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 :
1) NON-PSYCHOTIC THOUGHT:
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)
2) QUASI-PSYCHOTIC THOUGHT:
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 which 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
3) TRUE PSYCHOTIC THOUGHT.
Full-blown delusions and hallucinations.
RESULTS OF THE STUDY:
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).
OTHER TYPES OF DISORDERED THINKING FOUND TO EXIST IN THE BPD IN-PATIENTS STUDIED:
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
- 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.
THE VITAL IMPORTANCE OF REDUCING STRESS:
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 behaviour therapy) keep toxic stress levels down to an absolute minimum.
David Hosier BSc Hons; MSc; PGDE(FAHE).