Hallucinations in patients with borderline personality disorder: characteristics, severity, and relationship with schizotypy and loneliness

Abstract

Hallucinations in patients with borderline personality disorder: characteristics, severity, and relationship with schizotypy and loneliness Slotema CW, Bayrak H, Linszen MMJ, Deen M, Sommer IEC. Hallucinations in patients with borderline personality disorder: characteristics, severity, and relationship with schizotypy and loneliness.Objective: In patients with borderline personality disorder (BPD), data are lacking on characteristics and severity of hallucinations in modalities other than the auditory (verbal) type. The same applies to relationships between hallucinations and the severity of depression, anxiety, schizotypy, and loneliness. Methods: In 60 female patients with BPD (37 also with hallucinations), this cross-sectional study explored characteristics and severity of (i) hallucinations and (ii) schizotypal features, (iii) severity of depression and anxiety, and (iv) loneliness, and the relationships between hallucinations and the other characteristics. Results: In patients with hallucinations, 80% experienced hallucinations in more than one modality; in the different modalities, the characteristics of the hallucinations were similar. The criteria for loneliness were fulfilled in 81% and 48% of patients with and without hallucinations. Compared to patients with BPD without hallucinations, the presence of hallucinations was associated with higher scores for depression, anxiety, loneliness, and schizotypy. Furthermore, the severity of hallucinations showed a positive correlation with the severity of loneliness and schizotypy. Conclusion: Patients with BPD experienced hallucinations with characteristics similar to the more frequently studied auditory (verbal) hallucinations. Higher scores for schizotypy and loneliness indicate that patients with hallucinations had more characteristics of cluster A personality disorders. Significant outcomes• In patients with hallucinations, 80% experienced hallucinations in more than one modality and the characteristics of these hallucinations were similar across the different modalities.• The criteria for loneliness were fulfilled in 81% of patients with hallucinations and in 48% of patients without hallucinations.• Compared to patients without hallucinations, the presence of hallucinations was associated with higher scores for the three clusters of schizotypy. Limitations• Since this study has a cross-sectional design, no assumptions can be made regarding causality.• Also, the study population was of only moderate size.• In most patients, the presence of a schizotypal personality disorder was explored by means of the DSM-5 criteria, without the use of a structured clinical interview.

Preliminary Evidence for the Cognitive Model of Auditory Verbal Hallucinations in Youth With Borderline Personality Disorder

“…The Cronbach’s alpha scores in the current study were 0.94 and 0.87 for depression and anxiety, respectively, indicating excellent internal consistency. The depression and anxiety subscales of the DASS-21 were used as outcome variables in this study measuring amount and intensity of distress instead of the PSYRATS-AH items because a) the DASS-21 subscales are continuous in contrast to the four-point Likert scale of the PSYRATS items, and b) previous research found that nearly two-thirds of voice-hearers diagnosed with schizophrenia experience at least moderate depression (17) and that AVH is associated with increased levels of depression and anxiety in adults with BPD, too (27).…”

“…Recent evidence indicates that AVH in adults with BPD are phenomenologically similar to those in schizophrenia, elicit high levels of distress, depression, and anxiety, and are associated with more psychiatric comorbidity, suicidal plans and attempts, and hospitalizations (2–3, 4, 6, 25–27). Limited evidence exists regarding whether the cognitive, emotional, and behavioral responses to voices in patients with BPD are similar or different to those in patients with schizophrenia.…”

Self-isolation, psychotic symptoms and cognitive problems during the COVID-19 worldwide outbreak

“…Overall, the relationship between social isolation (or loneliness) and psychotic symptoms appears robust, as it has been described in various conditions: borderline personality disorder ( Slotema et al, 2019 ), Alzheimer disease ( El Haj et al, 2016 ), psychotic continuum ( Chau et al, 2019 ) and the general population ( Narita et al, 2020 ).…”

Psychosis proneness, loneliness, and hallucinations in nonclinical individuals

“…Loneliness is a specific stressor that has been linked to psychotic-like experiences Previous work suggests that aspects of social isolation, like living alone or feeling lonely, are associated with emergence of psychotic-like symptoms [ 16 ]. The association between loneliness and hallucinations has been demonstrated across several different disorders including borderline personality disorder [ 17 ], Alzheimer’s disease [ 18 ], and psychosis [ 19 ]. Additionally, in the presence of loneliness, psychotic-like symptoms increased for individuals with high levels of negative and disorganized schizotypal traits [ 20 ].…”