Psychotic Experiences in Borderline Personality Disorder: The Relationship with Childhood Trauma

This study aimed to explore the relationship between psychotic experiences, their severity (distress), and childhood trauma in individuals diagnosed with borderline personality disorder (BPD) within an Egyptian adult population.

Using a cross-sectional design, the study analyzed psychotic experiences, associated distress, and childhood trauma in a sample of 117 participants, including individuals with BPD and matched controls. Standardized self-report measures were administered to assess psychotic experiences, psychotic symptom severity (distress), and childhood trauma history. Path analysis was conducted to investigate trauma types as predictors of psychotic outcomes and BPD diagnosis.

Participants with BPD reported significantly higher levels of psychotic experiences and distress compared to controls. All subtypes of childhood trauma were more prevalent in the BPD group. Among these, physical neglect and sexual abuse emerged as significant predictors of psychotic symptoms and distress. Path analysis identified physical neglect as the strongest predictor of BPD, showing both direct and indirect effects on psychotic symptomatology.

The findings highlight the role of specific trauma types - particularly physical neglect - in the development of BPD and its psychotic features. By integrating Linehan’s Biosocial Model with trauma theory, the study emphasizes how early neglect may shape invalidating environments, contributing to BPD symptom expression. Physical neglect appeared to be a key risk factor, potentially contributing to BPD development and subsequent psychotic experiences and distress in Egyptians.

The study expanded existing research on trauma-based models of BPD and its psychotic symptoms, providing culturally relevant insights into the impact of childhood trauma and emphasizing the role of social environments and early relational experiences in non-Western contexts. By integrating Linehan’s Biosocial Model with trauma theory, this study's findings highlighted that early physical neglect – often overlooked in BPD models – may strongly contribute to shaping invalidating environments and thus influencing BPD symptom expression.