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.
Takeaway
What is the link between BPD and psychosis?
The link between personality disorders and psychotic experiences is still under investigation. One condition, schizotypal personality disorder, is characterized by persistent psychotic symptoms like paranoid ideation, distorted thinking, and unusual beliefs that fall outside the realm of reality. Psychotic symptom rating scales are often used to capture the nuance of psychosis in personality disorders, as they often appear different from psychotic phenomena that appear in patients diagnosed with conditions like schizophrenia, schizoaffective disorder, or schizophreniform disorder.
A study exploring schizophrenia spectrum psychopathology in people diagnosed with borderline personality disorder. Each participant underwent a comprehensive psychiatric evaluation that assessed possible psychotic features present in their daily lives. The study found that 67% of the borderline patients included in the study met diagnostic criteria for schizophreniform disorder, now commonly referred to as schizophrenia spectrum disorder (SPD). SPD features symptoms similar to schizophrenia, but episodes are typically shorter with less severe symptoms.
While 67% of participants met the criteria for SPD, 20% met the criteria for schizophrenia, much higher than what the researchers expected. The results of their study indicated a significant link between borderline disorder and psychosis. The psychotic symptoms experienced by those with borderline personality disorder are typically less severe. Those diagnosed with a psychotic spectrum disorder tend to experience more severe hallucinations, delusions, and distorted thinking.
What is an example of a BPD delusion?
Someone with a borderline diagnosis may experience paranoid delusions that, while not as severe as those seen in psychotic spectrum disorder, can substantially impact social relationships. An example of a BPD delusion might be thinking that an innocent comment from a friend was intended as a personal attack or that someone’s neutral tone indicates they are plotting against the person they are speaking to. These delusions are typically referred to as persecutory delusions, which are common in borderline personality disorder.
Mood dysregulation is common in borderline personality disorder and other psychiatric disorders. This often lowers a person's resilience to stress, which may induce stress-related paranoid ideation or other psychotic symptoms. If the person also has a comorbid diagnosis, such as post-traumatic spectrum disorder, their delusions may be stronger and more rigid.
What does a BPD psychotic episode look like?
A psychotic episode due to borderline personality disorder (or another personality pathology) typically looks similar to psychotic episodes caused by schizophrenia spectrum disorders but with less severe symptoms. A person experiencing schizotypal symptoms might experience severe hallucinations or delusions that are more extensive than what is found in BPD. Those with BPD often experience many of the positive symptoms associated with psychosis, such as hallucinations, delusions, paranoia and confusion. Auditory hallucinations are the most common type of hallucination in BPD, while persecutory delusions (believing that others are trying to harm them) is the most common delusion. Negative symptoms, such as stunted affect and loss of motivation, can also occur.
What is the average life expectancy of someone with BPD?
Evidence suggests that those with borderline personality disorder have a life expectancy that is, on average, 20 years shorter than the average person. Life expectancy may be shorter if other conditions are present, such as comorbid PTSD. Defining borderline patient’s health risks can be complex and may vary considerably from person to person. In general, the reduced life expectancy of those with BPD is due to cardiovascular health problems caused by a lack of self-care. Those with BPD are more likely to be overweight, lead a sedentary lifestyle, and smoke cigarettes. BPD also raises the risk of self-harm and suicidal ideation. Finally, those with borderline personality disorder are more likely to engage in substance abuse.
What does high-functioning BPD look like?
In general, a high-functioning person with a psychiatric diagnosis or severe mental illness can navigate activities of daily living without significant distress. They can typically function normally at work or school, maintain social relationships, and care for themselves at home. Although someone with BPD might be high-functioning, it does not mean that they do not experience symptoms of their condition. In addition, they might also experience comorbid symptoms from other diagnoses unrelated to BPD. Because borderline personality disorder features can vary from person to person and based on severity, many high-functioning BPD patients may not realize they have the condition without professional assessment.
What are BPD splits?
In borderline personality disorder, “splitting” refers to establishing a framework where a situation can be interpreted in a black-and-white context. This can lead to thought processes that are not consistent with reality. For example, a friend of someone with BPD might give them a small gift or other kind gesture. The person with BPD might then view their friend as completely positive - they are always their friend and always kind to them. The following week, their friend makes an offhanded comment that the person with BPD interpreted as an attack, even though it wasn’t intended to be. The person with BPD then might view their friend as entirely negative - their friend is their enemy based only on the perceived slight.
By interpreting their friend’s actions in a black-and-white context, the person with BPD “splits” them into two distinct individuals - the friend who is kind to them and the enemy who hurts them. Both cannot be true simultaneously, so the person with BPD might oscillate back and forth based on their friend’s recent actions. In contrast, someone with a more flexible interpretation typically understands that a small gift does not indicate undying loyalty, and an offhanded comment does not amount to an attack.
What are strange behaviors of people with BPD?
According to the American Psychiatric Association, the most common unusual behavior associated with BPD is disordered emotional regulation. Common symptoms include difficulty managing emotional expression, increased suspicion and paranoia, and increased risk of psychotic reactivity. Reactive psychosis occurs when a person experiences high levels of stress. Because most people with BPD also struggle with stress management, they are at a greater risk of subsequent psychotic symptoms. They might believe things that are untrue, hear things others cannot, and report difficulty thinking clearly. Cognitive behavioral therapy and medications can often help people with BPD develop skills to regulate their feelings and behavior.
How long does BPD psychosis last?
The duration of a psychotic episode varies based on the underlying condition, its severity, and the episode’s triggers. Most episodes are relatively short and resolve in hours or days, often without treatment. However, severe cases might require intense treatment, especially if the person is diagnosed with a psychotic disorder and comorbid borderline personality disorder. Someone with a comorbid diagnosis might experience more severe hallucinations, delusions, and paranoia than someone diagnosed with BPD alone. Other conditions, such as mood disorders or affective disorders, might also change how BPD’s psychotic features present.
What do people with BPD hallucinate about?
Hallucinations in BPD can be about anything. Those with the condition most commonly experience auditory hallucinations, meaning they hear things that others cannot. Many people report hallucinations that relate to self-hate or paranoia, such as hearing derogatory or insulting comments about their personality or appearance. They might also hear things that indicate they are unlikeable, worthless, or that their friends are actually their enemies.
What are the psychotic features of BPD?
The psychotic features of BPD are similar to what is seen in psychotic disorders, but the symptoms are typically less severe. Evidence suggests that nearly three-quarters of those with BPD meet the criteria for a schizophrenia spectrum disorder. Schizophrenia spectrum psychopathology is complex, and many people with BPD exhibit psychotic symptoms aligned with the schizophrenia spectrum, like hallucinations, delusions, and paranoia.
Some people use the term “borderline schizophrenia” to refer to the psychotic symptoms seen in those with BPD. Because BPD is closely associated with childhood trauma and emotional abuse, more research effort is being put into discovering how traumatic experiences can induce psychotic or semi-psychotic features.
- Previous Article
- Next Article