Psychotic features in Borderline Personality Disorder (BPD) are temporary, stress-induced experiences like hallucinations (hearing voices, seeing things), paranoia, and delusions, which differ from primary psychotic disorders because they are often brief, tied to intense emotions (like fear of abandonment), and the person usually has some awareness of reality. Common forms include auditory hallucinations (critical voices), paranoid thoughts, and thought blocking (losing your train of thought), often triggered by severe emotional distress or relationship conflicts.
Psychotic symptoms in BPD can include paranoia, auditory hallucinations, visual distortions, and severe dissociative episodes. Relationship conflicts and abandonment fears commonly trigger psychotic episodes in people with BPD.
Some common types of delusions that may occur in individuals with BPD include: Persecutory delusions: Believing that one is being mistreated, harassed, or conspired against by others. Grandiose delusions: Believing one possesses extraordinary abilities, talents, or powers.
At least one of these symptoms must be delusions, hallucinations, or disorganized speech. The symptoms in BPD last between one day to one month, with a complete return to premorbid level of functioning after the disease course in response to antipsychotic medications.
BPD Meltdown
During a meltdown, people may experience extreme mood swings, impulsivity, and difficulty calming down. Understanding how BPD contributes to meltdowns is crucial for developing coping strategies and providing support to manage and navigate these overwhelming emotional experiences.
People with borderline personality disorder have a strong fear of abandonment or being left alone. Even though they want to have loving and lasting relationships, the fear of being abandoned often leads to mood swings and anger. It also leads to impulsiveness and self-injury that may push others away.
These thoughts may spiral into thought patterns like, "She probably hates me," or "I'll never have a friend who sticks by my side." With these spiraling thoughts come spiraling symptoms, such as intense emotions, anger, and urges to self-harm.
Warning signs of psychosis include hallucinations (seeing/hearing things not there), delusions (strong false beliefs), confused thinking, disorganized speech, social withdrawal, changes in mood/emotion, sleep/appetite issues, and difficulty with daily tasks, often signaled by a sudden drop in performance at school or work. These symptoms reflect a break from reality, impacting perception, thought, and behavior, and warrant early help.
BPD splitting involves intense shifts in perceptions and emotions. People may quickly alternate between idealising and devaluing people, situations, and themselves. This can lead to unstable relationships, rapid mood swings, impulsive behaviour, and difficulty tolerating ambiguity.
An episode of psychosis is treatable, and it is possible to recover. It is widely accepted that the earlier people get help the better the outcome. 25% of people who develop psychosis will never have another episode, another 50% may have more than one episode but will be able to live normal lives.
How can I help myself in the longer term?
Things like impulsively spending money you don't have, binge eating, driving recklessly, stealing, having random sex, or overdoing drugs and/or alcohol. Having suicidal behavior, cutting yourself, or intentionally burning yourself is a common symptom of BPD.
Researchers have used MRI to study the brains of people with BPD. MRI scans use strong magnetic fields and radio waves to produce a detailed image of the inside of the body. The scans revealed that in many people with BPD, 3 parts of the brain were either smaller than expected or had unusual levels of activity.
Impulsive and risky behavior, including gambling, reckless driving, unsafe sex, spending sprees, binge eating, drug abuse or self-destructive behaviors such as quitting a good job or relationship. Suicidal threats or behavior or self-injurious actions in fear of separation or rejection.
BPD is more prevalent among adolescents and young adults than elderly, and symptoms may remit with age. The term 'borderline' is debated, as it referred to concepts of borderline insanity and patients on the border between neurosis and psychosis, which are now considered clinically imprecise.
It is defined as the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.
The "3 C's of BPD" typically refer to advice for loved ones of someone with Borderline Personality Disorder, reminding them: "I didn't cause it, I can't cure it, I can't control it," to help set boundaries and avoid taking on undue responsibility for the person's actions or illness. Another set of "C's" describes core BPD traits for individuals: Clinginess (fear of abandonment), Conflict (intense relationships/moods), and Confusion (unstable self-image).
If left untreated, the person suffering from BPD may find themselves involved with extravagant spending, substance abuse, binge eating, reckless driving, and indiscriminate sex, Hooper says. The reckless behavior is usually linked to the poor self-image many BPD patients struggle with.
Being married to someone with BPD can make you feel like you're being left alone with your worries and stresses. The stress and uncertainty associated with caring for the individual through their mood swings can take an emotional toll on a spouse.
In cases of hyperactive delirium, symptoms are often mistaken for those of a psychosis—typically schizophrenia or mania. In hypoactive cases of delirium, symptoms may lead to a misdiagnosis of severe depression.
The “5 As of psychosis” is a pneumonic to remember the negative symptoms of psychosis:
Common triggers for psychotic episodes are stress and anxiety, substance use, sleep deprivation, and unresolved trauma. Early signs of psychosis, such as social withdrawal, neglect of personal hygiene, mood fluctuations, and increased suspicion, are critical for early detection and intervention.
Uncommon symptoms of borderline personality disorder
Splitting is a term used to describe a cognitive distortion where a person views situations and people in extremes—seeing them as either all good or all bad, with no middle ground.
Precautions When Taking Medication for BPD
Some concerns to think about include: Benzodiazepines may worsen symptoms for some individuals. Research suggests that benzodiazepines may worsen the symptoms of impulsivity and suicidality in people with BPD, so their use is discouraged.