Borderline schizophrenia

The concept borderline schizophrenia is a term which has lost its meaning. The last published article titled borderline schizophrenia was in 1984. It was often used interchangeably with the term latent schizophrenia. This was developed in a time when the disorder was conceptualised in broad diagnostic terms. This allowed patients who were not severely ill to be included in the diagnostic category of schizophrenia. Today this term has evolved into the diagnostic categories of schizotypal and schizoid personality disorders.

Schizotypal disorder shares many characteristics with schizophrenia. There appears to be a genetic predisposition and there is a higher risk amongst relatives of schizophrenia patients. The hallmark of the diagnosis is extremely strange behaviour and presentation, speech and thinking. They do not usually experience overt episodes of pscyhosis, but may do say briefly when they decompensate under stress. Clinically they have odd beliefs or magical thinking, unusual perceptual experiences, paranoid behaviour, odd, eccentric or peculiar behaviour, there is excessive social anxiety and a lack of close friendships. Apart from these symptoms, schizoptypal disorder is characterised by marked interpersonal and social dysfunction, although some patients do manage to work and marry despite their oddities.

Schizoid personality disorder must also be considered within the concept of borderline schizophrenia. They also experience difficulties in interpersonal relationships, are introverted, and socially withdrawn. They are often seen by others as being aloof. They are differentiated from schizotypal personality disorder by the absence of odd behaviour. Clinically, they lack friends, choose solitary activities, show an emotional detachment, appear indifferent to the praise or criticism of others, don't appear to enjoy being part of a family or enjoy close relationships, and do not appear to take pleasure in any activities. They also have a restricted range of emotions that they express.

Another consideration with borderline schizophrenia is the diagnosis of borderline personality disorder. The borderline which is being referred to is that between neurosis and psychosis. Schizophrenia is viewed as the disintergration of the ego - patients describe their bodies fusing with objects, being taken over and controlled by others. Borderline personality disorder is viewed as having a fragile, thin ego, having to "fuse" with another person to prevent themselves from disintergrating. Thus the conceptual borderline is that fragile ego which is on the verge of disintergrating. Patients with borderline personlity disorder can also suffer from psychotic symptoms. Clinically the patient with borderline disorder presents with unstable moods and behaviour, and little self image (fragile ego).

The characteristic presentation is usually a female with a background of sexual abuse, episodes of depression and anxiety, self harming and repeated suicide attempts, promiscuity and substance abuse. They usually come from highly unstable conflictual personal relationships, are impulsive, have poor self image, feel chronically empty, and have inappropriate hostile outbursts. They may also have transiet psychotic symptoms when under stress. They always appear to be in a constant state of crisis and demonstrate an ambivalence in their relationships with overidealisation followed by devaluation.

Borderline schizophrenia might also be considered under the schizophrenia prodrome.