Borderline personality disorder (BPD) is a serious mental health condition that usually begins during late adolescence. Young people with BPD often struggle to hold a clear sense of self-identity and experience patterns of unstable relationships. They may experience chronic feelings of emptiness and other intense emotions and be prone to impulsive and risky behaviours.
Hallucinations and delusions are some of the lesser-known – and less often discussed – symptoms of BPD. While research shows that these experiences are common among young people with the disorder, conversations and awareness about the connection are still lacking. In assessments and treatment, they are also often overlooked.
Without support, BPD symptoms can make daily life difficult – and sometimes feel almost impossible – for young people. However, with effective treatment alongside awareness and support from the community around them, adolescents and young adults can live fulfilling and happy lives. That’s why it’s so important to increase our understanding of how BPD affects young people – and ensure they can access the treatment that they need.
This blog offers some information about hallucinations and delusions among young people with BPD, why they happen, and how treatment can support them to manage or recover from their distressing experiences.
What Are Hallucinations and Delusions?
Hallucinations and delusions happen when someone perceives or believes reality very differently from other people. They are types of psychotic experiences, also known as psychosis.
While psychotic experiences can feel very frightening or distressing, they are quite common, even among people who don’t have a mental health condition, affecting one in fifty people at some point in their lives. Among young people with BPD, these rates are higher.
- Hallucinations are when someone hears, sees, feels, or smells something that other people do not. They might involve hearing voices or seeing objects move in a way they normally do not.
- Delusions are beliefs that other people don’t share and that are shown to be untrue by other perceptions or experiences. They might involve ideas of heightened self-importance (delusions of grandeur) or threats to the self or others (paranoid delusions).
While psychosis is surrounded by a lot of stigma, in reality, people with psychosis are not dangerous. Instead, young people who have psychotic experiences require care and support to help them manage or reduce their experiences and navigate everyday life.
How Common Are Hallucinations and Other Experiences of Psychosis Among People With BPD?
Research shows that between 26% and 54% of people with BPD experience hallucinations, delusions, or other types of psychosis. They’re most likely to experience auditory hallucinations of repetitive words or whole phrases. Many people say that their hallucinations are connected to previous traumatic experiences.
Some people with BPD find that their hallucinations are mildly distressing, while for others they cause severe distress. They may affect their ability to navigate one part of their day or have a wider effect.
While hallucinations and delusions are common in young people with BPD, disorganised and negative psychotic symptoms (such as disorganised thinking, slowed speech or thinking, decreased motivation, or a lack of interest in others) are relatively rare.
When these symptoms co-occur, it may be a sign that a young person is living with a comorbid psychotic disorder alongside BPD.
Why Do People With BPD Experience Hallucinations and Delusions?
Psychotic experiences can have many different causes, and scientists are still learning about exactly why they happen. Some of these causes may include:
- Physical illness or injury
- Traumatic experiences or abuse
- Social isolation
Some of these factors, including a history of trauma, stress, and social isolation, are common among young people with BPD. These experiences may make it more likely that they experience psychotic episodes and go some way to explaining the links between BPD and psychosis.
Childhood Trauma, Disassociation, and Hallucinations
Young people with borderline personality disorder are much more likely than other people to have experienced trauma or abuse during childhood or adolescence.
When a young person with BPD dissociatesChildhood trauma can affect the way young people develop emotionally and learn to form relationships with others. In particular, abuse or neglect from a caregiver can lead to insecure attachments to others and fears of abandonment that characterise BPD.
These experiences of trauma may also make psychotic experiences more likely. Studies have found that hallucinations in individuals with BPD are associated with post-traumatic stress disorder and a history of childhood trauma, especially emotional abuse.
Research has also shown that auditory verbal hallucinations (like hearing voices) are associated with experiences of dissociation and childhood trauma among young people with BPD. Dissociation is a type of stress response to situations that are too intense or distressing for the mind or body to cope with.
When a young person with BPD dissociates, they experience a disconnect between their thoughts, emotions, perceptions, identity, and body. They may feel like they are separated from their body or that the external world feels unreal or unfamiliar.
Experts think that people with BPD may experience dissociative symptoms more often than those with schizophrenia or other psychotic disorders. This relationship may help mental health professionals to effectively identify and diagnose BPD where psychosis is present and distinguish it from other disorders.
Hallucinations and Stress
Scientists think that feeling stressed can contribute to or trigger experiences of psychosis. Stress is a reaction to internal or external events that cause tension in our minds and bodies.
Our stress responses are complex and involve different functions, including the release of hormones like cortisol, adrenaline, and dopamine. Research has found that dopamine dysregulation can lead to psychotic symptoms and may in part explain the link between stress and hallucinations.
While there is still not much research exploring how stress affects hallucinations among people with BPD, some studies suggest a possible connection.
One study found that those with the most current life stressors were more likely to experience hallucinations. Another found that people with BPD experience stronger psychotic responses to stress than other people, including those with psychotic disorders, other personality disorders, and those without either.
Loneliness and Hallucinations
Young people experience loneliness when they feel like they lack meaningful social connections with others. People with BPD may be especially likely to feel lonely, especially when they struggle to maintain stable and supportive relationships with friends, partners, or others around them.
Loneliness, boredom, isolation, and hopelessness may also be related to (or constitute) the chronic feelings of emptiness that characterise BPD.
Experts think that loneliness and isolation may contribute to the development or content of psychotic experiences. Schizophrenia is strongly associated with previous social isolation, and research has found a positive correlation between loneliness and psychosis.
Scientists aren’t exactly sure about why loneliness and psychosis are linked – but they have some ideas. One theory suggests that when some vulnerable people experience loneliness, their brain creates a series of false social connections in the form of complex hallucinations and delusions.
Others propose that as humans, we instinctively want and need to maintain social relationships with others in our environment. When this is not possible, people may compensate for loneliness by perceiving humanness in non-human objects. This may manifest as hearing voices or other hallucinations.
BPD and Psychotic Experiences in Young Adulthood
Both borderline personality disorder and psychosis usually begin during adolescence. Some studies have explored whether a BPD diagnosis might increase the risk of psychotic symptoms turning into a psychotic disorder, but they found that it neither increased nor decreased the risk.
Other research has looked into the experience of young people with BPD with, and without, psychotic symptoms. They found that those who had psychotic experiences tended to experience more severe BPD symptoms in general and those with auditory hallucinations were more likely to self-harm, dissociate, have paranoid thoughts, and feel distressed.
Young people with BPD and hallucinations tended to be most at risk of developing other mental health disorders later on, including both psychotic and non-psychotic disorders.
Treating Borderline Personality Disorder, Hallucinations, and Delusions
For young people with BPD, hallucinations and delusions can feel scary and distressing. They can also make it more difficult to focus on things like school or work and pursue the things they care about.
The good news is that hallucinations, delusions, and other BPD symptoms are treatable. With effective support, young people can learn to manage or reduce psychotic experiences and lead fulfilling daily lives.
Some young people may be able to fully recover from psychosis and not experience any future episodes. Treatment and interventions can also help prevent symptoms from becoming more severe or other mental health conditions developing.
Some evidence-based approaches that may treat psychotic experiences include:
- Anti-psychotic medication can help to reduce, stop, or decrease the intensity of psychotic experiences
- Cognitive-behavioural therapy can help young people to reduce the distress associated with psychotic experiences and understand what they are and what may trigger them
- Interpersonal therapies to help young people remain connected to others
- Life skills training that supports independence and self-care
For young people with BPD, treatment for hallucinations and delusions should make up part of a wider program that addresses the other aspects of their disorder and offers care and support in their daily lives.
Support for young people with BPD usually involves a team of different professionals, community members, and loved ones who can support them to manage symptoms, respond to a crisis, and work with them to plan for the future.
Within this team, psychologists, psychiatrists, and mental health professionals offer therapeutic support that addresses the symptoms and characteristics of the disorder. Therapeutic options may include:
- Cognitive behavioural therapy (CBT) helps young people identify and change core beliefs and behaviours that may underlie emotional distress, unstable sense of self, and interpersonal difficulties. CBT can improve symptoms of anxiety and help young people develop healthy coping mechanisms instead of engaging in self-harm or suicidal behaviours.
- Dialectical behavioural therapy (DBT) is a type of CBT developed specifically for borderline personality disorder. It focuses on acceptance and understanding as well as change, supporting young people to understand where their emotions and behaviours come from and avoid self-blame while developing strategies to change unhelpful behaviours into more positive ones. DBT centres around skills training that usually takes place in groups, emphasising mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation.
- Mentalisation-based therapy (MBT) centres around mentalisation skills – the ability to think about thinking. Many young people with BPD experience strong urges to act in a certain way and follow these urges without thinking. MBT teaches them to examine their thoughts, feelings, and impulses, take a step back, think about where they come from, and assess whether they are valid.
- Arts therapy can support young people with BPD who find it hard to express their feelings verbally. Sometimes, teenagers and adolescents may be experiencing suppressed emotions that feel too difficult to mentalise or articulate with words. Creative arts therapies, including art, music, or drama, use creation as an alternative form of expression that can help them communicate with a therapist or others around them.
For young people with BPD, reaching out for help is the most important thing. With the right support, teenagers, adolescents, and adults with the disorder can lead productive and fulfilling lives and pursue the things they care about.
The Wave Clinic – Transformative Recovery Programs for Young People
The Wave Clinic offers specialist recovery programs for young people who are living with borderline personality disorder, eating disorders, and other mental health concerns.
Our trauma-focused approach addresses the underlying causes of their experiences while supporting teenagers and adolescents to plan and build better futures.
Situated in Malaysia, our residential centre sets the global standard for young people’s mental health care, combining exceptional clinical care with education, community connections, and a gap year experience.
At the Wave, our core values of inclusivity, acceptance, and fairness permeate everything we do. We believe that every young person should be able to access exemplary treatment, regardless of their presenting issues.
We support young people to grow in self-confidence, reconnect with themselves, and find a life path where they can realise their true selves.
If you’d like to find out more about our programs, contact us today. We’re here to help.