Psychiatrists spend a lot of time talking with people who have unusual sensory experiences and thought processes. Some, but not all, will have a disorder of the mind we call psychosis.
If you wouldn't mind answering a question, I have one. The classic, original definition of borderline pd, of course, is straddling the line between neurosis and psychosis. I realize there's more to it than that, and I also realize that you may not hold with that definition, or you may have a more complicated view. I'm asking that we stipulate it for the sake of the question.
In my experience with BPD in family and friends, I've usually thought that, to the degree one of them (OK, my mother) slips into psychosis (or in the neighborhood, or with the symptoms, even if you wouldn't characterize it as full psychosis), it's in the form of persecutory delusions.
Baroque fantasies that her children are literally conspiring to "get" her in some way (often unspecified), to "ruin her reputation," or that landlords/others are conspiring to make her homeless, etc.
So I've said to myself, "This is the common way that my mother and other borderlines I've known have displayed psychosis-like symptoms." Would you say that's reasonable, or do you see it differently?
Further, what in your experience is the most common way someone with BPD develops psychosis symptoms? What are they? What do they look like?
I had no idea before reading your article that so many borderlines reported hearing voices; thank you for expanding my understanding.
I suppose the most prototypical voices in schizophrenia are third person commentary, or hearing your own thoughts aloud. These types of voices may or may not be derogatory but would definitely push me more towards a primary psychotic disorder
As you may be aware voices are usually derogatory in borderline personality disorder but are often derogatory in illnesses like schizophrenia too, so it’s not differentiating if they *are* derogatory
In my experience, people with borderline PD can experience these types of symptoms (particularly paranoia and derogatory voices) at times of emotional crisis or when they are under a great deal of stress.
I do not view these symptoms as being on the same spectrum as psychotic illnesses like schizophrenia (although they may seem superficially similar). Meanwhile, some typical schizophrenia symptoms (thought alienation, passivity, negative syndrome) are rarely, if ever, seen in borderline PD.
I don’t really think the conceptualisation of borderline PD being between psychosis and neurosis is valid - most psychiatrists I know don’t see it through that lens
I enjoyed this very much. I had no idea BPD patients had these hallucinations. I worked as a mental health tech for five years and we absolutely dreaded getting patients with BPD. They would just tear up a unit.
Also, I wonder if hardcore conspiracy theorists are on the schizophrenia spectrum at all, They seem to have a completely fantastical understanding of how the world works.
I think there’s definitely people out there who hold beliefs that are well beyond what would be considered normal/conventional. Conspiracy theories are a good example. Whether this should be regarded as a spectrum of mental illness is a debatable point!
There’s also the concept of schizotypal personality disorder where individuals have idiosyncratic/unusual beliefs and odd mannerisms - but seem to be stable over time unlike psychosis which is typically episodic.
This article offers a nuanced exploration of psychosis, highlighting the complexity of categorizing and understanding various psychotic symptoms.
It's enlightening to see how symptoms traditionally associated with severe mental illnesses like schizophrenia can manifest in different contexts, from physical illnesses to substance withdrawal.
The concept of a psychosis continuum is particularly intriguing, suggesting that these experiences might not be as black-and-white as traditionally thought.
Your approach to demystifying and contextualizing these experiences is invaluable, especially in a field often clouded by misunderstandings and stigma. This thoughtful piece contributes significantly to a more empathetic and informed understanding of mental health.
Great post— had never heard of the "praecox feeling"! In neurology we often distinguish between visual and auditory hallucinations: visual often from delirium, certain dementias, Charles Bonnet syndrome, or the hypnagogic hallucinations you mention, while auditory tend to be more restricted to psychiatric disorders.
I guess the phenomenology of the hallucination and full clinical picture may distinguish between psychiatric and neurological causes in these instances
This was really enlightening, thank you!
If you wouldn't mind answering a question, I have one. The classic, original definition of borderline pd, of course, is straddling the line between neurosis and psychosis. I realize there's more to it than that, and I also realize that you may not hold with that definition, or you may have a more complicated view. I'm asking that we stipulate it for the sake of the question.
In my experience with BPD in family and friends, I've usually thought that, to the degree one of them (OK, my mother) slips into psychosis (or in the neighborhood, or with the symptoms, even if you wouldn't characterize it as full psychosis), it's in the form of persecutory delusions.
Baroque fantasies that her children are literally conspiring to "get" her in some way (often unspecified), to "ruin her reputation," or that landlords/others are conspiring to make her homeless, etc.
So I've said to myself, "This is the common way that my mother and other borderlines I've known have displayed psychosis-like symptoms." Would you say that's reasonable, or do you see it differently?
Further, what in your experience is the most common way someone with BPD develops psychosis symptoms? What are they? What do they look like?
I had no idea before reading your article that so many borderlines reported hearing voices; thank you for expanding my understanding.
does it make a difference in your diagnostic intuition if, in the case of hearing voices, the voices are *not* derogatory?
I suppose the most prototypical voices in schizophrenia are third person commentary, or hearing your own thoughts aloud. These types of voices may or may not be derogatory but would definitely push me more towards a primary psychotic disorder
As you may be aware voices are usually derogatory in borderline personality disorder but are often derogatory in illnesses like schizophrenia too, so it’s not differentiating if they *are* derogatory
Thanks for this thoughtful comment.
In my experience, people with borderline PD can experience these types of symptoms (particularly paranoia and derogatory voices) at times of emotional crisis or when they are under a great deal of stress.
I do not view these symptoms as being on the same spectrum as psychotic illnesses like schizophrenia (although they may seem superficially similar). Meanwhile, some typical schizophrenia symptoms (thought alienation, passivity, negative syndrome) are rarely, if ever, seen in borderline PD.
I don’t really think the conceptualisation of borderline PD being between psychosis and neurosis is valid - most psychiatrists I know don’t see it through that lens
I enjoyed this very much. I had no idea BPD patients had these hallucinations. I worked as a mental health tech for five years and we absolutely dreaded getting patients with BPD. They would just tear up a unit.
Also, I wonder if hardcore conspiracy theorists are on the schizophrenia spectrum at all, They seem to have a completely fantastical understanding of how the world works.
I think there’s definitely people out there who hold beliefs that are well beyond what would be considered normal/conventional. Conspiracy theories are a good example. Whether this should be regarded as a spectrum of mental illness is a debatable point!
There’s also the concept of schizotypal personality disorder where individuals have idiosyncratic/unusual beliefs and odd mannerisms - but seem to be stable over time unlike psychosis which is typically episodic.
Psychosis itself is not always 'psychosis' either https://open.substack.com/pub/callystarforth/p/the-weapon-of-psychiatry?r=1eq51l&utm_campaign=post&utm_medium=web
This article offers a nuanced exploration of psychosis, highlighting the complexity of categorizing and understanding various psychotic symptoms.
It's enlightening to see how symptoms traditionally associated with severe mental illnesses like schizophrenia can manifest in different contexts, from physical illnesses to substance withdrawal.
The concept of a psychosis continuum is particularly intriguing, suggesting that these experiences might not be as black-and-white as traditionally thought.
Your approach to demystifying and contextualizing these experiences is invaluable, especially in a field often clouded by misunderstandings and stigma. This thoughtful piece contributes significantly to a more empathetic and informed understanding of mental health.
Keep up the great work! 🧠📚✨
Robert from Beyond AI
Great post— had never heard of the "praecox feeling"! In neurology we often distinguish between visual and auditory hallucinations: visual often from delirium, certain dementias, Charles Bonnet syndrome, or the hypnagogic hallucinations you mention, while auditory tend to be more restricted to psychiatric disorders.
Good point! There is some evidence that visual hallucinations are also common in first episode psychosis, in up to 1/3 according to this meta-analysis https://academic.oup.com/schizbullopen/article/4/1/sgad002/7008614 (which I intuitively feel is a bit inflated).
I guess the phenomenology of the hallucination and full clinical picture may distinguish between psychiatric and neurological causes in these instances