Borderline personality features and development of psychosis in an ‘Ultra High Risk’ (UHR) population: a case control study

Abstract

Co-occurring BPD or BPD features does not appear to strongly influence the risk of short-term transition to psychosis or the risk of developing a non-affective psychotic disorder in this population.

Borderline personality pathology in young people at ultra high risk of developing a psychotic disorder

“…Borderline personality pathology did not significantly predict the onset of psychotic disorder. This is consistent with the previous reports . In contrast to previous research, the only significant predictor of psychosis was the absence of depression.…”

“…The prevalence of borderline personality pathology in this sample was 25.2%, which was higher than previous literature (14%-21%). [1][2][3] We used a screening tool to assess BPD pathology, rather than the full diagnosis, which may explain our high prevalence rates compared with other studies.…”

“…Individuals identified as being ultra high risk (UHR) of psychosis typically experience subthreshold positive psychotic experiences that are accompanied by a decline in social and occupational functioning. There is a high degree of co‐morbid psychopathology within UHR groups, including borderline personality pathology, with rates ranging from 14.6% to 21% . However, little is known about the impact borderline personality pathology has on the progression to psychosis in the UHR group, with the one study investigating this issue finding that borderline personality disorder (BPD) pathology was not associated with increased risk of transition within a 24‐month period .…”

Attenuated Psychosis Syndrome: Don't Jump the Gun

“…The rationale for this is that at this very early stage of disorder it is not yet clear whether symptoms are part of the prodromal phase of an emerging disorder, such as a psychotic disorder, or represent an existing disorder, such as borderline personality disorder, or indeed are symptoms of comorbid disorders, such as concurrent psychotic disorder and borderline personality disorder. It is not clear why there should be a change of approach for DSM-5, particularly given data indicating that ‘at-risk' patients with borderline personality disorder features are just as likely to transition to psychotic disorder as those who do not present with borderline personality disorder features [23]. As with point 1, this specification defines a narrower group than the ‘at-risk' criteria without providing sufficient validation of this narrower construct.…”

Perceptual abnormalities in an ultra‐high risk for psychosis population relationship to trauma and co‐morbid disorder

“…A meta‐analysis conducted by Fusar‐Poli, Nelson, Valmaggia, Yung, and McGuire () reported rates of co‐morbid depression of 40% and anxiety disorder of 15% in the available UHR studies. The possible role played by comorbid disorders in altering risk of transition to psychosis has been investigated in a number of studies (Fusar‐Poli et al, ; Salokangas et al, ; Thompson et al, ; Yung et al, ), with evidence suggesting that co‐morbid psychiatric disorders at baseline entry to a UHR clinic are not associated with a higher risk of transition to psychosis in the UHR population. However, given that a number of the cognitive theories proposed to explain the development of perceptual abnormalities identify a role for anxiety and low mood in the aetiology and persistence of hallucinations (Bentall & Slade, ; Morrison, Frame, & Larkin, ; Morrison, Haddock, & Tarrier, ; Myin‐Germeys & van Os, ; van Os, Linscott, Myin‐Germeys, Delespaul, & Krabbendam, ), it is surprising that little attention has to date been paid to the relationship between perceptual abnormalities specifically and comorbid disorders at baseline in the UHR population.…”