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.
This is a preview of subscription content, log in to check access.
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.
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.
Barnow S, Arens EA, Sieswerda S et al (2010) Borderline personality disorder and psychosis: a review. Curr Psychiatry Rep 12:186–195CrossRefPubMedGoogle Scholar
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
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
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
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
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
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
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
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
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
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
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