Is it really schizophrenia?

My 20 year old son was diagnosed with schizophrenia but he is definately not a textbook case. His doctors refuse to reevaluate him even though he is not responding to his medications and therapy. I've read a lot on BPD lately and it sounds so much like
him. What are the differences in the 2 illnesses and is there a chance that a change in diagnosis could help. He is in danger of being kicked out of the mental health authority due to rule breaking and has nowhere else to go. I am bipolar and his coming home is not an option. He has been seen by doctors since the age of 3 and spent from ages 13-17 in residential treatment including state mental hospital. His beliefs are bizarre and his actions even more so. He also refuse to believe he is sick and would rather be known as a junkie and alcoholic than as a mentally ill person. We are really in need of help and are getting nowhere with his doctors.  Thanks

[HFHS MD - RG]

Dear Ginny,

The main difference of these two diagnoses lie on their definition as indicated below. Depending on his presentation at the time of the examination combined with his personal and family history, a diagnosis is made. It is not uncommon to have two or more diagnoses.

Depending of his level of mental functioning, state institutions have placed patients successfully in group homes and other settings. However, I am not aware that patients are "kicked out" of mental hospitals for "rule breaking".

You may want to seek a second opinion if you feel that your son is not getting the treatment he deserves. But keep in mind that not all medications work for all patients, oftentimes it takes a longer period of time to find a medication and its appropriate dosage that would be effective for some individuals that are not responsive to traditional medications.

Schizophrenia is described as a disturbance that lasts for at least 6 months and includes at least a month of active-phase
symptoms, that is, 2 or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized
behavior, "negative symptoms" like affective flattening (flat emotions), avolition (no motivation), alogia (no speech).

Borderline Personality Disorder. It is a pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity beginning by early adulthood. Persons may feel real or imagined abandonment, have unstable interpersonal relationships,suffer from poor self-image, feel chronically empty and be inappropriately angry and impulsive. Regarding its natural history, the disorder is fairly
stable in that patients with borderline personality may change little over time. Longitudinal studies do not show a progression toward Schizophrenia, but patients do have a high incidence of depressive disorders.