Vol.:(0123456789) 1 3 European Child & Adolescent Psychiatry https://doi.org/10.1007/s00787-018-1257-2 ORIGINAL CONTRIBUTION Psychotic symptoms in adolescents with borderline personality disorder features Katherine N. Thompson 1,2  · Marialuisa Cavelti 1,2,4  · Andrew M. Chanen 1,2,3 Received: 23 April 2018 / Accepted: 14 November 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract 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 frst to examine the prevalence of psychotic symptoms in 15–18-year olds with BPD features. It was hypothesised that adoles- cents with full-threshold BPD would have signifcantly more psychotic symptoms than adolescents with sub-threshold BPD features, and that both these groups would have signifcantly 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. Keywords Adolescence · Borderline personality disorder · Psychosis · Hallucinations · Paranoia Introduction Psychotic symptoms are commonly reported among adult individuals with borderline personality disorder (BPD) [1, 2]. Historically, their clinical signifcance has often been dismissed, in part because they were believed to be of short duration, transient in nature, and to not signifcantly afect patients’ lives [2]. Consequently, there is little information about the frequency and character of psychotic symptoms, and their functional consequences, during the clinical onset of BPD. This is especially important for early detection and treatment because the transition from childhood to adult- hood is the peak period for the onset of BPD and the major psychotic disorders and it is also the period during which BPD features are at their most severe [3–5]. Recent studies of adults with BPD have used standard- ised instruments assessing for psychotic symptoms. Audi- tory verbal hallucinations (AVHs) were found to occur in 22–50% of patients with BPD and to be phenomenologically * Andrew M. Chanen andrew.chanen@orygen.org.au Katherine N. Thompson katherine.thompson@orygen.org.au Marialuisa Cavelti marialuisa.cavelti@orygen.org.au 1 Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC 3052, Australia 2 Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia 3 Orygen Youth Health, Melbourne, Australia 4 Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland