Psychotic symptoms in adolescents with borderline personality disorder features

  • Katherine N. Thompson
  • Marialuisa Cavelti
  • Andrew M. Chanen
Original Contribution


Psychotic symptoms have been found to be relatively common among adults with borderline personality disorder (BPD), and to be a marker of BPD severity, but are not recognised in daily clinical practice in these patients. This study is the first to examine the prevalence of psychotic symptoms in 15–18-year olds with BPD features. It was hypothesised that adolescents with full-threshold BPD would have significantly more psychotic symptoms than adolescents with sub-threshold BPD features, and that both these groups would have significantly more psychotic symptoms than adolescents with no BPD features. A total of 171 psychiatric outpatients, aged 15–18 years, were assessed using a structured interview for DSM-IV personality disorder and categorised into three groups: no BPD features (n = 48), sub-threshold BPD features (n = 80), and full-threshold BPD (n = 43). The groups were compared on measures of psychopathology and functioning (e.g. Youth Self Report, Symptom Check List-90-R, SOFAS). Adolescents with full-threshold BPD reported more psychotic symptoms than the sub-threshold BPD group (p < .001), and both these groups reported more psychotic symptoms than those with no BPD features (p < .001). Adolescents with full-threshold BPD reported more confusion (p < .01), paranoia (p < .001), visual hallucinations (p < .001) and strange thoughts (p < .01), than the other two groups. Psychotic symptoms predicted group membership, determined by BPD severity, after adjusting for other psychopathology and functional impairment (p < .01). Assessment of unusual perceptual experiences, paranoia or odd thoughts is highly clinically relevant in adolescents with BPD features, as these symptoms are associated with a more severe clinical presentation of BPD.


Adolescence Borderline personality disorder Psychosis Hallucinations Paranoia 



Dr. Marialuisa Cavelti is supported by the Swiss National Science Foundation, and the Gottfried and Julia Bangerter-Rhyner-Foundation.


Funding was received for Dr Marialuisa Cavelti as stated in the acknowledgements.

Compliance with ethical standards

Conflict of interest

All Authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Barnow S, Arens EA, Sieswerda S et al (2010) Borderline personality disorder and psychosis: a review. Curr Psychiatry Rep 12:186–195CrossRefPubMedGoogle Scholar
  2. 2.
    Slotema CW, Daalman K, Blom JD et al (2012) Auditory verbal hallucinations in patients with borderline personality disorder are similar to those in schizophrenia. Psychol Med 42:1–6CrossRefGoogle Scholar
  3. 3.
    Chanen AM, Sharp C, Hoffman P, Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (2017) Prevention and early intervention for borderline personality disorder: a novel public health priority. World Psychiatry 16:215–216. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chanen AM, McCutcheon L (2013) Prevention and early intervention for borderline personality disorder: current status and recent evidence. Br J Psychiatry Suppl 54:s24–s29CrossRefPubMedGoogle Scholar
  5. 5.
    Sharp C, Fonagy P (2015) Practitioner review: borderline personality disorder in adolescence–recent conceptualization, intervention, and implications for clinical practice. J Child Psychol Psychiatry 56:1266–1288CrossRefPubMedGoogle Scholar
  6. 6.
    Tschoeke S, Steinert T, Flammer E, Uhlmann C (2014) Similarities and differences in borderline personality disorder and schizophrenia with voice hearing. J Nerv Ment Dis 202:544–549. CrossRefPubMedGoogle Scholar
  7. 7.
    Hepworth CR, Ashcroft K, Kingdon D (2013) Auditory hallucinations: a comparison of beliefs about voices in individuals with schizophrenia and borderline personality disorder. Clin Psychol Psychother 20:239–245CrossRefPubMedGoogle Scholar
  8. 8.
    Kingdon DG, Ashcroft K, Bhandari B et al (2010) Schizophrenia and borderline personality disorder: similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma. J Nerv Ment Dis 198:399–403CrossRefPubMedGoogle Scholar
  9. 9.
    Pearse LJ, Dibben C, Ziauddeen H et al (2014) A study of psychotic symptoms in borderline personality disorder. J Nerv Ment Dis 202:368–371CrossRefPubMedGoogle Scholar
  10. 10.
    Slotema CW, Niemantsverdriet MBA, Blom JD et al (2017) Suicidality and hospitalisation in patients with borderline personality disorder who experience auditory verbal hallucinations. Eur Psychiatry 41:47–52. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Yee L, Yee L, Korner AJ et al (2005) Persistent hallucinosis in borderline personality disorder. Compr Psychiatry 46:147–154. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Niemantsverdriet MBA, Slotema CW, Blom JD et al (2017) Hallucinations in borderline personality disorder: prevalence, characteristics and associations with comorbid symptoms and disorders. Sci Rep 7:13920. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Zanarini MC, Frankenburg FR, Wedig MM, Fitzmaurice GM (2013) Cognitive experiences reported by patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry 170:671–679. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kelleher I, Devlin N, Wigman JTW et al (2014) Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning. Psychol Med 44:1615–1624. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kelleher I, Keeley H, Corcoran P et al (2012) Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. Br J Psychiatry 201:26–32CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kelleher I, Connor D, Clarke MC et al (2012) Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychol Med 42:1857–1863CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kelleher I, Lynch F, Harley M et al (2012) Psychotic symptoms in adolescence index risk for suicidal behavior: findings from two population-based case-control clinical interview studies. Arch Gen Psychiatry 69:1277–1283. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Thompson A, Nelson B, Bechdolf A et al (2012) Borderline personality features and development of psychosis in an “Ultra High Risk” (UHR) population: a case control study. Early Interv Psychiatry 6:247–255. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Chanen AM, Jovev M, Jackson HJ (2007) Adaptive functioning and psychiatric symptoms in adolescents with borderline personality disorder. J Clin Psychiatry 68:297–306CrossRefGoogle Scholar
  20. 20.
    Chanen AM, Jackson HJ, McGorry PD et al (2004) 2-year stability of personality disorder in older adolescent outpatients. J Pers Disord 18:526–541. CrossRefPubMedGoogle Scholar
  21. 21.
    Chanen AM, Jovev M, Djaja D et al (2008) Screening for borderline personality disorder in outpatient youth. J Pers Disord 22:353–364. CrossRefPubMedGoogle Scholar
  22. 22.
    Goldman HH, Skodol AE, Lave TR (1992) Revising axis V for DSM-IV: a review of measures of social functioning. Am J Psychiatry 149:1148–1156. CrossRefPubMedGoogle Scholar
  23. 23.
    Achenbach TM (1991) Manual for the youth self-report and 1991 profile. VT University of Vermont Department of Psychiatry, BurlingtonGoogle Scholar
  24. 24.
    Achenbach TM (1997) Manual for the young adult self-report and young adult behavior checklist. Department of Psychiatry, University of Vermont, BurlingtonGoogle Scholar
  25. 25.
    Wigman JTW, van Winkel R, Raaijmakers QAW et al (2011) Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study. Psychol Med 41:2317–2329. CrossRefPubMedGoogle Scholar
  26. 26.
    Griffith-Lendering MFH, Wigman JTW, Prince van Leeuwen A et al (2013) Cannabis use and vulnerability for psychosis in early adolescence–a TRAILS study. Addiction 108:733–740. CrossRefPubMedGoogle Scholar
  27. 27.
    Welham J, Scott J, Williams G et al (2009) Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study. Psychol Med 39:625–634CrossRefPubMedGoogle Scholar
  28. 28.
    Dhossche D, Ferdinand R, Van der Ende J et al (2002) Diagnostic outcome of self-reported hallucinations in a community sample of adolescents. Psychol Med 32:619–627CrossRefPubMedGoogle Scholar
  29. 29.
    Derogatis LR (1992) SCL-90-R: Administration, scoring and procedures manual for the revised version and other instruments of the psychopathology rating scale series, 2nd edn. MD Clinical Psychometric Research, TowsonGoogle Scholar
  30. 30.
    Thompson KN, Jackson HJ, Cavelti M et al (2018) The clinical significance of subthreshold borderline personality disorder features in outpatient youth. J Pers Disord 32:1–11CrossRefGoogle Scholar
  31. 31.
    Kelleher I, Wigman JTW, Harley M et al (2015) Psychotic experiences in the population: association with functioning and mental distress. Schizophr Res 165:9–14. CrossRefPubMedGoogle Scholar
  32. 32.
    Martin G, Thomas H, Andrews T et al (2015) Psychotic experiences and psychological distress predict contemporaneous and future non-suicidal self-injury and suicide attempts in a sample of Australian school-based adolescents. Psychol Med 45:429–437. CrossRefPubMedGoogle Scholar
  33. 33.
    Wigman JTW, Devlin N, Kelleher I et al (2014) Psychotic symptoms, functioning and coping in adolescents with mental illness. BMC Psychiatry 14:97. CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    McGrath JJ, Saha S, Al-Hamzawi A et al (2016) The bidirectional associations between psychotic experiences and DSM-IV mental disorders. Am J Psychiatry 173:997–1006. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Gleeson JFM, Chanen A, Cotton S et al (2012) Treating co-occurring first-episode psychosis and borderline personality: a pilot randomized controlled trial. Early Intervention Psychiatry 6:21–29CrossRefGoogle Scholar
  36. 36.
    France SM, Jovev M, Phassouliotis C (2017) Does co-occurring borderline personality disorder influence acute phase treatment for first-episode psychosis? Early Intervention Psychiatry. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleAustralia
  2. 2.Centre for Youth Mental HealthUniversity of MelbourneMelbourneAustralia
  3. 3.Orygen Youth HealthMelbourneAustralia
  4. 4.Translational Research Centre, University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland

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