+A BRIEF LOOK AT BORDERLINE PERSONALITY DISORDER AND PSYCHOSIS

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A blog comment last night caught my attention.  I have been doing a lot of thinking about the fact that YES I believe my abusive mother suffered from Borderline Personality Disorder.  And, YES, she was psychotic.  Did her psychotic break make her a special kind of Borderline?  Do I have to specify some kind of distinction when I publish between ‘ordinary’ BPD and ‘psychotic’ BPD?

What might the research say?  Here are a few samples…

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From Germany:

It seems that BPD people can suffer from psychotic symptoms without having a psychotic disorder.

I cannot access the full article of this study online, but here is the abstract for –

Borderline personality disorder and psychosis: a review.

By Barnow S, Arens EA, Sieswerda S, Dinu-Biringer R, Spitzer C, Lang S.

Published in – Curr Psychiatry Rep. 2010 Jun;12(3):186-95.

Early views of borderline personality disorder (BPD) were based on the idea that patients with this pathology were “on the border” of psychosis. However, more recent studies have not supported this view, although they have found evidence of a malevolent interpersonal evaluation and a significant proportion of BPD patients showing psychotic symptoms. For example, in one study, 24% of BPD patients reported severe psychotic symptoms and about 75% had dissociative experiences and paranoid ideation.

Thus, we start with an overview regarding the prevalence of psychotic symptoms in BPD patients. Furthermore, we report findings of studies investigating the role of comorbidity (eg, post-traumatic stress disorder) in the severity and frequency of psychotic symptoms in BPD patients. We then present results of genetic and neurobiological studies comparing BPD patients with patients with schizophrenia or nonschizophrenic psychotic disorders. In conclusion, this review reveals that psychotic symptoms in BPD patients may not predict the development of a psychotic disorder but are often permanent and severe and need careful consideration by clinicians. Therefore, adequate diagnosis and treatment of psychotic symptoms in BPD patients is emphasized.

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From the Netherlands:

Psychotic reactivity in borderline personality disorder.

By Glaser JP, Van Os J, Thewissen V, Myin-Germeys I. (The Netherlands)

Published in – Acta Psychiatr Scand. 2010 Feb;121(2):125-34. Epub 2009 Jun 25.

Abstract

OBJECTIVE:

To investigate the stress relatedness and paranoia specificity of psychosis in borderline personality disorder (BPD).

METHOD:

Fifty-six borderline patients, 38 patients with cluster C personality disorder, 81 patients with psychotic disorder and 49 healthy controls were studied with the experience sampling method (a structured diary technique) to assess: i) appraised subjective stress and ii) intensity of psychotic experiences.

RESULTS:

All patient groups experienced significantly more increases in psychotic experiences in relation to daily life stress than healthy controls, borderline patients displaying the strongest reactivity. Borderline patients, moreover, reported significantly more hallucinatory reactivity than healthy controls and subjects with cluster C personality disorder. Paranoid reactivity to daily life stress did not differ between the patient groups.

CONCLUSION:

These results are the first to ecologically validate stress-related psychosis in BPD. However, psychotic reactivity was not limited to expression of paranoia but involved a broader range of psychotic experiences including hallucinations.

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From the United Kingdom:

Experiences of psychosis in borderline personality disorder: A qualitative analysis

By Bob Adams and Teri Sanders

Published in – Journal of Mental Health, August 2011, Vol. 20, No. 4 : Pages 381-391

Background. 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.

Aims. 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.

Method. 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.

Results. 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. [with negative connotations]

Conclusions. 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.

Read More: http://informahealthcare.com/doi/abs/10.3109/09638237.2011.577846

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Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical management.

By Schroeder K, Fisher HL, Schäfer I.

Curr Opin Psychiatry. 2012 Nov 20. [Epub ahead of print]

Source – Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany bMRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK.

Abstract

PURPOSE OF REVIEW:

The aim of this article is to review findings on the prevalence, phenomenology and treatment of psychotic features in borderline personality disorder (BPD), and to discuss factors that might be related to their occurrence.

RECENT FINDINGS:

Of patients with BPD about 20-50% report psychotic symptoms. Hallucinations can be similar to those in patients with psychotic disorders in terms of phenomenology, emotional impact, and their persistence over time. Although more research is needed on the exact nature of psychotic phenomena in patients with BPD, terms like pseudo-psychotic or quasi-psychotic are misleading and should be avoided. Childhood trauma might play an important role in the development of psychotic symptoms in patients with BPD, as in other populations. More research is necessary on the role of comorbid disorders, especially posttraumatic stress disorder (PTSD). Atypical antipsychotics seem to be beneficial in some patients; evidence on psychotherapy of psychotic symptoms is sparse.

SUMMARY:

Psychotic symptoms, especially hallucinations, seem to be an important feature of BPD. More research on potential mediators and adequate treatment approaches for psychotic symptoms in BPD is needed, and current diagnostic systems might require revision to emphasise psychotic symptoms.

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Very interesting – USA:

Etiological features of borderline personality related characteristics in a birth cohort of 12-year-old children.

By Belsky DW, Caspi A, Arseneault L, Bleidorn W, Fonagy P, Goodman M, Houts R, Moffitt TE.

Published in – Dev Psychopathol. 2012 Feb;24(1):251-65.

Abstract

It has been reported that borderline personality related characteristics can be observed in children, and that these characteristics are associated with increased risk for the development of borderline personality disorder. It is not clear whether borderline personality related characteristics in children share etiological features with adult borderline personality disorder. We investigated the etiology of borderline personality related characteristics in a longitudinal cohort study of 1,116 pairs of same-sex twins followed from birth through age 12 years.

Borderline personality related characteristics measured at age 12 years were highly heritable, were more common in children who had exhibited poor cognitive function, impulsivity, and more behavioral and emotional problems at age 5 years, and co-occurred with symptoms of conduct disorder, depression, anxiety, and psychosis.

Exposure to harsh treatment in the family environment through age 10 years predicted borderline personality related characteristics at age 12 years. This association showed evidence of environmental mediation and was stronger among children with a family history of psychiatric illness, consistent with diathesis-stress models of borderline etiology. Results indicate that borderline personality related characteristics in children share etiological features with borderline personality disorder in adults and suggest that inherited and environmental risk factors make independent and interactive contributions to borderline etiology.

SUMMARY:

Psychotic symptoms, especially hallucinations, seem to be an important feature of BPD. More research on potential mediators and adequate treatment approaches for psychotic symptoms in BPD is needed, and current diagnostic systems might require revision to emphasise psychotic symptoms.

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From Germany:

Psychotic-like cognitive biases in borderline personality disorder.

By Moritz S, Schilling L, Wingenfeld K, Köther U, Wittekind C, Terfehr K, Spitzer C.

Published in – J Behav Ther Exp Psychiatry. 2011 Sep;42(3):349-54. Epub 2011 Mar 23.

Abstract

Whereas a large body of research has linked borderline personality disorder (BPD) with affective rather than psychotic disorders, BPD patients frequently display psychotic and psychosis-prone symptoms, respectively. The present study investigated whether cognitive biases implicated in the pathogenesis of psychotic symptoms, especially delusions, are also evident in BPD.

A total of 20 patients diagnosed with BPD and 20 healthy controls were administered tasks measuring neuropsychological deficits (psychomotor speed, executive functioning) and cognitive biases (e.g., one-sided reasoning, jumping to conclusions, problems with intentionalizing). Whereas BPD patients performed similar to controls on standard neuropsychological tests, they showed markedly increased scores on four out of five subscales of the Cognitive Biases Questionnaire for Psychosis (CBQp) and displayed a one-sided attributional style on the revised Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R) with a marked tendency to attribute events to themselves.

The study awaits replication with larger samples, but we tentatively suggest that the investigation of psychosis-related cognitive biases may prove useful for the understanding and treatment of BPD.

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Due to be published 2013 – the new DSM-V

from Wickipedia:

Personality disorders

Main article: Personality disorder

Major changes have been proposed in the assessment and diagnosis of personality disorders.[30] These include a revamped definition of personality disorder and a dimensional rather than a categorical approach based on the severity of dysfunctional personality trait domains (negative emotionality,introversionantagonismdisinhibitioncompulsivity, and schizotypy). In addition, patients would be assessed on how much they match each of six prototypic personality disorder types: antisocial/psychopathicavoidant,borderlinenarcissisticobsessive-compulsive, and schizotypal with their criteria being derived directly from the dimensional personality trait domains. Some former personality disorders, like histrionic personality disorder, will be submerged under facets of various personality type domains (in this case, the narcissism and histrionism facets of antagonism).

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