Sexual hallucinations and delusions in borderline personality disorder

Sexual hallucinations have lifetime prevalence rates of 0.4% in the general population and up to 44% in schizophrenia spectrum disorders. For borderline personality disorder (BPD) these rates are unknown. We therefore studied prevalence rates of sexual hallucinations and delusions in this group, as well as their phenomenological characteristics and their connection with childhood trauma.

We carried out a cross-sectional study among outpatients with BPD, using the Sexual Hallucinations and Delusions Questionnaire (SHDQ), the Psychotic Symptom Rating Scales-Auditory Verbal Hallucinations (PSYRATS-AVH) and the Childhood Trauma Questionnaire (CTQ).

Among 81 people interviewed, we found a lifetime prevalence rate of 59.3% for sexual hallucinations, and 49.4% for sexual delusions. For the last month these rates were 36.0% and 31.0%, respectively. In this group somatic, visual, tactile and auditory sexual hallucinations were more common than olfactory and gustatory ones. Childhood trauma was reported by all participants, with emotional abuse and sexual abuse showing the strongest link with sexual hallucinations and delusions.

Sexual hallucinations and delusions are very common in people with BPD. They may well explain (part of) the emotional and behavioral aspects considered characteristic of BPD. Our finding that childhood trauma was reported by all participants indicates that more research is needed to explore the impact of trauma in this specific population. We also provide recommendations for clinical practice, including treatment options.