AAPEL
bpd and schizophrenia.
what we call "madness" in everyday language

Introduction:

Borderline personality and schizophrenia. In fact, I did not find a lot of studies on the subject. Why ? Certainly because BPD and schizophrenia are two different disorders. You will find on the last part of this document our vision which we hope comprehensive and listening to the suffering
Meme page en Francais / Same page in french
Presentation of the disorder
Data, studies
What they say ?
Aapel view

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Presentation of the disorder (from DSM IV)

Psychosis:
where the individual "loses touch with reality." Hallucinations and delusions are generally considered psychotic symptoms. The individual experiencing them may be described as psychotic.

Schizophrenia:
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): (only one if "high" hallucinations or delusions)

(1) delusions (false belief)
(2) hallucinations
(3) disorganized speech (e.g., frequent derailment or incoherence)
(4) grossly disorganized or catatonic (excessive, but purposeless movement) behavior
(5) negative symptoms, i.e., absence of affective expression, mutism, or avolition (Absence of initiative)
B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset...

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective (criteria A during depressive or manic episode) and Mood Disorder (eg bipolar) exclusion: .

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: (additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month).

Classification of longitudinal course (can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms):
Episodic With Interepisode Residual Symptoms (episodes are defined by the reemergence of prominent psychotic symptoms); also specify if: With Prominent Negative Symptoms
Episodic With No Interepisode Residual Symptoms
Continuous (prominent psychotic symptoms are present throughout the period of observation)...
Single Episode In Partial Remission
Single Episode In Full Remission
Other or Unspecified Pattern

Delusional Disorder (false belief) (was named as "paranoid disorder")
A. Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month's duration.

B. Criterion A for Schizophrenia has never been met. Note: Tactile and olfactory hallucinations may be present in Delusional Disorder if they are related to the delusional theme.

C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.

D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.

E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type (the following types are assigned based on the predominant delusional theme):
Erotomanic: delusions that another person, usually of higher status, is in love with the individual
Grandiose: delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person
Jealous: delusions that the individual's sexual partner is unfaithful
Persecutory: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way
Somatic: delusions that the person has some physical defect or general medical condition
Mixed: delusions characteristic of more than one of the above types but no one theme predominates

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Data, studies (statistics, prevalence, comorbidity, co-occurency)
* Fenton WS, McGlashan TH. - Chestnut Lodge Research Institute, Rockville, MD
1989 Am J Psychiatry. - Risk of schizophrenia in character disordered patients.
Inpatients ...  with character disorder were studied to predict future schizophrenic decompensation. Individually, three DSM-III criteria for schizotypal personality disorder predicted schizophrenia at long-term follow-up: magical thinking, suspiciousness or paranoid ideation, and social isolation. Additionally, lower IQ, poorer premorbid quality of work, and transient delusional experiences were predictive. No borderline personality disorder criterion was predictive. This suggests that schizotypal but not borderline personality disorder belongs in the schizophrenic spectrum. Within schizotypal personality disorder, criteria from both familial and clinical traditions appear to be dimensions of vulnerability to psychosis.

* Miller FT, Abrams T, Dulit R, Fyer M. - Cornell University Medical College
1993 Hosp Community Psychiatry. - Psychotic symptoms in patients with borderline personality disorder and concurrent axis I disorder.
OBJECTIVE: Whether psychotic symptoms are part of the fundamental psychopathology of borderline personality disorder remains in dispute. The goal of the study was to examine the incidence and nature of psychotic symptoms in a sample of patients with the disorder. METHODS: The inpatient psychiatric records of 92 patients with a discharge diagnosis of borderline personality disorder, some of whom had comorbid affective disorder or substance abuse disorder, were examined to obtain data on the presence of psychotic symptoms (narrowly defined as delusions and auditory and visual hallucinations), the duration of psychotic episodes, and the clinical characteristics of the patients. RESULTS: Twenty-seven (27%) percent of the patients had psychotic episodes, typically lasting many weeks. Comorbid affective or substance abuse disorders did not predict psychotic symptoms.
CONCLUSIONS: Psychotic episodes are common but not universal among patients with borderline personality disorder, regardless of whether a concurrent axis I disorder is present. Those episodes are not necessarily brief or transient, and borderline patients who experience psychotic episodes are likely to have repeated hospitalizations.

* Links PS, Steiner M, Mitton J.- Dept of Psychiatry, McMaster University, Hamilton, Ont., Canada.
1989 Psychopathology. - Characteristics of psychosis in borderline personality disorder.
Comparing a sample of 88 inpatients with borderline personality disorder (BPD) to inpatients with borderline traits, this paper addresses four hypotheses regarding the association between BPD and psychotic symptoms:
(1) narrowly defined psychotic symptoms are rare in BPD;
(2) broadly defined psychotic symptoms are often reported in BPD;
(3) narrowly defined psychotic symptoms are due to concomitant disorders
(4) psychotic symptoms may be factitious.
Consecutive admissions to acute inpatient services were screened for borderline features and patients were examined using the Diagnostic Interview for Borderlines and the Schedule for Affective Disorders and Schizophrenia. The results generally supported the proposed explanations for the association between BPD and psychotic symptoms. Factitious psychotic symptoms were found in only 13% of the BPD sample.

* Isohanni I, Jarvelin MR, Jones P,... - Oulu Polytechnic, Finland.
1999 Acta Psychiatr Scand. - Can excellent school performance be a precursor of schizophrenia? A 28-year follow-up in the Northern Finland.
Conclusion: However, adult schizophrenia may be linked to excellent school performance.

* McAllister TW. - Dartmouth Hitchcock Medical Center, Lebanon, NH
1998 Semin Clin Neuropsychiatry. - Traumatic Brain Injury and Psychosis: What Is the Connection?
Psychotic syndromes occur more frequently in individuals who have had a traumatic brain injury (TBI) than in the general population.

* Chabrol H, Chouicha K, Montovany A...
2001 Encephale - Symptoms of DSM IV borderline personality disorder in a nonclinical population of adolescents: study of a series of 35 patients.
Symptoms of the borderline disorder in 107 students between 15 and 18 years 32% have a borderline disorder DSM IV
"The high incidence of paranoid ideation (97.1%) and dissociative experiences (65.7%) in the borderline group suggests the pertinence of criterion 9 in the diagnosis of borderline personality disorder in adolescents... Moreover, 31.4% of the borderline group reported transient "quasi" psychotic experiences, mainly "quasi" visual hallucinations. Auditory hallucinations or delusional ideas were not observed. This symptomatology suggests a "quasi" psychotic dimension of adolescent borderline personality disorder..."


BPD and schizophrenia, what they say
"The term borderline comes from thinking by psychiatrists in the 1940s and 1950s that the disorder bordered on and shared features of psychotic and neurotic disorders. But that view doesn't reflect current thinking" (Mayo Foundation for Medical Education and Research ,"Borderline personality disorder", www.mayoclinic.com 2OO2)

"borderline personality disorder (BPD) does not develop into schizophrenia. Ocasionally, someone with severe BPD can have brief periods of some symptoms which are similar to some of those experienced in schizophrenia but this is the only similarity" (Dr Margaret Honeyman,"Does a personality disorder lead to schizophrenia?", 27/05/2OO2)

"Bpd: There is no association with Schizophrenia" (Leland M. Heller, MD, “Dr leland heller discusses BPD - schizophrenia”, www.biologicalunhappiness.com)

"Schizophrenia is Not 'Split Personality'. There is a common misconception that schizophrenia is the same as a 'split personality'  such as a Dr. Jekyll-Mr. Hyde switch in character.
Another related  misconception is that schizophrenia results in several different personalities, and the individual switches between these different personas.
These perceptions are not correct. Such characterizations could be a part of several other possible mental disorders, such as Multiple Personality Disorder, Borderline Personality Disorder or Bi-polar Disorder, but only if other specific symptoms are also present. These symptoms are not descriptive of schizophrenia" (Donald J. Franklin Ph.D,"Schizophrenia information and treatment", Psychology Information Online)

"While schizophrenic and dissociative features are similar and related, Schizophrenia and Dissociation are two different things...and it is _dissociation_, not schizophrenia, that is most common associated with BPD. Finally, the confusion over the association of dissociation (forgive the play on words) and BPD is most often generated by the "black-and-white" temperament that BPs tend to present. It is, technically speaking, a "splitting", but it is a splitting of a much different sort than that suggested by schizophrenia or dissociation...the former being psycho-social, the latter being organic." (Tim and Andrea Pheil,”Relationship Between BPD, MPD, DID and Schizophrenia”, mhsanctuary)

"Compared to the psychosis seen in schizophrenia or bipolar disorder, the psychosis seen in borderline patients is usually tied to a stressor, often serves some secondary gain for the patient, often starts and stops quickly, and is described by the patient without much anxiety" (Luciano Anthony Picchio M.D, "Understanding And Working With Borderline Personality Disorder", Dauphin County RADAR Network Center)

"Paranoid personality disorders is sometimes a precursor of schizophrenia or delusional disorder" (Alex Buckley and Nicola Davies,"Paranoid Personality Disorder",psychhelp)

"Schizotypal disorder, a condition genetically related to and a possible precursor of schizophrenia" (Journal of the American Academy of Child and Adolescent Psychiatry dec 2001)


Aapel view of Schizophrenia and Borderline Personality Disorder
Here is our feeling.

What is schizophrenia ?
A mental illness where the individual has psychotic symptom, when he "loses touch with reality"

What is a delusional Disorder ?
A mental illness where the individual has psychotic symptom with false belief. The subject is resistant to every argument: It is then impossible to think logically with him / her, even confronted with tangible proofs, he or she continue to firmly maintain it.

Are BPD, schizophrenia and delusional disorder 3 entities ?
Obviously yes

Is it possible to have both borderline and schizophrenic disorder or borderline and delusional disorder ?
Probably yes

Do some BPD people have psychotics symptom ?
It is possible but not necessary.  In case of BPD it is probably better to speak about dissociation and not about "real" psychotic symptom. The Dsm criteria of BPD talk about "severe dissociative symptoms" and not about psychotic symptom.

Does borderline lead to schizophrenia, to what we call "madness" ?
No !
Some studies says that there is some link with schizotypal, paranoid personality disorders, excellent school result, autism, mental retardation, traumatic brain Injury, and of course genetics, etc ... but not with borderline disorder.

What about prevalence and suicide of each disorder ?
The BPD prevalence is about twice the schizophrenia prevalence.
And about suicide rate, it is the same rate, one in ten

Please read Bpd and dissociation, Bpd and splitting, BPD data

 

AAPEL - Back to BPD summary page
 

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Warning:
All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
But more especially, to support everyone affected by it, sick or not.  In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
The name of what you’ve got doesn’t matter so much, getting the right treatment for the right patient does
 

last update  2008
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Author, Alain Tortosa, psychotherapist, founder president of the Aapel
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