The BPD-Psychosis Connection And Mental Health
When you think of borderline personality disorder (BPD), hallucinations and delusions might not be the first things that come to mind. However, a growing body of research suggests that BPD may trigger psychotic symptoms like these more often than one might think. Individuals with borderline personality disorder, psychosis, or both may benefit from seeking therapy to manage their symptoms.
What is borderline personality disorder?
Borderline personality disorder (BPD) is a disorder that can significantly affect the ways people think, feel, and behave. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), BPD falls into the category of “cluster B” disorders. Other disorders in this category include the following:
- Antisocial personality disorder
- Narcissistic personality disorder
- Histrionic personality disorder
Symptoms of borderline personality disorder
Borderline personality disorder usually makes it hard for people to manage their emotions, and this can severely affect their self-image. People with BPD often struggle with an intense fear of rejection. They also tend to have trouble controlling their impulses, which can lead to challenges at work and in relationships. Symptoms of BPD may include those listed below:
- Extreme mood swings
- Frequent feelings of detachment or emptiness
- An unstable sense of self
- An extreme fear of abandonment
- Impulsive or reckless behaviors, such as unsafe sex or binge shopping
- Trouble managing anger
- Thoughts of suicide
Causes of borderline personality disorder
It’s thought that a combination of genetics and life experiences, such as trauma or childhood abandonment, may make a person more likely to develop BPD.
Co-occurring disorders with BPD
Borderline personality disorder often occurs alongside other psychiatric disorders, such as depression and anxiety.
BPD can also be associated with post-traumatic stress disorder.
Understanding psychosis
Psychosis can be defined as a mental state in which a person loses track of reality. When a person is in a state of psychosis (sometimes called a “psychotic episode”), they might experience things that aren’t real, struggle to think clearly, and act unpredictably. This can be distressing and confusing.
Symptoms of psychosis
Symptoms of psychosis can look different from person to person. However, they tend to take a few main forms.
Changes in thinking, speech, and behavior: People having psychotic episodes often seem different than their usual selves. They may withdraw socially, stop showing emotions, or stop taking care of themselves. They may also mix up words, repeat themselves, or drift off-topic when speaking. These changes in speaking patterns tend to reflect changes in their ways of thinking.
Hallucinations: Hallucinating can be thought of as perceiving something that isn’t there. For example, when people in psychosis hear voices that aren’t real, these are typically called auditory verbal hallucinations. It’s also possible to see images, shapes, and colors when in psychosis. These are normally called visual hallucinations. Some people may also hallucinate tastes, smells, and physical sensations.
Delusions: Delusions can be defined as untrue beliefs. When a person is having a delusion, it is often impossible to talk them out of it with facts or logic. People in psychosis may develop a wide range of delusions. Some common examples include believing that others are conspiring against them, that they are a religious figure, or that their thoughts are being implanted in their mind.
Causes of psychosis
Several mental illnesses may lead to psychosis. Schizophrenia spectrum disorders, such as schizophrenia and brief psychotic disorder, can serve as common examples. Other mental illnesses, like bipolar disorder and depression, may also trigger psychosis. However, these aren’t the only possible causes. Psychotic symptoms may also be brought on by the following:
- Posttraumatic stress disorder
- Alzheimer’s disease
- Substance or alcohol use
- Epilepsy
- Stroke
- Some medications
Low blood sugar, head injuries, extreme stress, and certain sexually transmitted infections can also cause psychosis in some people.
A closer look at the BPD psychosis connection
Although BPD is usually associated with emotional and relationship challenges, psychotic symptoms can also occur. In a 2022 study, researchers compared the experiences of 89 patients with BPD or a schizophrenia spectrum disorder. Those with BPD usually reported higher rates of paranoia and suspicion than those in the schizophrenia group.
High prevalence of psychotic symptoms and comorbidity in BPD patients
Researchers also found that, among those with BPD:
- 81% reported seeing or feeling things that weren’t there
- 74% reported smelling things that weren’t there
- 94% experienced delusions
Furthermore, it can be possible to have both BPD and a separate psychotic disorder. In a different study from 2018, researchers performed psychiatric interviews on 84 women with BPD. They found that approximately 38% of them met the criteria for comorbid psychotic disorders.
BPD psychosis connection: Theoretical links and overlaps
Studies like these suggest that there may be a link between psychosis and BPD. It’s possible that there may be an overlap in the ways these two disorders develop. Trauma and hardship in childhood are often factors in developing BPD, and research has found that childhood trauma may also be associated with developing psychosis. That said, there’s still a lot we don’t know about this link. The prevalence and clinical management of BPD with psychosis is still being researched.
Getting help for BPD and psychosis
Living with either BPD, psychosis, or both can be challenging. However, these conditions are often treatable.
Treatment for psychosis and related symptoms
According to the Yale School of Medicine, people often fully recover from psychotic episodes, and with proper treatment, as many as 25% will never have another one. Your doctor may recommend antipsychotic medications, community support programs, or other treatments to manage symptoms of psychosis.
Treatment for borderline personality disorder and mental health
The National Health Service (NHS) reports that BPD, too, can often be treated, with many people overcoming their symptoms. Treatment for BPD often includes therapy, which may help people learn to regulate their emotions, control urges, and change unhelpful thought patterns.
The role of therapy
Having ongoing mental health support through therapy may also be useful for managing stress, which may be a trigger for psychosis in people who are vulnerable to it.
Benefits of online therapy for BPD and mental health
Living with BPD can make relationships more challenging. Having a therapist with whom you connect may make it easier to form a trusting, sustainable therapeutic relationship. However, sometimes it can take trial and error to find a therapist who’s the right fit for you. With online therapy platforms, you may change therapists at any time for no additional charge.
Research shows that online therapy may benefit people with BPD. In a 2022 review, researchers looked at data from 11 studies of virtual therapy for people with personality disorders, including BPD. Several studies found that online therapy could significantly improve symptoms of BPD.
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