Persistent Hallucinosis in Borderline Personality Disorder – BPD

Persistent Hallucinosis in Borderline Personality Disorder – BPD

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In a series of 171 patients with Borderline Personality Disorder (BPD), the Westmead research program found that about 30% reported a form of auditory hallucinosis. A smaller series of 10 patients were examined in detail through a semi-structured interview and using the Dissociative Experiences Scale (DES), The Structured Clinical Interview for DSM-IV (SCID-D) and McGuffin’s Opcrit questionnaire. In this series the hallucinations were persistent, longstanding, and a significant source of distress and disability.

The failure to emphasize this phenomenon in current systems of classification risks misdiagnosis or inappropriate treatment. The use of terms such as pseudohallucination tends to be dismissive of the phenomenon, or conveys the sense of it as “not real”.  This series is discussed in the context of an emerging literature on hallucinosis in the general population. A nomenclature is proposed for hallucinsosis that is expressed in positive terms, reflecting the clinical significance of the phenomenon in different contexts. The four categories in this schema are: 1) normative hallucinosis, 2) traumatic-intrusive hallucinosis (as in the Westmead series), 3) psychotic hallucinosis, and 4) organic hallucinosis.

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