Psychotic symptoms in adolescents with borderline personality disorder features

Thompson, Katherine N; Cavelti, Marialuisa; Chanen, Andrew M (2019). Psychotic symptoms in adolescents with borderline personality disorder features. European child & adolescent psychiatry, 28(7), pp. 985-992. Springer 10.1007/s00787-018-1257-2

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Psychotic symptoms have been found to be relatively common among adults with borderline personality disorder (BPD),
and to be a marker of BPD severity, but are not recognised in daily clinical practice in these patients. This study is the first
to examine the prevalence of psychotic symptoms in 15–18-year olds with BPD features. It was hypothesised that adolescents
with full-threshold BPD would have significantly more psychotic symptoms than adolescents with sub-threshold
BPD features, and that both these groups would have significantly more psychotic symptoms than adolescents with no BPD
features. A total of 171 psychiatric outpatients, aged 15–18 years, were assessed using a structured interview for DSM-IV
personality disorder and categorised into three groups: no BPD features (n = 48), sub-threshold BPD features (n = 80), and
full-threshold BPD (n = 43). The groups were compared on measures of psychopathology and functioning (e.g. Youth Self
Report, Symptom Check List-90-R, SOFAS). Adolescents with full-threshold BPD reported more psychotic symptoms
than the sub-threshold BPD group (p < .001), and both these groups reported more psychotic symptoms than those with no
BPD features (p < .001). Adolescents with full-threshold BPD reported more confusion (p < .01), paranoia (p < .001), visual
hallucinations (p < .001) and strange thoughts (p < .01), than the other two groups. Psychotic symptoms predicted group
membership, determined by BPD severity, after adjusting for other psychopathology and functional impairment (p < .01).
Assessment of unusual perceptual experiences, paranoia or odd thoughts is highly clinically relevant in adolescents with
BPD features, as these symptoms are associated with a more severe clinical presentation of BPD.

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