Sunday, November 4, 2012

Borderline Personality Disorder and Hallucinations

I often (maybe too often) talk about the misdiagnosis of those with BPD and along with many other diagnosis I find those with BPD have been diagnosed with Schizoaffective Disorder due to the hallucinations.  Part of this I believe is also the disassociation those with Borderline Personality Disorder deal with from past trauma. The term Borderline came from the original belief that those with BPD were  on the border between psychosis and neurosis.  Although this is no longer the belief, some still suffer with the psychosis elements.  

[source] A study of 171 Borderline personality disorder (BPD) patients revealed that 29.2% reported hallucinations. Most patients expressed that the hallucinations were distressing, occurred with great frequency over prolonged periods, took control of actions or behavior (especially, self-harming behavior) and had a critical quality. Although the majority of hallucinations were auditory, visual and olfactory hallucinations were also reported.

Hallucinations: Coping Strategies [source]
When voices are distressing, some patients may self-adjust their prescription medications or use drugs or alcohol to minimize the hallucinations. But there are better ways to deal with this issue.
  • Fighting back. This technique involves yelling or talking back to the hallucinations. While resisting the voices may seem like a good idea, studies show that the "fight or flight" response can lead to depression, since the voices typically don't go away on their own.
  • Passive acceptance. Although accepting that the voices are part of life for a person with schizophrenia seems to have more positive emotional effects, some argue that the danger of acceptance is that the hallucinations may start to consume your life.
  • Mindfulness techniques. In a trial of a therapy called Acceptance and Commitment, participants significantly reduced the effects of their symptoms, and had slightly fewer re-hospitalizations, than a control group using traditional therapy. With this philosophy, the patient agrees to acknowledge the voices but does not agree to accept guidance from them.
For coping with delusions, not all strategies work for every person, and many people report using more than one strategy.
  • Distraction. Focusing on a task, reciting numbers, taking a nap, or watching television can help distract the person from delusional, often paranoid, thoughts. A recent study showed that the choice of distraction is important. Researchers found that choosing favorite music or a news program was a more effective distraction tool than white noise. The study also reported that a personal music player with headphones might be the best way to listen to music when trying to ignore delusions. Headphones minimize other distractions, and people who used them tended to stick with this technique even after the study was completed.
  • Asking for help. Some people with schizophrenia seek out the company of friends and family when they are experiencing delusions. Friends and family can help by providing a distracting activity, or even just a listening ear.
  • Religion and meditative activities. People who are religious believers report using prayer or meditation to help deal with their active schizophrenia symptoms. Yoga, exercise, or walking can also shift the focus from the delusions and provide a sense of calm.
  • Be selective. Some voices are positive and some voices are negative. An organization called Hearing Voices takes an interesting approach: The voices may not be physical beings, but they should still treat you with the respect that you expect from other people. This group recommends engaging with the voices, but politely. The patient should ask the voices to make an appointment, or tell the negative voices that they are not welcome until they have useful information.


  1. An interesting article.During DBT I was not able to discuss auditory and visual hallucinations as my therapist's attitude was one of smirking ridicule. This led me to believe these events were an extra 'unspeakable' madness on my part (as I was told by my parents when I experienced hallucinations as a child - extremely frightening at the time, I learned to keep them to myself).I find that psychosis occurs only under extreme stress, although as I also scored nearly as high on schizotypal disorder as BPD I wonder if I am more prone to it. It is good that you are raising this issue as it is one of the less discussed - it is only through meeting someone else who suffers similarly that I am coming to realise these episoded are symptoms of my conditions, not part of me or 'the world'. Seeing it like that gives a distance which makes things less scary and more controllable in most instances.

    Just one note, to me delusion and paranoia are not the same, they don't necessarily go hand in hand, it is possible to realise that something is a delusion / hallucination whilst actually seeing /hearing it, but in my own experience it is all too common for other people (including some mental health workers I have met)to assume that seeing or hearing things that aren't there invalidates the person's thoughts entirely. Just because I hear someone in my room when I know nobody can feasibly be there doesn't mean that someone else in my life isn't acting in a way that would cause anyone a lot of stress, although in my case I may be tipped over into symptoms of psychosis.

    It would be interesting to know if people have tried to suggestions in your article and the results. I just tend to try to use logic and the benefit of long experience, although that isn't always effective in the middle of night.

  2. "Seeing it like that gives a distance which makes things less scary and more controllable in most instances." Exactly.

    I also use the "LovingKindness Meditation" with some delusional or paranoid clients:

    This meditation uses words, images, and feelings to evoke a lovingkindness and friendliness toward oneself and others. With each recitation of the phrases, we are expressing an intention, planting the seeds of loving wishes over and over in our heart.

    With a loving heart as the background, all that we attempt, all that we encounter will open and flow more easily. You can begin the practice of lovingkindness by meditating for fifteen or twenty minutes in a quiet place. Let yourself sit in a comfortable fashion. Let your body rest and be relaxed. Let your heart be soft. Let go of any plans or preoccupations.

    Begin with yourself. Breathe gently, and recite inwardly the following traditional phrases directed toward our own well-being. You being with yourself because without loving yourself it is almost impossible to love others.

    May I be filled with lovingkindness.

    May I be safe from inner and outer dangers.

    May I be well in body and mind.

    May I be at ease and happy.

    As you repeat these phrases, picture yourself as you are now, and hold that image in a heart of lovingkindness. Or perhaps you will find it easier to picture yourself as a young and beloved child. Adjust the words and images in any way you wish. Create the exact phrases that best open your heart of kindness. Repeat these phrases over and over again, letting the feelings permeate your body and mind. Practice this meditation for a number of weeks, until the sense of lovingkindness for yourself grows.

    Be aware that this meditation may at times feel mechanical or awkward. It can also bring up feelings contrary to lovingkindness, feelings of irritation and anger. If this happens, it is especially important to be patient and kind toward yourself, allowing whatever arises to be received in a spirit of friendliness and kind affection. When you feel you have established some stronger sense of lovingkindness for yourself, you can then expand your meditation to include others. After focusing on yourself for five or ten minutes, choose a benefactor, someone in your life who has loved and truly cared for you. Picture this person and carefully recite the same phrases:

    May you be filled with lovingkindness.

    May you be safe from inner and outer dangers.

    May you be well in body and mind.

    May you be at ease and happy.

    Let the image and feelings you have for your benefactor support the meditation. Whether the image or feelings are clear or not does not matter. In meditation they will be subject to change. Simply continue to plant the seeds of loving wishes, repeating the phrases gently no matter what arises.

    Expressing gratitude to our benefactors is a natural form of love. In fact, some people find lovingkindness for themselves so hard, they begin their practice with a benefactor. This too is fine. The rule in lovingkindness practice is to follow the way that most easily opens your heart.

    When lovingkindness for your benefactor has developed, you can gradually begin to include other people in your meditation. Picturing each beloved person, recite inwardly the same phrases, evoking a sense of lovingkindness for each person in turn.

    After this you can include others: Spend some time wishing well to a wider circle of friends. Then gradually extend your meditation to picture and include community members, neighbors, people everywhere, animals, all beings, the whole earth.

  3. Finally, include the difficult people in your life, even your enemies, wishing that they too may be filled with lovingkindness and peace. This will take practice. But as your heart opens, first to loved ones and friends, you will find that in the end you won’t want to close it anymore.

    Lovingkindness can be practiced anywhere. You can use this meditation in traffic jams, in buses, and on airplanes. As you silently practice this meditation among people, you will come to feel a wonderful connection with them – the power of lovingkindness. It will calm your mind and keep you connected to your heart.