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

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-no M) 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-no M 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-no M. In BPD-no M 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.