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Psychotic features in borderline patients: is there a connection to mood dysregulation?


  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

Antonella Benvenuti, MD, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Via Roma 67, 56100, Pisa, Italy. Fax: +3905021581;


Objective:  To investigate the relationship between lifetime mood and psychotic spectrum features in patients with borderline personality disorder (BPD).

Method:  The study sample consisted of BPD patients with (n = 39, BPD-M) or without (n = 21, BPD-noM) lifetime mood disorders. The diagnostic assessment was conducted with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The diagnosis of BPD was made clinically and then confirmed by Gunderson's diagnostic interview for borderlines. Subjects were also administered the Structured Clinical Interview for Psychotic Spectrum (SCI-PSY) and the Mood Spectrum self-report questionnaire (MOODS-SR).

Results:  BPD-M had significantly higher scores than BPD-noM on the ‘lifetime’ mood spectrum subdomains ‘depressive mood’ and ‘depressive cognition’. The two groups did not differ on the scores of psychotic spectrum except for higher ‘hypertrophic self-esteem’ scores in BPD-noM. In BPD-noM both the depressive and the manic-hypomanic component of mood spectrum were significantly correlated with the ‘delusion’ subdomain of the psychotic spectrum. The depressive component was correlated with ‘depersonalization/derealization’ and the manic-hypomanic component was correlated with ‘hypertrophic self-esteem’. In BPD-M, the manic-hypomanic component of mood spectrum was correlated with different subdomains of the psychotic spectrum: ‘hypertrophic self-esteem’, ‘self-reference’, ‘interpretive attitude’, ‘anger/overreactivity, ‘unusual and odd thoughts’, ‘illusions’, ‘delusions’, ‘hallucinations’ and ‘catatonia’. The depressive component of mood spectrum was ‘uncorrelated’ with the subdomains of the psychotic spectrum.

Conclusions:  Our data support the hypothesis that ‘lifetime’ manic-hypomanic mood dysregulations are correlated with psychotic spectrum features in borderline patients. The assessment of these spectrum features in borderline patients may be useful to inform treatment choices.