Auditory verbal hallucinations in patients with borderline personality disorder

Abstract

Auditory verbal hallucinations (AVH) experienced by patients diagnosed with borderline personality disorder (BPD) tend to be considered less severe and qualitatively different from those occurring in the context of psychotic disorders. But only few studies have investigated the prevalence, phenomenology, and severity of AVH in this patient group. We present the results of two studies in which AVH occurring in patients diagnosed with BPD were compared with those in patients diagnosed with schizophrenia. In our two studies, 48 patients diagnosed with BPD, 86 with schizophrenia, and 17 with BPD and schizophrenia were included. In the BPD group, the mean duration of the history of AVH was 17 years, and their phenomenological characteristics did not differ from those in the other two diagnostic groups. Moreover, the negative content of the AVH and the ensuing distress were higher in the BPD group, whereas the disruption of life was higher in the schizophrenia group. We conclude that patients diagnosed with BPD can experience AVH that are very similar to those in patients diagnosed with schizophrenia. Those AVH also tend to exist for substantial periods of time, and to resist differentiation according to their perceived location ('inside' or 'outside' the head). The ensuing distress was found to be high. We therefore conclude that the voices experienced by patients diagnosed with BPD fulfil all the criteria of hallucinations proper, and advise to call them AVH rather than 'pseudohallucinations'. We also advise that more attention be paid to AVH in this patient group, as well as to treatment methods such as antipsychotic agents and psychological interventions.