizophrenia and the goal is to either eliminate or reduce the degree of symptoms, decrease the daily distress and improve the level of daily functioning by teaching the client certain management skills. Specific CBT approaches used include:
- cognitive restructuring,
- behavioral experiments / reality testing,
- coping skills training.
- Behavioral activation
CBT for schizophrenia can focus specifically on psychotic symptoms (i.e. hallucinations or delusional beliefs) but has also been shown to be helpful for addressing depression, anxiety and certain symptoms of personality disorders associated with psychotic symptoms and their impact on the person’s life.
Use of medication sometimes becomes a necessity for the treatment of psychological disorders. Although there is no particular medicine for treating bipolar schizophrenia, certain medications may the patients with symptoms or co-occurring problems such as psychosis, depression, impulsiveness, aggression or anxiety. Medications may include antidepressants, antipsychotics or mood-stabilizing drugs. It’s better to consult a physician about the benefits and side effects of medications.
Hospitalization is usually done when the clients can no longer be treated as an outpatient because of many reasons, few of which are a threat to society, no response to the medicine or suicidal ideation or intent. In such cases patients require 24/7 care and hospitalization is the best alternative.
Recovery takes time
Psychotherapy is effective yet a time taking treatment. Learning to manage your emotions, thoughts and behaviors takes time. Most people improve considerably, but you may always struggle with some symptoms of borderline schizophrenia. Clients may experience times when symptoms are better or worse. But treatment can improve one’s ability to function and help the patients to feel better about themselves.
FAQs about Borderline Schizophrenia
Q1: What are the risk factors of schizophrenia?
Ans: The common risk factors of schizophrenia are
– Genetic causes
– Environmental factors
– Brain structure
Q2: Is Borderline Schizophrenia curable?
Ans: Borderline Schizophrenia is an informal term used for the symptom of both schizophrenia and borderline however the severity in less as compared to schizophrenia. Because of the mild symptoms, with the right medication and psychotherapy it can be cured.
Q3: Which medicine is used to treat schizophrenia?
Ans: Aripiprazole lauroxil is usually used to treat schizophrenia/