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Odd, Quasi-Psychotic And True Psychotic Thinking In BPD Sufferers

A study conducted by Zachirini et al. (2013)investigated the prevalence of disturbed thought in 290 in-patients who had been diagnosed with BPD (borderline personality disorder). The quality of disordered thinking measured in these 290 BPD in-patients was compared to the quality of disordered thinking measured in 72 non-BPD in-patients who had another (i.e. different) Axis II disorder (BPD is an Axis ii disorder, but the category includes several other personality disorders including paranoid, schizoid, schizotypal, antisocial, histrionic or narcissistic personality disorder).

The types of disordered thought of interest to the researchers in this total of 362 in-patients were divided into three main categories which were as follows :


This category was broken down into:

  • odd thinking
  • atypical perceptual experiences
  • paranoid thoughts (of a type that fell below the threshold to be considered delusional)


Delusions and hallucinations that related only to limited aspects of perception/thought, were ephemeral (i.e. of short duration limited to hours or days) and ‘non-bizarre’ (i.e. involving situations that could theoretically and conceivably happen in real life such as fear of others conspiring and plotting against one, fear that somebody is attempting to poison one or fear one is being covertly followed); such ‘non-bizarre’ delusions most frequently occur due to the BPD sufferer’s misinterpretation of their experiences/perceptions.


Full-blown delusions and hallucinations. In contrast to quasi-psychotic thinking, true psychotic thinking is prolonged, widespread, and bizarre (Schneiderian). delusions associated with true psychotic thought are often referred to by psychiatrists as ‘bizarre.’


It was found that the BPD in-patients had significantly more disordered thought in relation to all three of the above categories, i.e. (1) non-psychotic but odd, atypical, and non-delusional paranoid thinking; (2) quasi-psychotic thinking, and (3) true psychotic thinking than those non-BPD in-patients who had been diagnosed with other Axis II disorders (see above).


The participants in the study were followed up over a sixteen-year period by the researchers and during this time 17 more specific types of thinking/perception problems were examined and it was found that the BPD sufferers, when compared to the individuals who had been diagnosed with other Axis II disorders, also had a significantly increased likelihood (over this sixteen-year period) of suffering from the following eleven of these 17 types of disordered thinking; I list these below:

  • overvalued ideas
  • recurrent illusions
  • undue suspiciousness (e.g. ‘everybody despises me’; ‘everybody wants to destroy me.’).
  • quasi-psychotic hallucinations
  • true-psychotic hallucinations
  • quasi-psychotic delusions
  • derealization
  • depersonalization
  • ideas of reference (e.g. ‘I’m a terrible person’; ‘I’m irreparably damaged, and my condition will never improve, no matter what.’)
  • paranoid ideation
  • magical thinking (the belief that one’s own desires, thoughts, and wishes can directly influence the real world e.g. ‘putting a curse’ on somebody or putting pins into a voodoo doll).

However, there is better news: as time went on over the sixteen-year period of study, it was found that symptoms of the above types of disordered thought in BPD sufferers diminished (with the exception of true-psychotic hallucinations).

The researchers concluded that the type and intensity of thought disorder in BPD sufferers could help to distinguish those suffering from the disorder from those suffering from other Axis ll personality disorders such as those mentioned above. It was also pointed out by the authors of the study that, whilst thought/perception disorder tends to diminish over time in those suffering from BPD, such thought disturbance (particularly in relation to non-psychotic thought disorder) can remain a residual problem.

Quasi And True Psychotic Thinking In BPD Patients Compared To Patients With Schizophrenia. A Study Investigating The Difference:

A second study (Dalmotto et al., 2014) found that quasi-psychotic thought (e.g. undue suspiciousness’ and ‘ideas of refrence’) was more frequent in BPD sufferers compared to those suffering from schizophrenia although true psychotic thought was more prevalent in schizophrenic patients than in those with BPD. However, both true psychotic thought and quasi-psychotic thought were experienced by both BPD and schizophrenic patients.

As might be expected, it was also found that among BPD sufferers there was a strong negative correlation between the severity of their non-delusional paranoia and their level of personal and social functioning (those with lower social/personal functioning were more likely to experience non-delusional paranoia.

The researchers also concluded from their study that non-delusional paranoia in BPD sufferers is stress-related.



As alluded to above, full-blown psychotic thinking, if it does occur in BPD sufferers, tends to be ephemeral and transient, lasting no more than hours or days. Other research, as one would expect, suggests that if such disordered thinking does occur, in BPD patients, it is usually brought on by stress which provides yet another reason why it is imperative for those recovering from BPD (many do recover or go into remission with therapeutic help such as undergoing dialectical behavior therapy) keep toxic stress levels down to an absolute minimum.



Oliva F, Dalmotto M, Pirfo E, Furlan PM, Picci RL. A comparison of thought and perception disorders in borderline personality disorder and schizophrenia: psychotic experiences as a reaction to impaired social functioning. BMC Psychiatry. 2014;14:239. Published 2014 Oct 3. doi:10.1186/s12888-014-0239-2

Zanarini MC, Frankenburg FR, Wedig MM, Fitzmaurice GM.Cognitive experiences reported by patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry. 2013 Jun;170(6):671-9. doi: 10.1176/appi.ajp.2013.13010055.


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