A cross‐sectional study of auditory verbal hallucinations experienced by people with a diagnosis of borderline personality disorder

Abstract

Background The presence of auditory verbal hallucinations (AVHs) does not currently feature in the main diagnostic criteria for borderline personality disorder (BPD). However, there is accumulating evidence that a high proportion of BPD patients report longstanding and frequent AVHs which constitute a significant risk factor for suicide plans and attempts, and hospitalization. Aim This study addressed questions about the validity and phenomenology of AVHs in the context of BPD. The longer‐term aim is to facilitate the development and translation of treatment approaches to address the unmet need of this population. Method This was a cross‐sectional study, combining phenomenological and psychological assessments administered in person and online. We explored the experiences of 48 patients with a diagnosis of BPD who were hearing AVHs. Results Participants gave ‘consistent’ reports on the measure of AVH phenomenology, suggesting that these experiences were legitimate. Similar to AVHs in a psychosis context, AVHs were experienced as distressing and appraised as persecutory. AVHs were found to be weakly associated with BPD symptoms. AVHs were also rated highly as a treatment priority by the majority of participants. Conclusion The findings suggest that AVH is a legitimate and distressing symptom of BPD and a treatment priority for some patients. The relative independence of AVHs from other BPD symptoms and emotional states suggests that psychological treatment may need to be targeted specifically at the symptom of AVHs. This treatment could be adapted from cognitive behaviour therapy, the psychological intervention that is recommended for the treatment of AVHs in the context of psychosis.

From core schemas about the self and others to voice phenomenology: Anxiety and depression affect voice hearers differently

“…For example, Cole et al (2017), has suggested a path model in a transdiagnostic sample of voice hearers, where voice distress arises from anxious and avoidant attachment style, leading to negative schemas via persecutory beliefs about voices. As Hayward et al (2021) found a positive association between positive self schemas and benevolent beliefs about voices, a similar pathway to that of Cole et al (2017) might exist for protective factors.…”

A phenomenological comparison of auditory hallucinations between borderline personality disorder and schizophrenia: A systematic review

“…AHs in BPD were found to be persistent (Merrett et al, 2022; Pearse et al, 2014; Slotema et al, 2012, 2019; Yee et al, 2005) and repetitive (Merrett et al, 2022; Slotema et al, 2019). BPD clients were found to experience more than one AH (Adams & Sanders, 2011; Hayward et al, 2021; Pearse et al, 2014), which varied from second to third person (Pearse et al, 2014) and ranged from single to several sentences (Merrett et al, 2022). AH location in BPD occurred both internally and externally (Adams & Sanders, 2011; Hayward et al, 2021; Pearse et al, 2014; Slotema et al, 2012; Yee et al, 2005), and the content of AHs was predominantly negative and critical (Merrett et al, 2022; Pearse et al, 2014; Slotema et al, 2017, 2019; Yee et al, 2005).…”

“…BPD clients were found to experience more than one AH (Adams & Sanders, 2011;Hayward et al, 2021;Pearse et al, 2014), which varied from second to third person (Pearse et al, 2014) and ranged from single to several sentences (Merrett et al, 2022). AH location in BPD occurred both internally and externally (Adams & Sanders, 2011;Hayward et al, 2021;Pearse et al, 2014;Slotema et al, 2012;Yee et al, 2005), and the content of AHs was predominantly negative and critical (Merrett et al, 2022;Pearse et al, 2014;Slotema et al, 2017Slotema et al, , 2019Yee et al, 2005). BPD clients reported that AHs were experienced as uncontrollable (Yee et al, 2005) and tended to hold negative beliefs about them (Hayward et al, 2021;Slotema et al, 2017;Strawson et al, 2022).…”

“…Nine studies explored the phenomenology of AHs in BPD (see Table 3) (Adams & Sanders, 2011;Hayward et al, 2021;Merrett et al, 2022;Pearse et al, 2014;Slotema et al, 2012Slotema et al, , 2017Slotema et al, , 2019Strawson et al, 2022;Yee et al, 2005). AHs in BPD were found to be persistent (Merrett et al, 2022;Pearse et al, 2014;Slotema et al, 2012Slotema et al, , 2019Yee et al, 2005) and repetitive (Merrett et al, 2022;Slotema et al, 2019).…”

“…However, upon examining the domains of the Brief Core Schema Scale (BCSS) in relation to AH-related distress, no evidence was found to indicate that negative self-schema is associated with an increase in AH-related distress in BPD (Hayward et al, 2021). Hence, it might be that negative self-schema contributes to heightened depression in BPD but does not necessarily lead to increased distress specifically related to AHs.…”