Hallucinations in borderline personality disorder: Prevalence, characteristics and associations with comorbid symptoms and disorders

Maria B A Niemantsverdriet,Iris E C Sommer,Mark Van Der Gaag,Ingmar H Franken,Christina W Slotema,Jan Dirk Blom,Hans W Hoek

doi:10.1038/s41598-017-13108-6

Maria B A Niemantsverdriet, Iris E C Sommer + Show 5 more

Open Access

https://doi.org/10.1038/s41598-017-13108-6

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Abstract

To establish the point prevalence of hallucinations in borderline personality disorder (BPD), telephone interviews were conducted with 324 outpatients diagnosed with BPD. Then a subgroup (n = 98) was interviewed in person to investigate the co-occurrence of these phenomena with other psychotic symptoms, comorbid psychiatric disorders, prior childhood adversities, and adult life stressors. For hallucinations in general a point prevalence of 43% was found, with rates for hallucinations in separate sensory modalities ranging from 8–21%. Auditory verbal hallucinations consisted mostly of verbal abuse and were generally experienced as distressing. A significant association was found between the severity of hallucinations on the one hand, and delusions and unusual thought content on the other; this association was absent for negative symptoms and disorganization. The presence of hallucinations also correlated with the number of comorbid psychiatric disorders, and with posttraumatic stress disorder (PTSD) specifically. Childhood emotional abuse and adult life stressors were also associated with hallucinations. The latter three associations suggest that patients with BPD might have an etiological mechanism in common with other patient/nonpatient groups who experience hallucinations. Based on these findings, we advise to treat PTSD and hallucinations when found to be present in patients with BPD.

Highlights

In clinical practice, hallucinations experienced by patients with borderline personality disorder (BPD) are often designated as ‘pseudohallucinations’ to express the suspicion that they do not qualify as hallucinations proper[1]
The Psychotic Symptom Rating Scale (PSYRATS) interview was conducted among 28 of the patients who participated in the face-to-face interviews and experienced auditory verbal hallucinations (AVH) at least once per week
Our analysis of 324 outpatients diagnosed with BPD yields a point prevalence for hallucinations of 43%, with half of the hallucinations being multimodal in nature

Summary

Introduction

Hallucinations experienced by patients with borderline personality disorder (BPD) are often designated as ‘pseudohallucinations’ to express the suspicion that they do not qualify as hallucinations proper[1]. Studies during the last decade indicate that hallucinations proper are far from rare in patients with BPD, with prevalence rates ranging from 26–54%3,4 These hallucinations are not restricted to a single sensory modality: 21–59% of them are auditory, 30–33% visual, 10–30% olfactory, and 13% tactile in nature[1,3,5,6,7]. Regarding the DSM-5 criterion which states that hallucinations in BPD are only experienced during times of stress[2], we found only one empirical study to support that view, i.e. Glaser, van Os, Thewissen & Myin-Germeys[16] reported that hallucinatory reactivity in response to self-reported daily life stresses was significantly stronger in this group than in healthy controls and patients with a cluster C personality disorder

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