Vladimir D. Mendelevich , Maria K. Nesterina
Abstract
This article, based on the clinical case of Anna A., analyzes the complaints of patients with borderline personality disorder (BPD) about hearing "voices in their heads". It presents data from modern research indicating the importance of a cognitive model of verbal hallucinations for understanding the origin of these "voices". It is stated that complaints of patients with BPD about the presence of «voices in the head” cannot be unambiguously classified as perceptual disorders and designated by the term "verbal hallucinations". Incorrect interpretation of these phenomena in practice often leads to erroneous diagnosis of schizophrenia and schizophrenia spectrum disorders (most often schizotypal disorder), which entails inappropriate prescription of antipsychotics. The phenomenon of "hearing voices in the head" should be considered a symptom of dissociative disorders, primarily related to disturbances in thinking and imagination. Further psychopathological research will allow for a more precise definition and place for this phenomenon within the register of psychopathological symptoms.
Keywords: verbal hallucinations, borderline personality disorder, dissociation.
About the Author
Vladimir D. Mendelevich 1 , Maria K. Nesterina 11 Kazan State Medical University, Kazan, Russia
References
1. Scheunemann J, Schilling L, Andreou C et al. Psychotic-Like Reasoning Styles in Patients With Borderline Personality Disorder? An Experimental Investigation of the Jumping to Conclusions Bias. Clin Psychol Psychother 2025;32(2):e70051. DOI: 10.1002/cpp.70051
2. Залуцкая Н.М. Пограничное расстройство личности: вопросы диагностики и терапии. Современная терапия психических расстройств. 2012;(2):1-8.
Zalutskaya N.M. Borderline personality disorder: issues of diagnosis and therapy. Modern therapy of mental disorders. 2012;(2):1-8 (in Russian).
3. Менделевич В.Д., Гатин Ф.Ф., Хамитов Р.Р. и др. Психотические симптомы при непсихотических расстройствах: ошибки диагностики или новая реальность? Неврологический вестник. 2022;2:5-12. DOI: https: 10.17816/nb108655
Mendelevich V.D., Gatin F.F., Khamitov R.R. et al. Psychotic symptoms in non-psychotic disorders: diagnostic errors or a new reality? Neurological bulletin 2022;2:5-12. DOI: https: 10.17816/nb108655 (in Russian).
4. Хасанова А.К., Мосолов С.Н. Пограничное расстройство личности: клиника, классификация и дифференциальная диагностика. Психиатрия и психофармакотерапия. 2023;(5):4-17.
Khasanova A.K., Mosolov S.N. Borderline personality disorder: clinic, classification and differential diagnosis. Psychiatry and psychopharmacotherapy. 2023;(5):4-17 (in Russian).
5. Zandersen M, Parnas J. Borderline personality disorder or a disorder within the schizophrenia spectrum? A psychopathological study. World Psychiatry 2019;18(1):109-10. DOI: 10.1002/wps.20598
6. Зобин М.Л. Пограничное расстройство личности: идентификация, коморбидность и новые возможности лечения. Неврологический вестник. 2025;57(2):150-9. DOI: 10.17816/nb677346
Zobin M.L. Borderline personality disorder: identification, comorbidity and new treatment options. Neurological bulletin. 2025;57(2):150-9. DOI: 10.17816/nb677346 (in Russian).
7. Каледа В.Г., Кулешов А.А., Крылова Е.С. Пограничное расстройство личности в юношеском возрасте: особенности психопатологии и закономерности течения. Журнал неврологии и психиатрии им. С.С. Корсакова. 2023;123(4):91-7. DOI: 10.17116/jnevro 202312304191
Kaleda V.G., Kuleshov A.A., Krylova E.S. Borderline personality disorder in adolescence: features of psychopathology and patterns of course. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(4):91-7. DOI: 10.17116/jnevro202312304191 (in Russian).
8. Петрова Н.Н., Чарная Д.И., Чумаков Е.М. Пограничное расстройство личности: к вопросу о диагнозе. Доктор.Ру. 2022;21(8):66-71. DOI: 10.31550/1727-2378-2022-21-8-66-71
Petrova N.N., Charnaya D.I., Chumakov E.M. Borderline personality disorder: on the issue of diagnosis. Doctor.Ru. 2022;21(8):66-71. DOI: 10.31550/1727-2378-2022-21-8-66-71 (in Russian).
9. Schutte MJL, Linszen MMJ, Marschall TM et al. Hallucinations and other psychotic experiences across diagnoses: A comparison of phenomenological features. Psychiatry Res 2020;292:113314. DOI: 10.1016/j.psychres.2020.113314
10. Phillips J, Whitehead T, Barrera A. Auditory Hallucinations in Borderline Personality Disorder and Schizophrenia: A Quantitative Comparison Using Patient Records. J Pers Disord 2024;38(6):559-572. DOI: 10.1521/pedi.2024.38.6.559
11. Grasso V, Sotelo D. Características de las alucinaciones en el trastorno límite de la personalidad. Similitudes y diferencias con la esquizofrenia y el trastorno bipolar. Vertex. 2024;35(164, abr.-jun.):68-81. DOI: 10.53680/vertex.v35i164.549
12. Wallis S, Denno P, Ives J et al. The phenomenology of auditory verbal hallucinations in emotionally unstable personality disorder and post-traumatic stress disorder. Ir J Psychol Med 2022;39(2):196-206. DOI: 10.1017/ipm.2020.77
13. Cavelti M, Thompson KN, Hulbert C et al Exploratory comparison of auditory verbal hallucinations and other psychotic symptoms among youth with borderline personality disorder or schizophrenia spectrum disorder. Early Interv Psychiatry 2019;13(5):1252-62. DOI: 10.1111/eip.12763
14. Slotema CW, Bayrak H, Linszen MMJ et al. Hallucinations in patients with borderline personality disorder: characteristics, severity, and relationship with schizotypy and loneliness. Acta Psychiatrica Scandinavica 2019;139(5):434-42. DOI: 10.1111/acps.13012
15. Niemantsverdriet MBA, Slotema CW, Blom JD et al. Hallucinations in borderline personality disorder: Prevalence, characteristics and associations with comorbid symptoms and disorders. Scientific reports 2017;7:13920. DOI: 10.1038/s41598-017-13108-6
16. Belohradova Minarikova K, Prasko J, Holubova M et al. Hallucinations and Other Psychotic Symptoms in Patients with Borderline Personality Disorder. Neuropsychiatr Dis Treat 2022;18:787-799. DOI: 10.2147/NDT.S360013.
17. Slotema CW, Blom JD, Niemantsverdriet MBA. et al. Auditory verbal hallucinations in Borderline personality disorder and the efficacy of antipsychotics: A systematic review. Front Psychiatry 2018;9:347. DOI: 10.3389/fpsyt.2018.00347
18. Slotema CW, Daalman K, Blom JD et al. Auditory verbal hallucinations in patients with borderline personality disorder are similar to those in schizophrenia. Psychological Medicine 2012;42:1873-8. DOI: 10.1017/S0033291712000165
19. Beatson JA. Borderline personality disorder and auditory verbal hallucinations. Australasian Psychiatry 2019;(1):1-4. DOI: 10.1177/1039856219859290
20. Savero N, Aji AP, Alim AH et al. Hallucination in patients with Borderline personality disorder. Journal of Psychiatry Psychology and Behavioral Research 2022;3(1):40-2. DOI: 10.21776/ub.jppbr.2022.003.01.10
21. Hayward M, Jones A-M, Strawson WH et al. A crosssectional study of auditory verbal hallucinations experienced by people with a diagnosis of borderline personality disorder. Clinical Psychology & Psychotherapy 2022;29(2):631-41. DOI: 10.1002/cpp. 2655
22. Cavelti M, Thompson K, Chanen AM, Kaess M. Psychotic symptoms in borderline personality disorder: developmental aspects. Current Opinion in Psychology 2021;37:26-31. DOI: 10.1016/j.copsyc.2020.07.003.03
23. Менделевич В.Д. Терминологические основы феноменологической диагностики в психиатрии. М.: Городец, 2016.
Mendelevich V.D. Terminological foundations of phenomenological diagnostics in psychiatry. Moscow: Gorodets, 2016 (in Russian).
24. Рыбальский М.И. Иллюзии и галлюцинации. Баку: Маариф, 1983.
Rybalsky M.I. Illusions and hallucinations. Baku: Maarif, 1983 (in Russian).
25. Крылов В.И. Психопатологическая квалификация и диагностическое значение нарушений чувственного познания (галлюцинации, псевдогаллюцинации, галлюциноиды). Психиатрия и психофармакотерапия. 2017;19(6):4-9.
Krylov V.I. Psychopathological qualification and diagnostic significance of sensory cognition disorders (hallucinations, pseudohallucinations, hallucinoids). Psychiatry and psychopharmacotherapy. 2017;19(6):4-9 (in Russian).
26. Бехтерев В.М. О слышании собственных мыслей. Антология избранных тестов отечественных психиатров. Под ред. П.В. Морозова. М.: Городец, 2016.
Bekhterev V.M. On hearing one's own thoughts. An anthology of selected tests of Russian psychiatrists. Edited by P.V. Morozov. Moscow: Gorodets, 2016 (in Russian).
27. Шишковская Т.И. Внутренняя речь: размытая грань между патологией и нормой PsyAndNeuro. Психиатрия и Нейронауки. 2020. http://psyandneuro.ru/stati/private-speech/ (дата обращения: 20.12.2025).
Shishkovskaya T.I. Inner speech: the blurred line between pathology and norm PsyAndNeuro. Psychiatry and Neuroscience. 2020. http://psyandneuro.ru/stati/private-speech / (date of access: 12/20/2025) (in Russian).
28. Alderson-Day B, Fernyhough C. Inner speech: development, cognitive functions, phenomenology, and neurobiology. Psychological bulletin 2015;141(5):931-65. DOI: 10.1037/bul0000021
29. Price CJ. A review and synthesis of the fi rst 20 years of PET and fMRI studies of heard speech, spoken language and reading. Neuroimage 2012;62(2):816-47. DOI: 10.1016/j. neuroimage.2012.04.062
30. Менделевич Д.М. Вербальный галлюциноз. Казань: КФУ, 1980.
Mendelevich D.M. Verbal hallucinosis. Kazan: KFU, 1980 (in Russian).
31. Beatson J.A. Borderline personality disorder and auditoryverbal hallucinations. Australasian Psychiatry 2019;1:1-4. DOI: 10.1177/1039856219859290
32. Руднев В. Экстраекция и психоз, метапсихология галлюцинаций. Московский психотерапевтический журнал. 2001;(2):18-43.
Rudnev V. Extrajection and psychosis, metapsychology of hallucinations. Moscow Psychotherapeutic Journal 2001;(2):18-43 (in Russian).
33. Сагалакова О.А., Труевцев Д.В. Мультимодальные образы и «голос» межличностной травмы: диссоциативно-когнитивные механизмы в динамике формирования галлюцинаций и суицидального риска. Неврологический вестник. 2026;(1).
Sagalakova O.A., Truevtsev D.V. Multimodal images and the "voice" of interpersonal trauma: dissociative-cognitive mechanisms in the dynamics of hallucinations and suicidal risk formation. Neurological bulletin. 2026;(1) (in Russian).
34. Phillips J, Whitehead T, Barrera A. Auditory Hallucinations in Borderline Personality Disorder and Schizophrenia: A Quantitative Comparison Using Patient Records. J Pers Disord 2024;38(6):559-72. DOI: 10.1521/pedi.2024.38.6.559
35. Beatson JA, Broadbear JH, Duncan C et al. Avoiding misdiagnosis when auditory verbal hallucinations are present in borderline personality disorder. J Nerv Ment Dis 2019;207(12):1048-55.
36. Wallis S, Denno P, Ives J et al. The phenomenology of auditory verbal hallucinations in emotionally unstable personality disorder and post-traumatic stress disorder. Ir J Psychol Med 2022;39(2):196-206. DOI: 10.1017/ipm.2020.77
37. Moskowitz A, Corstens D. From psychotic perceptual aberration to dissociative part of the self: An historical and personal overview of changing perspectives on voice hearing. Psychol Psychother 2025;Oct 10. DOI: 10.1111/papt.70014
38. Strawson WH, Wang HT, Quadt L et al. Voice Hearing in Borderline Personality Disorder Across Perceptual, Subjective, and Neural Dimensions. Int J Neuropsychopharmacol 2022;25(5):375-86. DOI: 10.1093/ijnp/pyab093
39. Cavelti M, Thompson K, Hulbert C et al. Preliminary Evidence for the Cognitive Model of Auditory Verbal Hallucinations in Youth With Borderline Personality Disorder. Front Psychiatry 2019;10:292. DOI: 10.3389/fpsyt.2019.00292
40. O’Connell J, Lim MH, Kamitsis I et al. Hallucinations as sensory–perceptual intrusions from traumatic memory: Empirical investigation of a phenomenologically important subgroup. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication 2025;18(3):485-96. DOI: 10.1037/tra0001902
41. Tseng ST, Georgiades A. A phenomenological comparison of auditory hallucinations between borderline personality disorder and schizophrenia: A systematic review. Clin Psychol Psychother 2024;31(1):e2958. DOI: 10.1002/cpp.2958
42. Schroeder K, Schätzle A, Schäfer I et al. Dissociative experiences mediate the association between childhood trauma and verbal hallucinations, but not delusional thoughts, in borderline personality disorder. Front Psychiatry 2025;16:1532234. DOI: 10.3389/fpsyt.2025.1532234
43. Niemantsverdriet MBA, Slotema CW, Franken IHA et al. (2025) Recognition and management of auditory verbal hallucinations in borderline personality disorder. Front Psychiatry 16:1511280. DOI: 10.3389/fpsyt.2025.1511280
44. Merrett Z, Castle DJ, Thomas N et al. Comparison of the Phenomenology of Hallucination and Delusion Characteristics in People Diagnosed With Borderline Personality Disorder and Schizophrenia. J Pers Disord 2022;36(4):413-30.
45. Beatson JA, Broadbear JH, Duncan C et al. Avoiding Misdiagnosis When Auditory Verbal Hallucinations Are Present in Borderline Personality Disorder. J Nerv Ment Dis 2019;207(12):1048-55. DOI: 10.1097/NMD.0000000000001073
46. Parnas J, Yttri JE, Urfer-Parnas A. Phenomenology of auditory verbal hallucination in schizophrenia: An erroneous perception or something else? Schizophr Res 2024;265:83-8. DOI: 10.1016/j.schres.2023.03.045
For citation:Mendelevich V.D., Nesterina M.K. About "voices in the head" and the unsolved mysteries of borderline personality disorder. The case of Anna A. Clinical review for general practice. 2026; 7 (3): 66–73 (In Russ.). DOI: 10.47407/kr2026.7.3.00796
All accepted articles publish licensed under a Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.
