Abstract
Objectives
Objectives: To review the literature regarding the presence of hallucinations in borderline personality disorder (BPD) considering etiology, characteristics and association with comorbid symptoms.
Methods
Methods: We conducted a MEDLINE search using borderline personality disorder and hallucinations as keywords, selecting studies written in English.
Results
Results: Initially considered as a para-psychotic disorder, BPD was effectively redefined as an independent category by Otto F. Kernberg (1975), leading to its DSM-III definition, which excluded any psychotic symptom. Conversely, over the last decades, multiple studies indicated that hallucinations are far from rare in patients with BPD. Prevalence rates range from 26 to 54% and hallucinations are not restricted to a single sensory modality, with the auditory ones being the most frequent. Regarding etiology, it has been suggested that comorbid psychiatric disorders might well constitute the true cause of hallucinations in BPD. However, the evidence is not univocal. Clinical experience and research suggest that hallucinations in BPD are often dissociative in nature, highly correlated with the presence Schneider's first-rank symptoms and a history of childhood trauma. The hallucinatory experiences observed in BPD seemed phenomenologically similar to those described in the schizophrenia spectrum and they are experienced as equally or more severe than those in patients diagnosed with a schizophrenia, tending to be longstanding, highly distressing and a source of disability.
Conclusions
Conclusion: Hallucinations in BPD continue to be poorly understood and data are lacking on characteristics, severity and relationship between comorbid symptoms. Further research should try to clarify their pathophysiology. Such endeavor may contribute to develop more effective treatments for BPD.
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