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Lincoln, Tania M. and Peters, Emmanuelle 2018. A systematic review and discussion of symptom specific cognitive behavioural approaches to delusions and hallucinations. Schizophrenia Research,
Pellicciari, Alessandro Tedesco, Paola and Chiodo, Simona 2018. Transient hallucinations during interpersonal stress in an adolescent with borderline personality disorder. Australian & New Zealand Journal of Psychiatry, p. 000486741775355.
Baryshnikov, Ilya Aaltonen, Kari Suvisaari, Jaana Koivisto, Maaria Heikkinen, Martti Joffe, Grigori and Isometsä, Erkki 2018. Features of borderline personality disorder as a mediator of the relation between childhood traumatic experiences and psychosis-like experiences in patients with mood disorder. European Psychiatry, Vol. 49, p. 9.
Hardy, Amy 2017. Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis. Frontiers in Psychology, Vol. 8,
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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Lincoln, Tania M. and Peters, Emmanuelle 2018. A systematic review and discussion of symptom specific cognitive behavioural approaches to delusions and hallucinations. Schizophrenia Research,
Pellicciari, Alessandro Tedesco, Paola and Chiodo, Simona 2018. Transient hallucinations during interpersonal stress in an adolescent with borderline personality disorder. Australian & New Zealand Journal of Psychiatry, p. 000486741775355.
Baryshnikov, Ilya Aaltonen, Kari Suvisaari, Jaana Koivisto, Maaria Heikkinen, Martti Joffe, Grigori and Isometsä, Erkki 2018. Features of borderline personality disorder as a mediator of the relation between childhood traumatic experiences and psychosis-like experiences in patients with mood disorder. European Psychiatry, Vol. 49, p. 9.
Hardy, Amy 2017. Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis. Frontiers in Psychology, Vol. 8,
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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Conflict of interest: None Declared
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