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A Phenomenological Exploration of the Voices Reported by Borderline Personality and Schizophrenia Patients.

Alvaro Barrera, Tomasz Bajorek, Romanie Dekker, Gurjiven Hothi, Alexandra Lewis, Steve Pearce

Psychopathology 2021 DOI: 10.1159/000516208 (opens in new tab)

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AI-extracted from the abstract
Characteristics Phenomenological comparison study Peer reviewed
Sample size 21
Population DSM-IV participants with borderline personality disorder (n=11) or schizophrenia (n=10) who reported persistent verbal auditory hallucinations
Measures Psychotic Symptoms Rating Scale (PSYRATS), Revised Beliefs About Voices Questionnaire (BAVQ-R), Multidimensional Scale for Hallucinations (MSH), detailed clinical interview
Topics Philosophy of mind
Keywords Borderline personality disorder Differential diagnosis Schizophrenia Verbal auditory hallucinations
Key points The VAHs of BPD and schizophrenia participants were similar in intensity, location, and third-person quality, but the groups' stance toward them differed strikingly: BPD participants regarded their voices as identifiable (by gender and age) and unequivocally unpleasant, while schizophrenia participants regarded them more vaguely and ambiguously, found them more disruptive yet engaged with them more positively, and integrated them more into delusions. The authors suggest in-depth phenomenological assessment may help differentiate these clinical groups.

Abstract

Over time, there have been different views regarding the verbal auditory hallucinations (VAHs) reported by borderline personality disorder (BPD) and schizophrenia patients. More recently, their similarity has been emphasized, a view that undoubtedly has significant implications in terms of differential diagnosis and management. To explore this important issue, we undertook a detailed phenomenological assessment of persistent VAH reported by BPD and schizophrenia DSM-IV participants. The Psychotic Symptoms Rating Scale (PSYRATS), the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Multidimensional Scale for Hallucinations (MSH), and a detailed clinical interview were administered to 11 BPD and 10 schizophrenia DSM-IV participants. The VAHs of both groups were similar regarding intensity, reported as located inside or outside the head, and frequency in which they were described as a third-person phenomenon. However, the patients' stance towards their VAH was clearly different. Whilst BPD patients identified them in a clear way in terms of gender and age and disliked them, schizophrenia patients identified them more vaguely, reported them both as more disruptive but at the same time engaged with them more positively; schizophrenia patients also integrated their VAH more into delusions. Whilst reporting similar intensity of their VAH, the 2 groups' stance towards them were strikingly different in that BPD participants regarded them as identifiable and unequivocally unpleasant whilst schizophrenia participants regarded them in a rather vague and ambiguous manner. Methodologically, this preliminary study suggests that in-depth phenomenological assessment can help to elucidate the differential diagnosis of VAH in these, possibly other, clinical groups. Further research is warranted to establish whether these preliminary findings are replicated on a bigger clinical sample.

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