A neurobiological and phenomenological investigation of voice-hearing in borderline personality disorder.

Background: A developing evidence-base suggests that Auditory Verbal Hallucinations (AVH) are more common in Borderline Personality Disorder (BPD) than traditionally recognised, and that the level of distress, and length of symptoms is more similar to AVH in the context of schizophrenia than previously believed. These preliminary studies support the hypothesis that there may be shared phenomenology of voice-hearing in both diagnostic groups which may be reflected in similar AVH neurobiology. The present study sought to investigate AVH phenomena in BPD and to see if voice-hearing distress is associated with Grey-Matter Volume (GMV) deficits in frontal and temporal regions already implicated in schizophrenia. Method: Nineteen people with a diagnosis of BPD were compared to a sample of 106 people with a diagnosis of schizophrenia on the Psychotic Rating Scale (PSYRATS). A sample of 12 BPD participants took part in an MRI scan and GMV was investigated in frontal, speech and temporal language regions in relation to voice-hearing distress. The relationship between voice-hearing phenomena (PSYRATS and the Positive and Negative Syndrome Scale) was then explored within the BPD sample by correlational analysis with emotional variability (Affective Lability Scale-Short Form), state and trait anxiety (State-Trait Anxiety Inventory) and dissociation (Cambridge Depersonalisation Scale; Curious Experiences Scale). Results: No significant differences were found between the BPD and schizophrenia samples on voice-hearing attribution. Trend level relationships were found between voice-hearing distress, and GMV in frontal and speech production regions. Intensity of voice-hearing distress was found to negatively correlate with dissociation, and trait anxiety to emotional variability. Conclusions: The present study suggests that voice-hearing in BPD may have shared features to the experience observed in schizophrenia. There is some evidence that voice-hearing distress can be related to frontal and speech production regions. Preliminary evidence suggests that voice-hearing in BPD may benefit from the same interventions offered to those with a diagnosis of schizophrenia. Interpretations however are tentative considering the sample size of the present study, and replication in a study with sufficient statistical power is imperative.