Over the years, there have been various perspectives on psychotic symptoms associated with borderline personality disorder (BPD) and their management. There has been a lack of consistency in defining or classifying these symptoms, as well as an absence of guidelines to assist clinicians in treating these patients in clinical settings. The use of polypharmacy and various medications has occurred without established protocols regarding dosage, treatment duration, or outcome assessment. This narrative review examines the evidence surrounding these symptoms and their management to support clinicians in their everyday practice. Further research is essential for effective long-term management.