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Psychotic symptoms in borderline personality disorder

an update

D’Agostino, Alessandraa; Rossi Monti, Marioa; Starcevic, Vladanb

Current Opinion in Psychiatry: January 2019 - Volume 32 - Issue 1 - p 22–26
doi: 10.1097/YCO.0000000000000462
PERSONALITY DISORDERS: Edited by Charles B. Pull and Aleksandar Janca

Purpose of review The purpose of this article is to review the most recent literature on psychotic symptoms in borderline personality disorder (BPD).

Recent findings Both auditory hallucinations and delusional ideation (especially paranoid delusions) are relatively common in individuals with BPD. It is still difficult to distinguish these and related phenomena in BPD from the corresponding experiences in psychotic disorders and schizophrenia, despite numerous attempts to do so. The terminology introduced to help with this effort has not been particularly useful. The presence of auditory hallucinations may affect the course of BPD negatively. Psychotic symptoms in BPD seem to be significantly related to the context (usually stressful events) and appear or intensify in response to situational crisis. The role of certain co-occurring disorders in increasing the risk of psychotic symptoms in BPD remains uncertain.

Summary Psychotic symptoms in BPD continue to be poorly understood. Further research should try to ascertain the relationships between hallucinations and delusions on one hand and the processing of trauma, emotion regulation, distress tolerance and interpersonal sensitivity on the other. Ultimately, such endeavor will contribute to developing more effective treatments for BPD.

aBorderline & Body Lab, Department of Humanities, University of Urbino, Urbino, Italy

bUniversity of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of Psychiatry, Sydney, Australia

Correspondence to Dr Alessandra D’Agostino, Borderline & Body Lab, Department of Humanities, University of Urbino, Italy, via Saffi 15, 61029 Urbino (PU), Italy. Tel: +39 339 3727371; e-mail:

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