Psychosis and BPD
Recently, I was practicing modified yoga following a minor surgery. The woman leading the YouTube video wore a large smile. I followed along but her smile soon turned sinister. For a moment, I was convinced she was leering at me—that she could somehow understand my inner thoughts. I was sure she sensed all my failings and was mocking me. I shook my head, reminded myself it was a pre-recorded video, and tried to ignore the adrenaline spike and my racing pulse.
Psychosis involves losing contact with reality, and often manifests as hallucinations (seeing or hearing things that aren’t there) or delusions (false strong beliefs that aren’t shared by others). The connection between borderline personality disorder (BPD) and psychosis is often overlooked because it’s not technically a diagnostic symptom of the disorder. While paranoia is a symptom of BPD, it’s categorized as transient or stress-related, which differentiates it from the delusion paranoia common to psychosis.
However, psychosis is common in people with BPD. A 2016 study found that 20 to 50 per cent of people with BPD report experiencing psychotic symptoms. More recent research revealed that 81 per cent of individuals with BPD reported visual or tactile hallucinations, 75 per cent experienced olfactory hallucinations, and 94 per cent experienced delusions.
Why does this matter? Historically, psychotic symptoms in people with BPD have been dismissed as fake, impermanent, or “pseudo” in nature. As a 2021 article notes, including psychotic symptoms in BPD diagnoses can promote early intervention, prevent the development of severe mental illness, and improve overall health outcomes. It’s time to stop overlooking psychosis in BPD.
Meme of the Month
Mad Misinformation
It’s dissociation, not disassociation.
Nearly every day, I watch a TikTok video in which someone uses the word “disassociation.” And nearly every day, it irks me to no end.
Let’s be clear here: it’s “dissociation” not “disassociation,” particularly when discussing mental health.
First, let’s turn to the Diagnostic and Statistical Manual of Mental Disorders (any edition), a book that defines psychiatric illness. Nowhere in its pages can the word “disassociate” be found. It’s also missing from the regular and Canadian versions of the Oxford English Dictionary. Even the Wikipedia entry redirects to “dissociation.”
So why do so many people use it? “Disassociate” was once listed as a synonym for “dissociate” in the 4th edition of the Webster’s New World College Dictionary, which many American newsrooms use. The word, “disassociate” occasionally appeared in media in the early aughts; however, it was rarely used in mental health contexts. Take this New York Times headline: “U.N. Moves to Disassociate Itself From Remarks by Envoy to Iraq.” Here, disassociate is used to refer to the act of distancing oneself from a group or idea—it’s social and ideological separation as opposed to psychological. In a mental health context, dissociation is when an individual experiences a disconnection or lack of continuity between thoughts, memories, surroundings, sense of identity, or perceptions.
Say it with me: IT’S DISSOCIATION NOT DISASSOCIATION.
Thanks for reading. If you want to read more of my words, buy my book, read about my writing process, or hear me read unpublished work at Draft Reading Series on November 23rd at 2:30 p.m. EST.