borderline personality disorder (BPD) and hallucinations

   Borderline personality disorder (BPD) is also known as emotional regulation disorder (ERD), emotional intensity disorder (EID), and unstable personality disorder (UPD). The expression borderline personality disorder evolved out ofthe term borderline neurosis, which was introduced in 1938 by the American neurologist and psychiatrist Adolph Stern (1878-1958), the first American psychoanalyst who was analyzed by Sigmund Freud (1856-1939) himself. Stern introduced the expression borderline neurosis to designate a diagnostic category characterized by neurotic personality traits as well as psychotic symptoms such as delusions and - infrequently occurring -hallucinations. Thus the name borderline neurosis used to refer to the conceptual middle ground between the categories neurosis and *psychosis. Today the name BPD refers to a personality disorder characterized by a long-standing pattern of instability in various areas, including mood, interpersonal relationships, and self-image. Clinically, BPD is associated with extreme distress, harmful behaviour, and social and/or occupational dysfunctioning. The point prevalence of BPD has been reported as lying around 2% in the community population. In 1980, the diagnostic category BPD made its debut in the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual ofMental Disorders (DSM-III). As the DSM-III states, "During periods of extreme stress transient psychotic symptoms of insufficient severity or duration to warrant an additional diagnosis may occur". As a consequence, longer-lasting hallucinatory states occurring in individuals with a clinical diagnosis of BPD have often been referred to with somewhat ambiguous terms like *quasi-hallucination, *pseudohallucination, dissociative phenomenon, and micropsychotic episode. As the Australian psychiatrists Leslie Yee et al. point out, this practice has for a long time obscured the regular occurrence of hallucinations proper - as well as the occasional occurrence of *persistent hallucinosis - in individuals with a clinical diagnosis of BPD. Yee et al. draw attention to the growing literature on *auditory, * visual, and * olfactory hallucinations in association with BPD, suggesting that a significant proportion of the individuals with BPD may experience hallucinations that are not transient but ongoing, not circumscribed but pervasive, and phenomenologically indistinguishable from those in individuals diagnosed with one of the major psychotic disorders.

   References

   American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders. Third edition. Washington, DC: American Psychiatric Association.

   Stern, A. (1938). Psychoanalytic investigation of and therapy in the borderline group of neuroses. Psychoanalytic Quarterly, 7, 467489.

   Yee, L., Korner, A.J., McSwiggan, S., Meares, R.A., Stevenson, J. (2005). Persistent hallucinosis in borderline personality disorder. Comprehensive Psychiatry, 46, 147-154.