Psychosis in Borderline Personality Disorder: A Neglected Clinical Phenomenon.
Psychoanalytic review March 1, 2026 Mark L Ruffalo, Alex M Ray, Abigail Rasol et al.
Psychotic symptoms, such as hallucinations and delusions, occur in up to 60% of patients with borderline personality disorder (BPD), yet diagnostic frameworks often overlook them by focusing on emotional instability and relationship problems. This review traces the historical view of BPD as related to schizophrenia and examines the nature of these psychotic experiences. Drawing on psychoanalytic object-relations theory, the authors argue that psychotic symptoms in BPD serve a restorative function, helping maintain internal relational continuity during psychic breakdown. These symptoms are not incidental but reflect core features of the disorder, warranting greater clinical attention and theoretically informed treatment.