Experiences of psychosis in borderline personality disorder: a qualitative analysis

From clinical work and research it is clear that people suffering from borderline personality disorder (BPD) often complain of psychotic symptoms including hallucinations, yet little is known about how service users experience these symptoms.

The aim of this study was to examine the experience of psychotic symptoms in people with BPD and to establish how mental health professionals responded to reports of psychotic symptoms.

Seven semi-structured interviews were carried out with service users with BPD who had been known to present with psychotic symptoms. In parallel, medical case notes of these service users were analysed. Results were subjected to qualitative analysis using techniques of grounded theory.

Psychotic symptoms were often long standing and interfered with physical and emotional functioning. There were no clear distinctions from psychotic symptoms described by patients suffering from schizophrenia. Treating doctors had no common language to describe these symptoms. Furthermore, the language that was used had the implication that the symptoms were not real or true and could therefore be perceived as pejorative.

It is suggested that the diagnostic category of BPD requires revision to include psychotic symptoms. Terminology such as pseudo- and quasi-psychotic symptoms are confusing and use of these terms should be revised.