Abstract
Several mechanisms have been suggested to explain why adverse outcomes may be more likely when psychosis occurs in the presence of borderline personality traits. This article focuses on early psychosis, and suggests an additional mechanism: that adverse outcomes may stem from confusion over diagnostic issues. Observations from everyday practice are cited, particularly the notion that these individuals do not have “real” psychosis, and the arguments sometimes used to justify this view. We discuss some problems with these ways of thinking, and then consider how they may lead to adverse outcomes.