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Hallucinations in borderline personality disorder and common mental disorders

  • Ian Kelleher (a1) and Jordan E. DeVylder (a2)
Summary

Hallucinations are classically associated with psychotic disorders. Recent research, however, has highlighted that hallucinations frequently occur outside of the context of psychosis. Despite this, to our knowledge, there has been no epidemiological research to compare the prevalence of hallucinations across common mental disorders with the prevalence in borderline personality disorder (BPD). Using data from the Adult Psychiatric Morbidity Survey (n = 7403), we investigated the prevalence of hallucinations in individuals with a range of mental disorders and BPD. Hallucinations were prevalent in all disorders (range 11–24%). Hallucinations were no more prevalent in individuals with BPD (13.7%) than in individuals with a (non-psychotic) mental disorder (12.6%) (χ2 = 0.03, P = 0.92).

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Copyright
Corresponding author
Ian Kelleher, Royal College of Surgeons in Ireland, Ardilaun House, St Steven's Green, Dublin 2, Ireland. Email: iankelleher@rcsi.ie
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Declaration of interest

None.

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References
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1 Scott, J, Martin, G, Welham, J, Bor, W, Najman, J, O'Callaghan, M, et al. Psychopathology during childhood and adolescence predicts delusional-like experiences in adults: a 21-year birth cohort study. Am J Psychiatry 2009; 166: 567–74.
2 McGrath, JJ, Saha, S, Al-Hamzawi, A, Alonso, J, Bromet, EJ, Bruffaerts, R, et al. Psychotic experiences in the general population: a cross-national analysis based on 31,261 respondents from 18 countries. JAMA Psychiatry 2015; 72: 697705.
3 Wigman, JT, van Nierop, M, Vollebergh, WA, Lieb, R, Beesdo-Baum, K, Wittchen, HU, et al. Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity–implications for diagnosis and ultra-high risk research. Schizophr Bull 2012; 38: 247–57.
4 Kelleher, I, Devlin, N, Wigman, JT, Kehoe, A, Murtagh, A, Fitzpatrick, C, et al. Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning. Psychol Med 2014; 44: 1615–24.
5 Schroeder, K, Fisher, HL, Schafer, I. Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical management. Curr Opin Psychiatry 2013; 26: 113–9.
6 Marwaha, S, Broome, MR, Bebbington, PE, Kuipers, E, Freeman, D. Mood instability and psychosis: analyses of British national survey data. Schizophr Bull 2014; 40: 269–77.
7 McManus, S, Meltzer, H, Brugha, T, Bebbington, P, Jenkins, R. Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. NHS Information Centre for Health and Social Care, 2007.
8 Lewis, G, Pelosi, AJ, Araya, R, Dunn, G. Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychol Med 1992; 22; 465–86.
9 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (4th edn) (DSM-IV). APA, 1994.
10 Ekselius, L, Lindstrom, E, von Knorring, L, Bodlund, O, Kullgren, G. SCID II interviews and the SCID Screen questionnaire as diagnostic tools for personality disorders in DSM-III-R. Acta Psychiatr Scand 1994; 90: 120–3.
11 Bebbington, P, Nayani, T. The Psychosis Screening Questionnaire. Int J Meth Psychiatr Res 1995; 5: 11–9.
12 Kelleher, I, Harley, M, Murtagh, A, Cannon, M. Are screening instruments valid for psychotic-like experiences? A validation study of screening questions for psychotic-like experiences using in-depth clinical interview. Schizophr Bull 2011; 37: 362–9.
13 Zanarini, MC, Horwood, J, Wolke, D, Waylen, A, Fitzmaurice, G, Grant, BF. Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year-olds and 34,653 American adults. J Personal Disord 2011; 25: 607–19.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Hallucinations in borderline personality disorder and common mental disorders

  • Ian Kelleher (a1) and Jordan E. DeVylder (a2)
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eLetters

Hallucinations in Borderline Personality Disorder may be more prevalent than community sample study suggests.

Josephine Beatson, Senior Consultant Psychiatrist, Spectrum Statewide Service for Personality Disorder, Eastern Health
Jillian H Broadbear, Senior Research Fellow, Spectrum Statewide Service for Personality Disorder, Eastern Health
Dan I Lubman, Clinical Director at Turning Point Drug and Alcohol Centre, Eastern Health
Sathya Rao, Clinical Director at Spectrum Statewide Service for Personality Disorder, Eastern Health
25 May 2017

We read with interest the report by Kelleher and DeVylder (Mar 2017)1 regarding the prevalence of hallucinations in borderline personality disorder. Their conclusion that hallucinations are no more prevalent in borderline personality disorder than in depression and anxiety was unexpected and raises some interesting points. The prevalence of BPD in the community population they studied is low (0.4%) when compared to previously published prevalence rates of between 0.7 and 2.7%2. This suggests that the Adult Psychiatric Morbidity Survey may lack sensitivity for detecting BPD in a community sample (57% response rate; possible self-selection bias). Similarly, the correlation between hallucinations and borderline personality disorder in this study is considerably lower than clinical experience and research estimates would suggest. Schroeder et al3 reported rates between 20%-50% in a review of findings on the prevalence and clinical management of psychotic symptoms, particularly hallucinations, in BPD. The disparity between these findings may be explained by the use of community versus clinical sampling, since community sampling may underreport severe presentations of borderline personality disorder, which in turn are more likely to be accompanied by hallucinations4.

Well-conducted studies have demonstrated that hallucinations in BPD are highly correlated with the experience of childhood trauma, including childhood sexual abuse3. Childhood trauma is not as prevalent in patients with depression and anxiety. Although a similar prevalence of hallucinations in borderline personality disorder, depression and anxiety, as reported by Kelleher and DeVylder, could suggest that previous prevalence estimates in borderline personality disorder may be compounded by these co-occurring disorders5, we regard this as unlikely.

The probable association between hallucinations and severity of BPD presentation4 suggests that hallucinations might respond well to effective treatment. This is our clinical experience, supported by a small pilot study we conducted in 38 female patients diagnosed with BPD (aged 18-56 at intake). The presence and nature of hallucinations was recorded using the Psychotic Symptom Rating Scale (PSYRATS). At intake, 34% of participants reported hallucinations (PSYRATS score =15.30±17.22). 50% also reported a history of childhood sexual abuse (Childhood Trauma Questionnaire). After 12 months of individual psychotherapy using a common factors approach, the PSYRATS score was 7.00±13.93 (p=0.04). This correlated with a reduction in the number of BPD symptoms assessed using the Structured Clinical Interview for DSM IV-Axis II Personality Disorders (SCID II: intake: 7.00 ±1.63; 12 months: 4.60 ± 1.84, p=0.01). These preliminary data suggest, in agreement with previous findings4, that hallucinations may positively correlate with BPD severity. Our findings also suggest that treating BPD using appropriate psychotherapy reduces the experience of hallucinations.

1.Kelleher I, DeVylder JE. Hallucinations in borderline personality disorder and common mental disorders. BJP 2017, 210:230-231.

2.Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Personal Disord 2010; 24: 412-426.

3.Schroeder K, Fisher HL, Schafer I. Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical management. Curr Opin Psychiatry 2013; 26: 113–9.

4.Slotema CW, Niemantsverdriet MBA, Blom JD, van der Gaag M, Hoek HW, Sommer IEC. Suicidality and hospitalisation in patients with borderline personality disorder who experience auditory verbal hallucinations. European Psychiatry 41 (2017) 47–52.

5.Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry 2004; 161: 2108-2114.

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