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Do Borderlines Have Psychotic Episodes?

Despite psychosis not being recognized as a pillar of BPD, psychotic symptoms are key features of Borderline Personality Disorder. Paranoid thinking is a symptom of BPD and can develop into psychosis through trauma or anxiety. Psychosis in someone with BPD is often stress-related, which can manifest as paranoid ideation or dissociative states.

Can BPD cause psychosis?

When someone with BPD is unable to regulate their overwhelming emotions caused by trauma, psychotic episodes may occur. These episodes are particularly common after a breakup because people with BPD often don't know how to cope with the intense emotions that come with being abandoned. Paranoid thinking is a common symptom of BPD and is often seen hand-in-hand with anxiety, which in combination can cause psychotic episodes.

Psychotic episodes from people with BPD often include paranoid ideation or dissociative states.

Paranoid ideation is when someone is being suspicious, paranoid, or grandiose such as believing that they're being watched, followed, secretly tested, or that everyone is against them.

A dissociative state is when someone is disconnected and lacks continuity between thoughts, memories, environment, behaviors, and identity. Escaping reality in ways that are involuntary and unhealthy.

Besides dissociative experiences and paranoid ideation, the most common form of psychosis experienced by borderlines is AVH (auditory verbal hallucinations) which is hearing one or more voices. Other types of hallucinations someone with BPD may experience are: seeing beings or objects, feeling sensations in the body, or smelling odor. The severity of the hallucinations experienced by borderlines depends on the amount of stress the person has in their life. It’s been proven that the presence of both auditory and visual hallucinations in BPD is associated with an increase in suicide attempts.

Can BPD turn into schizophrenia?

Borderline doesn't develop into schizophrenia since they are two different illnesses with their own symptoms. However, BPD and schizophrenia frequently coexist. They have a bit of overlap in symptoms but also have a lot of differences. It has been observed that 6 to 15% of patients with schizophrenia also meet the criteria for BPD. And according to studies, 38% of Borderlines have comorbid Psychotic disorders.

Individuals with Borderline have psychotic symptoms earlier in life than people that suffer from schizophrenia. Psychotic symptoms in BPD are extremely similar to those found in the schizophrenia spectrum. Especially when it comes to the frequency of psychotic episodes and the types of delusions.

How long does BPD psychosis last?

Psychotic episodes in BPD tend to be less than two weeks. When they show up as longer-lasting, they are prolonged by other comorbid psychotic disorders. And if that is the case, it can take anywhere from 3 weeks to 4 months.

What does BPD psychosis look like

Since people with BPD are afraid of being abandoned, hallucinations and delusions are frequently associated with relationships. For example, suspecting the significant other of cheating, thinking that something has been said, or believing to be dating someone.

People who suffer from psychosis experience a break from reality and are not able to tell what is real from what isn't. Hallucinations are symptoms of psychosis, and common ones are hearing voices or seeing people when they are not there. In general, hallucinations are sensory experiences that occur without any external stimuli.

Delusions are false beliefs that are considered true by the person suffering, despite evidence to the contrary. Paranoid delusions also referred to as persecutory delusions, are fears and obsessions with nonexistent external threats. A common paranoid delusion is believing the government is onto you or that a serial killer is coming to get you. Another type of delusion is the grandiose delusion, where someone believes to be an important authority or that they can do great and impossible things.

Why do people with BPD experience psychosis?

When it comes to the development of psychosis, research has found that childhood trauma plays an important role in later psychotic symptoms.

It has been shown that both sexual and physical assault in childhood were predictors for the development of visual and auditory hallucinations later in life, as well as delusional experiences. Sexual and emotional abuse were important predictors for auditory hallucinations for both psychotic and non-psychotic patients.

People suffering from BPD often share a traumatic childhood characterized by all sorts of abuses. Between 40 to 70% of BPD patients report having experienced sexual abuse, while 92% report having lived through severe emotional abuse during their childhood. The high rates of abuse and trauma make so that 58-79% of patients with BPD will also receive a PTSD diagnosis.

Neuroscience of psychosis

The science behind how psychosis work is still relatively new, but research has found that the neurotransmitter dopamine plays a role in the development of psychosis. Dopamine is a neurotransmitter associated with the feeling of pleasure and fulfillment. Neurotransmitters are the messengers used by the brain to communicate through action potentials. People that suffer from psychosis have an overreactive dopamine transmission in the mesolimbic areas (responsible for the regulation of salience, motivation, and fear) and an underactive transmission in the prefrontal cortex (responsible for cognitive functions, attention, and impulse inhibition, among others).

Some common causes for psychosis excluding psychotic disorders are HIV, malaria, Alzheimer's and Parkinson's disease, lupus, MS, and brain tumor. Additionally, drugs and alcohol abuse can also cause psychosis. Lastly, some medications can have psychosis as a side effect. However, this is really rare.

How to deal with BPD psychosis

The most common way of treating psychosis is through medication, especially antipsychotics.

Antipsychotics do not cure psychosis, but they make the symptoms manageable. Additionally, they reduce the risk of relapse.


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