Affiliation:
1. Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN) King's College London London UK
2. Brent Early Intervention Service CNWL, NHS Foundation Trust London UK
Abstract
AbstractObjectiveBorderline personality disorder (BPD) with auditory hallucinations (AHs) may inadvertently be misdiagnosed with a primary psychotic disorder, such as schizophrenia (SZ). This misidentification can lead to challenges in providing effective psychological treatment. This review therefore aims to identify the phenomenological characteristics of AHs in BPD in comparison to SZ, as well as psychological interventions that explicitly target AHs in BPD.MethodsA systematic review was conducted to summarise the existing evidence base regarding the phenomenological similarities and differences of AHs in BPD and SZ, along with the identification of psychological interventions for AHs in BPD.ResultsEighteen studies were eligible for inclusion. Compared to the SZ group, BPD clients were characterised by more persistent and repetitive AHs, significantly more voice‐related distress and appraisals of omnipotence, and an earlier age of onset of AHs. The BPD group also reported more severe depression and anxiety, a higher incidence of childhood trauma, and more negative self‐schema. Cognitive Behaviour Therapy Coping Strategy Enhancement (CBT‐CSE) might be a promising intervention to reduce AH‐related distress in BPD, although further studies are required to determine its effectiveness.ConclusionIn order to prevent misdiagnosis of AHs in BPD, the DSM‐5 may need to acknowledge the broader and more frequent occurrence of psychosis symptoms in BPD clients. Such clarification may enhance diagnostic practices and facilitate more timely access to treatment. There is also a need to develop and trial psychological interventions that explicitly target AHs in BPD.