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

Josephine A. Beatson, Jillian H. Broadbear, Charlotte Duncan, David Bourton, Sathya Rao

Research output: Contribution to journalReview ArticleResearchpeer-review

24 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1048-1055
Number of pages8
JournalJournal of Nervous and Mental Disease
Issue number12
Publication statusPublished - Dec 2019
Externally publishedYes


  • auditory verbal hallucinations
  • AVH in BPD and childhood trauma
  • Borderline personality disorder
  • BPD and dissociation

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