Psychosis and Borderline Personality Disorder - Part 1

hi it's dr. Daniel Fox and today we're gonna talk about borderline personality disorder and psychosis now the term borderline actually was originally created because they were identifying folks that were on they were having this condition that appeared to be on the border of psychosis and research though over the years has not really supported this but psychotic symptoms do occur in those with with BPD and this causes us to sort of be more complex than it already is now this is going to be a two-part video now in this video I'm going to discuss the types of psychotic symptoms and the signs and symptoms and how they relate to BPD and then in the second video we'll talk in greater detail about BPD and psychosis and I'll give you some management tips that you might find helpful as well okay so let's get into it and please like share and subscribe to my channel to the video if if you enjoy it please share it with those you think may find it beneficial that would be great alright let's get into it here we go so now in the general public psychotic experiences are reported by proximately 8 to 17 percent of children and adolescents and about 5 percent of adults now one study found that 24 percent of those with BPD reported severe psychotic symptoms and approximately 75% had dissociative in paranoid ideation and we know dissociate dissociation and permanent paranoid ideation is actually a criteria in the DSM for borderline personality source we're not surprised to see 75 percent such a high number of individuals and experience that and I've I've experienced that with a lot of my clients they report having that experience as well a lot of folks have written me in the channel and they've also mentioned experiencing certainly dissociation psychotic like symptoms then I thought well that was sort of the drive to to get this video started so let's let's stay into it let's keep going forward okay so now notice that I'm saying psychotic symptoms not disorder or schizophrenia and that's important to note here that's why this these videos that's why I broke them up into two and why it's a little longer that's because there are symptoms in just the symptom number one symptom or even two symptoms is not enough to qualify for schizophrenia so it's important to be aware of that there are different types of psychotic disorders and we're gonna talk about that that's why I wanted to break everything down now let's break psychotic symptoms down let's really talk about it now the key symptoms of the various psychotic disorders include delusions hallucinations disorganized thinking or speech grossly disorganized behavior and negative symptoms now explain each of these symptoms now now we're going to start with delusions now delusions these are fixed beliefs that are not easily changed even when clear and concrete evidence is presented it's important also recognize that these are considered to be bizarre and clearly implausible and not understandable at the same culture peers okay and do not come from everyday life experiences so here it's important to note that we're stepping outside of the individual's culture right it's always important to take culture into consideration and it is that this is a deviation from those beliefs of that culture okay so it's important to consider that we're going to talk about the five types of delusions as well now there are persecutory delusions persecutory delusions these are the belief that one is going to be harmed harassed and so forth by an individual organization or other group and these are also the most common delusions which are the persecutory delusions now there's another type called referential delusions now these are the belief that certain gestures comments environmental cues and so on directed at oneself at the individual and are also common so this is another referential delusions are also very common as well now the next are grandiose delusions and these were an individual believes that he or she hey has exceptional abilities wealth or fame etc now you might think oh that's your narcissistic personality or no some narcissistic individuals obviously have grandiose beliefs about themselves beliefs about their environment so on and so forth but this is remember it is outside of the culture it is often bizarre so someone for example may believe that that they are a king or they may believe that they have been knighted when they actually haven't so that is more of your grandiose delusion not a belief that I am so special everybody should love me now there's there's a fine line and we can if you're interested please leave me some comments and we can do a narcissistic grandiose delusions you do a whole video on that but I want to stay with with BPD and psychotic symptoms here to keep going okay so that's grandiose delusions and then there's Arado manic delusions now right a manic delusions these are when an individual falsely believes that another person is in love with him or her now the next type there's nihilistic delusions and these are the firm belief that a major catastrophe will occur okay so the apocalypse not the zombie apocalypse could be the zombie Pollock's at apocalypse act actually but that they typically believe that this disease is gonna wipe out the planet and then it's gonna wipe all of us out and that there's going to be you know the all of these particular catastrophes like weather could be a disease could be a lot of different things but they are extreme so these are extreme delusions and outside the norm now the next one these are somatic delusions now somatic delusions this is a preoccupation regarding health an organ function now recognize that each of these delusions have to cause socio-economic they cannot occur right while you're drunk or high and they cannot be better explained by another disorder such as OCD or body dysmorphic disorder for example also if you're on a new medication sometimes people will experience psychotic symptoms associated with with their medication so those aren't actually delusions or psychotic symptoms that they're caused by the substance or it could be the the disease some some diseases progress to a certain area and starts to impact the brain and you can start have to have psychotic symptoms as well so it's important to note that now the next symptom we're going to talk about is hallucinations now these are when you're a countering something that is not actually there by your five senses right your sight sound touch smell or hearing now many of my clients have said that they have hallucinations but they are sometimes they are what's called hypnagogic hallucinations and these are these are the hallucinations that occur before your falling asleep now there's also hypnopompic hallucinations now these occur while you're waking up okay now these are not psychotic in nature this is not we're talking about now but I wanted to be sure that we delineate that because sometimes so my clients like yeah I hallucinate then we'll talk and we'll realize that's when they're waking up or when they're falling asleep those those are hypnagogic or hypnopompic hallucinations that's different than a psychotic disorder or an indication of a brief psychotic episode which we'll talk about in a little bit so they're different that's why it's so important to tease these things out to really investigate take time to learn about about yourself if your mental health provider learn about your clients when these hallucinations are occurring and how they're impacting your client so let's let's kind of stay with loosen ations so now remember these have to have social-economic dysfunction have to contribute to social economic dysfunction that means that you can't go to work or you're not able to keep a job or you can't keep relationships things like that they also occur right while you're not drunk or high right and they cannot be better explained by another disorder now the next category that we're gonna look at is called disorganized thinking or speech now this is composed of like topic jumping like right two different things answering questions in a loosely related fashion like it's very tangential which is you may ask okay one of the things I asked one of my clients is about their daily functioning I said well walk me through your day and some of it like well you know I get up at 6 a.m. and and then I'll have breakfast and then with breakfast I'll watch the news and I can't believe this is happening at the news I can't believe that this is happening and this is happening and that makes me feel good at it and then we go to and we're getting way off the tracks and then have to bring them back and that is being tangential ok but you know also depending on how severe that is that one component being tangential is not psychotic it's going it's having this greater disorganized speech okay and you're taught you're jumping from topic to topic as much as we try to reorient you continue to stay on that topic you go back to that topic and it they become very focused or fixated on that topic a and also what they're saying can also be very jumbled and incoherent which is very different than the tangential example that I just gave you as well hey you know it must be severe enough to impair communication so when I ask you the question you're unable or or the response adji it means very incoherent very jumbled and that is your disorganized thinking or speech again these lead to socio-economic dysfunction cannot occur while you're drunk or high and it cannot be better explained by another disorder notice all of these things have those three components because that is critical we have to rule these things out because it's like how disorder is very very serious okay so the next one that we're gonna talk about next symptom is grossly disorganized behavior and this is displayed in a lot of different ways such as can be someone who's very childlike silliness to an unpredictable agitation now can't Honea falls into this category and there are several ways that catatonia can manifest right it could be like what's called negativism which is a resistance to instruction mutism could also be like a stupor a lack of verbal or motor responses and catatonic excitement see a lot of people think catatonia is catatonia excuse me is that you know you just sit there you don't move but there's also a catatonic excitement okay and this is it's an excessive motor movement a without an obvious cost you're moving in you're moving right and it's going and go and go without an obvious cause so it's not like this individual just did meth and they're moving and moving and moving and they're bouncing around or they did cocaine and they're moving you know obviously that would be a rule out but it's there's no explanation for for this this hyperactive and continual movement so we have to rule that out as well and if you're thinking what about ADHD hyperactivity that's a really that's an excellent thought that's an excellent point okay so that's why we have to rule it out we have to look at how it's happening how it's occurring what is the origin of it and how remember we're talking about grossly disorganized behavior so some folks that are hyperactive you can rein them in for a little bit this is an extreme movement movement movement okay and this constant movement and again cannot the these you're grossly disorganized behavior right has to cause social economic dysfunction cannot be wait junk are high and cannot be better explained by another disorder such as bipolar disorder or depression right or ADHD it's important to rule that out now let's talk about negative symptoms now negative symptoms are significantly associated with schizophrenia but they're less likely to be seen in the other psychotic disorders which we're going to cover in just a little bit negative symptoms are very very critical now there are two prominent negatives symptoms the associated with schizophrenia and they are a diminished emotional expression that's like a facial expression eye contact nonverbal movement there's another type called a volition and this is a lack of motivation or ability to do tasks or activities that have an end goal such as like paying bills attending a school function things like that so these are those negative symptoms now others to consider diminish speech output lack of interest in things that you want to enjoyed a lack of interest in social interactions then this last one does not mean that you're psychotic and having one of these is not either right remember that now these must occur together these symptoms that we just talked about at least two of them and they must occur for an extended period of time impact socio-economic functioning right not better accounted for by another condition or disease and you must be sober while experiencing them so just because as we're going through you're like oh my god you know why can't I have that oh my god I had that that does not mean that you have a psychotic disorder okay it's important to rule that out that's why it's so important to talk to a mental health provider that we sit with you guys and we talk with you folks about what is going on and not just I just simply say oh well you know okay so he or she has you know psychotic features or psychotic episodes or things like that and then just say okay well here you know here's this antipsychotic and everything should be okay so it's very very different okay so having some of these features can complicate borderline personality disorder certainly and for those of you that experience some of these symptoms or maybe several of these symptoms you you know you know what I mean or you may have a loved one who experiences as well and it can get very complex and very difficult to manage and very difficult to rein it in and that's why you know these videos I think in this information is so important so that you can build your insight and understand what symptoms are having in experiences that you're having and learning how to better manage those symptoms so now that we've gone over the symptoms let's like let's talk about the psychotic disorders now this is the psychotic disorders we're going to talk about our schizotypal personality disorder we're talking about brief psychotic disorder we're gonna talk about delusional disorder schizophrenia form I ski so effective and schizophrenia okay so let's get into it so schizotypal personality disorder now this is a persistent pattern of social and interpersonal deficits okay now it includes a reduced capacity for close relationships now cognitive or physical distortions are sometimes present eccentricities of behavior that usually begins in early adulthood but in some cases first becoming a parent in childhood or adolescence now abnormalities and beliefs thinking and perceptions are below the threshold for the diagnosis of psychotic disorder okay so we haven't quite hit it it's not as impactful as your psychotic disorders but what we see is that for skeeto typo it's sort of a very eccentric way of approaching the world very eccentric types of beliefs okay and what I have found is that a lot of these folks are actually misdiagnosed with an autistic spectrum disorder and it is very important to tease that out there are several factors that we can look at and examine to t set out but you know we don't want to be too tangential right we don't want to go off go off the track too much here but if you're interested leave a comment and I can do a sceeto typo PD and autistic spectrum disorder video as well and I know folks have asked for borderline personalities over an autistic spectrum disorder and I'll certainly add that in as well now how do we know the difference between the different psychotic disorders and what about which ones are most likely to impact BPD now I knew that I mentioned a moment ago that we were going to go through each one and the video kin is going to be very very very long and I don't I don't want to do that but I don't feel like I'm taking away from it either so let's let's just talk about that because time is so critical but time is critical also in the diagnosis as well and that's that critical distinguishing factor that's why act talk specifically about schizotypal personality disorder because that is that is very very different the other ones the other types of disorders your brief psychotic disorder your delusional disorder or schizophrenia form skis affective as well as schizophrenia time is such a central component and for brief psychotic disorder now the psychotic symptoms last more than a day and remit by one month schizophrenia form disorder looks just like schizophrenia except that it lasts for less than six months now schizophrenia lasts for at least six months and includes at least one month of active phase symptoms and that means right that we're seeing all the sudden we just talked about hallucinations delusions disorganized thinking and speech all those things that we just talked about now in schizoaffective disorder it is a mood episode and the active phase symptoms so you have a continuation of psychotic symptoms but then you have periods of mood symptoms right that's the affective component so you have the schizo the psychotic symptoms and it is intermixed with affective symptoms that's key to effective very rare and often misdiagnosed who that is a lot of stuff okay many of the psychotic symptoms we discussed may be experienced by those with BPD but a brief psychotic disorder is most likely be associated with those with DPD but also it's important to recognize that those of the PD are at a higher likelihood to actually have a psychotic break that maybe lasts for just a few hours and what happens is sometimes that person has their first psychotic break they go to the hospital and when they're evaluated the the doctor in the emergency room where it is sees the psychotic symptoms hits them with schizophrenia but remember we just talked about all these different types of features and just because you're actively psychotic at that time we have to look the time line that's the critical component and sometimes in the emergency rooms they're not doing that because they're so busy and there's so much going on so it's important that when you're not in crisis that's when we needs to start delineating these symptoms and really sort of examining that but also the other factors as well and I know that I talked about the difference between pure BPD and complex BPD and this would be a good time if you're like what what's that complex BPD has these other symptoms and and components that make BPD more complex to treat and understand and live with so if you have some time check out the second part of this video we're going to get into more specific BPD features and psychosis and things of that nature I hope you enjoyed the video please like share and subscribe and thank you very much and take care bye bye

Channel: Dr. Daniel Fox

Views: 55,977

Rating: 4.9424124 out of 5

Keywords: bpd and psychosis, borderline, borderline personality disorder, bpd, bpd emotions, bpd symptoms, bpd treatment, daniel fox personality disorders, dr fox, dr fox personality, drfox bpd, mental health, signs of borderline personality disorder, signs of bpd, symptoms of bpd, treatment for bpd, psychosis, depression, schizophrenia, mental illness, schizoaffective disorder, psychotic, psychiatry, anxiety, hallucinations, schizoaffective, paranoid, schizophrenic, psychology, life hacks

Id: pWF4mEZzaws

Length: 20min 36sec (1236 seconds)

Published: Sun May 31 2020