Psychotic symptoms in patients with borderline personality disorder and concurrent axis I disorder

Whether psychotic symptoms are part of the fundamental psychopathology of borderline personality disorder remains in dispute. The goal of the study was to examine the incidence and nature of psychotic symptoms in a sample of patients with the disorder.

The inpatient psychiatric records of 92 patients with a discharge diagnosis of borderline personality disorder, some of whom had comorbid affective disorder or substance abuse disorder, were examined to obtain data on the presence of psychotic symptoms (narrowly defined as delusions and auditory and visual hallucinations), the duration of psychotic episodes, and the clinical characteristics of the patients.

Twenty-seven percent of the patients had psychotic episodes, typically lasting many weeks. Comorbid affective or substance abuse disorders did not predict psychotic symptoms.

Psychotic episodes are common but not universal among patients with borderline personality disorder, regardless of whether a concurrent axis I disorder is present. Those episodes are not necessarily brief or transient, and borderline patients who experience psychotic episodes are likely to have repeated hospitalizations.