Auditory Verbal Hallucinations in Borderline Personality Disorder and the Efficacy of Antipsychotics: A Systematic Review.

Christina W. Slotema,Iris E. C. Sommer,Jan Dirk Blom,Marieke B. A. Niemantsverdriet

doi:10.3389/fpsyt.2018.00347

Abstract

Background: Auditory verbal hallucinations (AVH) are experienced more frequently by patients with borderline personality disorder (BPD) than previously assumed. However, consensus is lacking on how to treat them.Objective: To provide a systematic review of studies reporting on AVH in patients with BPD, with a focus on the efficacy of treatment of psychotic symptoms.Methods: For this review a systematic search was made in the PubMed and Ovid databases, and mean weighted prevalence rates, adjusted for sample size, were computed.Results: The search yielded 36 studies describing a total of 1,263 patients. Auditory hallucinations (including AVH) were reported in 27% of hospitalized BPD patients; AVH were reported in 25% of all patients and in 24% of outpatients. Of the hallucinating patients, 78% experienced AVH at least once per day, for a duration of several days to many years. On the whole, patients with BPD regarded their voices as malevolent and omnipotent in nature. Compared to patients with schizophrenia, the phenomenological characteristics of AVH were similar and the ensuing distress was equal or even higher, whereas scores for other positive symptoms were lower. The presence of AVH in BPD was associated with an increase of suicide plans and attempts, and more frequent hospitalization. Moreover, AVH in the context of BPD were associated with higher prevalence rates for post-traumatic stress disorder and emotional abuse. The efficacy of antipsychotics was investigated in 21 studies. Based on these studies, we conclude that both typical and atypical antipsychotics tend to have positive effects on AVH experienced in the context of BPD. The efficacy of cognitive-behavioral therapy and non-invasive brain stimulation has not yet been systematically assessed.Conclusions: These findings indicate that AVH experienced in the context of BPD are in need of proper diagnosis and treatment, and that antipsychotics tend to be beneficial in treating these (and other psychotic) symptoms.There is an urgent need for studies assessing the efficacy of cognitive-behavioral therapy and non-invasive brain stimulation in this underdiagnosed and undertreated group.

Highlights

Auditory verbal hallucinations (AVH) are voices perceived during wakefulness, in the absence of an external origin [9]
Articles were considered eligible for inclusion when they were written in English and presented original data either regarding auditory hallucinations in patients with a primary diagnosis of borderline personality disorder (BPD), or regarding the efficacy of antipsychotics, cognitive-behavioral therapy (CBT), non-invasive brain stimulation or the effects on treatment on the severity of psychotic symptoms in patients with BPD
Even BPD patients with persistent hallucinations are rarely diagnosed with a DSM-5 diagnosis of schizophrenia spectrum disorder [30], we argue that, in specific cases, it would be better to diagnose both disorders and offer treatment especially when the distress caused by those hallucinations is high

Summary

Introduction

Auditory verbal hallucinations (AVH) are voices perceived during wakefulness, in the absence of an external origin [9]. AVH experienced by patients with BPD have long been characterized as “pseudohallucinations,” since they were thought to be mild and phenomenologically different from those in schizophrenia [19]. This line of thought is still reflected in the operational criteria for BPD featuring in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM-5; [20]], which states that, “Some individuals develop psychotic-like symptoms (e.g., hallucinations, bodyimage distortions, ideas of reference, hypnagogic phenomena) during times of stress.”.

Methods

Results

Discussion

Conclusion