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Cited by 46Personality Disorders and PsychopathologySchizophrenia research and treatmentBipolar Disorder and Treatment

Comorbid diagnosis of psychotic disorders in borderline personality disorder: prevalence and influence on outcome

Open access
Slotema, C. W., Blom, Jan D., Niemantsverdriet, Marieke B. A., Deen, Mathijs, Sommer, Iris E. C.·2018·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2018.00084PMC PMC5861147
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Abstract

Background: A diagnosis of psychotic disorder is traditionally considered incompatible with borderline personality disorder (BPD), even though patients sometimes fulfill the diagnostic criteria for both disorders. How often this happens is barely known, as is the influence of comorbid psychotic disorders on the outcome of BPD. Since studies on isolated auditory verbal hallucinations in patients with BPD indicate that these perceptual symptoms have severe consequences, and are associated with suicidal behavior and hospitalization, patients with comorbid psychotic disorders are unlikely to fare better. Objective: To examine the point prevalence of psychotic disorders in patients with BPD, their association with the outcome of BPD, and their predictive value for outcome. Methods: In a cross-sectional design, 84 female outpatients diagnosed with BPD were interviewed with the aid of the MINI-International Neuropsychiatric Interview to establish the point prevalence of comorbid psychotic and other comorbid disorders. After termination of their treatment at a specialized outpatient clinic, the type of referral was considered to be a ‘good ‘outcome when they were referred to their general practitioner or to basic psychiatric care for noncomplex patients, and a ‘poor’ outcome when referred to a specialized psychiatric department or to a psychiatric district team for patients with severe psychiatric disorders. Results: Psychotic disorders were present in 38% of the patients with BPD. With a prevalence of 20%, psychotic disorder not otherwise specified (NOS) was the most common subtype; the least common types were schizophrenia (2%), substance-induced psychotic disorder (2%), and brief psychotic disorder (1%). Among six types of comorbid disorders, only psychotic disorders were associated with a poor outcome; they were also predictors for a poor outcome, along with comorbid mood disorders, eating disorders, and somatoform disorders, as well as the severity of BPD, and, counterintuitively, more years of education. Conclusion: Psychotic disorders, notably of the psychotic disorder NOS subtype, are common among patients with BPD, and their presence is associated with a poor outcome. This implies that adequate diagnosis and treatment of both disorders is warranted in this subgroup with a dual diagnosis.

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  • The prevalence of post-traumatic stress disorder among borderline personality disorder patients is relatively high, ranging from 34 to 46%.

    “Finally, the prevalence of PTSD among BPD patients is relatively high, ranging from 34 to 46% (17).”

    From Timing of imagery rescripting during schema therapy for borderline personality disorder: the LUCY trial (2023) · cites this paper as [17]

    Table 2 in Results > Comorbidity reports PTSD in 41% (34 of 84) of patients with BPD, supporting that it was common in this sample. The paper gives a single point prevalence, not the claimed 34–46% range; 34 is the number of patients, not a percentage. (LLM, conf=0.86)

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  • Trauma treatment for patients with borderline personality disorder can be performed safely.

    “Current evidence suggests that trauma treatment for patients with BPD can be performed safely”

    From Timing of imagery rescripting during schema therapy for borderline personality disorder: the LUCY trial (2023) · cites this paper as [17]

    The Discussion (Implications for Clinical Practice and Future Research; page unavailable) addresses treatment for BPD with comorbid disorders, but does not assess the safety of trauma treatment. Searches for trauma-focused treatment and safety found no passage in our copy supporting that point. (LLM, conf=0.76)

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  • No stabilization is needed before trauma treatment for post-traumatic stress disorder in borderline personality disorder patients.

    “Initial evidence suggests that trauma treatment for PTSD can be performed safely in BPD patients, and no stabilization is needed (17).”

    From Timing of imagery rescripting during schema therapy for borderline personality disorder: the LUCY trial (2023) · cites this paper as [17]

    The Discussion (Implications for Clinical Practice and Future Research; page unavailable) addresses treatment of comorbid psychotic disorders in BPD, not trauma treatment for PTSD. Searches for PTSD trauma treatment and stabilization found no passage assessing whether treatment is safe without prior stabilization. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 4

  1. [1]American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association (2000).
  2. [4]American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association (2013).
  3. [9]World Health Organization. International Classification of Diseases and Related Health Problems, Tenth Revised Edition. Geneva: World Health Organization (2008).
  4. [22]First MV Gibbon M Spitzer RL Williams JBW Benjamin LS User’s Guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Washington, DC: American Psychiatric Press (1997).

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Authors
Slotema, C. W., Blom, J. D., Niemantsverdriet, M. B. A., Deen, M., & Sommer, I. E. C.
Affiliations
  • Parnassia Groep (NL)
  • Leiden University (NL)
  • University Medical Center Groningen (NL)
Corresponding author
Slotema, C. W.
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2018-03-14
Volume
9
Pages
84-84
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2018.00084
PMC
PMC5861147
OpenAlex
W2790351884
Cited by
46
References
49
Citations by year
2026: 5 · 2025: 3 · 2024: 8 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 8 · 2019: 4 · 2018: 2
FWCI
5.58
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
Funders
  • Stichting tot Steun Vereniging tot Christelijke Verzorging van Geestes- en Zenuwzieken (3125)
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek (100002033)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
borderline personality disorder, psychosis, comorbidities, schizophrenia, drug-induced psychosis, brief psychotic disorder, outcome prediction, point prevalence, dual diagnosis, auditory verbal hallucinations, mood disorders, eating disorders, somatoform disorders, educational attainment, psychiatric referral

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