Background: Auditory verbal hallucinations (AVH) are experienced by 21-54% of patients diagnosed with a borderline personality disorder (BPD), and ensuing distress is often high. Little is known about the beliefs these patients foster about their voices, and the influence thereof on distress and need for hospitalisation. Methods: In a convenience sample of 38 BPD outpatients with AVH, data were collected with the aid of the Psychotic Symptom Rating Scales (PSYRATS), Beliefs about Voices Questionnaire (BAVQ), Social Comparison Rating Scale (SCRS), and Voice Power Differential Scale (VPDS). Results: The majority of patients with BPD who experience AVH rate their voices as malevolent and omnipotent, and higher in social rank than themselves. Moreover, their resistance against them tends to be high. These parameters correlate positively and significantly with high levels of distress experienced in relation to these AVH. The need for hospitalisation, in turn, is associated with high scores for omnipotence of the voices and distress due to AVH. However, these findings could not be confirmed in regression analyses. Conclusions: As negative beliefs can be altered with cognitive-behavioural therapy (CBT), we expect CBT to be beneficial in the treatment of AVH in BPD patients, whether or not in combination with antipsychotic medication.

Kingdon DG, Ashcroft K, Bhandari B, Gleeson S, Warikoo N, Symons M, et al: Schizophrenia and borderline personality disorder: similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma. J Nerv Ment Dis 2010;198:399-403.
Slotema CW, Daalman K, Blom JD, Diederen KMJ, Hoek HW, Sommer IE: Auditory verbal hallucinations in patients with borderline personality disorder are similar to those with schizophrenia. Psychol Med 2012;42:1873-1878.
Schroeder K, Fisher HL, Schäfer I: Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical management. Curr Opin Psychiatry 2013;26:113-119.
Aleman A, Larøi F: Hallucinations: The Science of Idiosyncratic Perception. Washington, American Psychological Association, 2008.
Daalman K, Boks MP, Diederen KM, de Weijer AD, Blom JD, Kahn RS, et al: The same or different? A phenomenological comparison of auditory verbal hallucinations in healthy and psychotic individuals. J Clin Psychiatry 2011;72:320-325.
Chadwick PDJ, Birchwood M: The omnipotence of voices. A cognitive approach to auditory hallucinations. Br J Psychiatry 1994;164:190-201.
Hill K, Varese F, Jackson M, Linden DE: The relationship between metacognitive beliefs, auditory hallucinations, and hallucination-related distress in clinical and non-clinical voice-hearers. Br J Clin Psychol 2012;51:434-447.
Peters ER, Williams SL, Cooke MA, Kuipers E: It's not what you hear, it's the way you think about it: appraisals as determinants of affect and behaviour in voice hearers. Psychol Med 2012;42:1507-1514.
Van der Gaag M, Hageman MC, Birchwood M: Evidence for a cognitive model of auditory hallucinations. J Nerv Ment Dis 2003;191:542-545.
Lobban F, Haddock G, Kinderman P, Wells A: The role of metacognitive beliefs in auditory hallucinations. Pers Individ Dif 2002;8:1351-1363.
Blom JD: Auditory hallucinations. Handb Clin Neurol 2015;129:433-455.
Larøi F, Sommer IE, Blom JD, Fernyhough C, Ffytche DH, Hugdahl K, et al: The characteristic features of auditory verbal hallucinations in clinical and nonclinical groups: state-of-the-art overview and future directions. Schizophr Bull 2012;38:724-733.
Blom JD: A Dictionary of Hallucinations. New York, Springer, 2010.
Slotema CW, Niemantsverdriet MBA, Blom JD, van der Gaag M, Hoek HW, Sommer IE: Suicidality and hospitalisation in patients with borderline personality disorder who experience auditory verbal hallucinations. Eur Psychiatry 2017;41:47-52.
Hepworth CR, Ashcroft K, Kingdon D: Auditory hallucinations: a comparison of beliefs about voices in individuals with schizophrenia and borderline personality disorder. Clin Psychol Psychother 2013;20:239-245.
Maffei C, Fossati A, Agostoni I, Barraco A, Bagnato M, Deborah, D, et al: Interrater reliability and internal consistency of the structured clinical interview for DSM-IV axis II personality disorders (SCID-II), version 2.0. J Pers Disord 1997;11:279-284.
Andreasen NC, Flaum M, Arndt S: The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology. Arch Gen Psychiatry 1992;49:615-623.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs, Weiller J, et al: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59(suppl 20):22-33, quiz 34-57.
Haddock G, McCarron J, Tarrier N, Faragher EB: Scales to measure dimensions of hallucinations and delusions: the Psychotic Symptom Rating Scales (PSYRATS). Psychol Med 1999;29:879-889.
Chadwick P, Lees S, Birchwood M: The revised Beliefs about Voices Questionnaire (BAVQ-R). Br J Psychiatry 2000;177:229-232.
Birchwood M, Meaden A, Trower P, Gilbert P, Plaistow J: The power and omnipotence of voices: subordination and entrapment by voices and significant others. Psychol Med 2000;30:337-344.
Birchwood M, Meaden A, Trower P, Gilbert P: Shame, humiliation, and entrapment in psychosis. A social rank theory approach to cognitive intervention with voices and delusions; in Morrison AP (ed): A Casebook of Cognitive Therapy for Psychosis. Hove, Brunner-Routledge, 2002, pp 108-131.
Benjamini Y, Hochberg Y: Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc 1995;57:289-300.
Friedman J, Hastie T, Tibshirani R: Regularization paths for generalized linear models via coordinate descent. J Stat Softw 2010;33:1-22.
R Core Team: R: A Language and Environment for Statistical Computing. Vienna, R Foundation for Statistical Computing, 2016.
Zou H, Hastie T: Regularization and variable selection via the elastic net. J R Stat Soc Ser B Stat Methodol 2005;67:301-320.
Van Oosterhout B, Krabbendam L, Smeets G, van der Gaag M: Metacognitive beliefs, beliefs about voices and affective symptoms in patients with severe auditory verbal hallucinations. Br J Clin Psychol 2013;52:235-248.
Sommer IEC, Slotema CW, Daskalakis ZJ, Derks EM, Blom JD, van der Gaag M: The treatment of hallucinations in schizophrenia spectrum disorders. Schizophr Bull 2012;38:704-714.
Ingenhoven T, Lafay P, Rinne T, Passchier J, Duivenvoorden H: Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. J Clin Psychiatry 2010;71:14-25.
Lieb K, Völlm B, Rücker G, Timmer A, Stoffers JM: Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials. Br J Psychiatry 2010;196:4-12.
Ingenhoven TJ, Duivenvoorden HJ: Differential effectiveness of antipsychotics in borderline personality disorder: meta-analyses of placebo-controlled, randomized clinical trials on symptomatic outcome domains. J Clin Psychopharmacol 2011;31:489-496.
Penn DL, Meyer PS, Evans E, Wirth RJ, Cai K, Burchinal M: A randomized controlled trial of group cognitive-behavioral therapy vs. enhanced supportive therapy for auditory hallucinations. Schizophr Res 2009;109:52-59.
Trower P, Birchwood M, Meaden A, Byrne S, Nelson A, Ross K: Cognitive therapy for command hallucinations: randomised controlled trial. Br J Psychiatry 2004;184:312-320.
Bucci S, Birchwood M, Twist L, Tarrier N, Emsley R, Haddock G: Predicting compliance with command hallucinations: anger, impulsivity and appraisals of voices' power and intent. Schizophr Res 2013;147:163-168.
Birchwood M, Michail M, Meaden A, Tarrier N, Lewis S, Wykes T, et al: Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): A randomised controlled trial. Lancet Psychiatry 2014;1:23-33.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.