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Avoiding Misdiagnosis When Auditory Verbal Hallucinations Are Present in Borderline Personality Disorder

Beatson, Josephine A. FRANZCP; Broadbear, Jillian H. PhD; Duncan, Charlotte FRANZCP; Bourton, David BSc; Rao, Sathya FRANZCP

The Journal of Nervous and Mental Disease: December 2019 - Volume 207 - Issue 12 - p 1048–1055
doi: 10.1097/NMD.0000000000001073
Review Article

Misdiagnosis is common for patients with a primary diagnosis of borderline personality disorder (BPD) who experience auditory verbal hallucinations (AVHs). AVHs in BPD are associated with severe BPD and high levels of suicidality. Wrongly treating these patients as though they are suffering from schizophrenia or other primary psychotic disorder and not treating BPD can cause significant iatrogenic damage. We outline a specific pattern of symptoms and phenomenology that will assist diagnostic accuracy in these cases. A focused review identified the following characteristic pattern: AVHs in BPD cannot be distinguished phenomenologically from AVH in schizophrenia, often meet the criteria for First-Rank Symptoms (FRSs), are highly stress related, and are strongly associated with dissociative experiences and childhood trauma. Formal thought disorder is uncommon, negative symptoms are usually absent, bizarre delusions are absent, affect remains reactive, and sociability is usually retained. Diagnostic accuracy can be improved by examining the overall clinical presentation and is essential to improving the prognosis for these patients.

Spectrum, Statewide Service for Personality Disorder, Eastern Health, Richmond, Australia.

Send reprint requests to Josephine A. Beatson, FRANZCP, 1/17 Park Tower, 201 Spring St, Melbourne, Victoria 3000, Australia. E-mail:

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