Borderline personality disorder and early psychosis: a narrative review.

Background The purpose of the present review was to summarize the main literature contribution on the relationship between borderline personality disorder (BPD) and early psychosis. While retracing the historical path of the term “borderline”, specifc attention was paid to psychotic and psychotic-like symptoms in BPD. Its relationship with At Risk Mental State was evaluated, as well. Methods This search was conducted on PUBMED/MEDLINE and PsycInfo, looking for“Borderline personality disorder, First Episode Psychosis, Early Psychosis, Ultra-High Risk AND/OR Clinical High Risk” for psychosis. Results Eight pertinent papers were identifed on this topic. Their main fndings were then discussed. The term “borderline” has undergone diferent changes in meaning and use, despite always referring to states considered on the fence between neurosis and psychosis. However, considering the history of psychopathology and its relationship with diagnostic manuals, little attention has been given to its psychotic features. Being those symptoms highly burdensome, this neglect has often led to misdiagnosis and under-treatment. Conclusions Psychotic symptoms in BPD can be severe and distressing. Nonetheless they can be easily neglected, and when found they challenge clinicians in defning a diferential diagnosis to distinguish between BPD and Psychosis Spectrum Disorders. Given specifc needs and interventions for these diferent conditions, a dimensional, rather than categorical, approach should be considered, as well as specifc care pathways and monitoring should be advised.