Abstract
Voice hearing has been conceptualized as an interrelational framework, where the interaction between voice and voice hearer is reciprocal and resembles “real-life interpersonal interactions.” Although gender influences social functioning in “real-life situations,” little is known about respective effects of gender in the voice hearing experience. One hundred seventeen participants with a schizophrenia spectrum disorder took part in a semi-structured interview about the phenomenology of their voices and completed standardized self-rating questionnaires on their beliefs about their most dominant male and female voices and the power differentials in their respective voice-voice hearer interactions. Additionally, the voice hearers’ individual masculine/feminine traits were recorded. Men heard significantly more male than female dominant voices, while the gender ratio of dominant voices was balanced in women. Although basic phenomenological characteristics of voices were similar in both genders, women showed greater amounts of distress caused by the voices and reported a persistence of voices for longer time periods. Command hallucinations that encouraged participants to harm others were predominantly male. Regarding voice appraisals, high levels of traits associated with masculinity (=instrumentality/agency) correlated with favorable voice appraisals and balanced power perceptions between voice and voice hearer. These positive effects seem to be more pronounced in women. The gender of both voice and voice hearer shapes the voice hearing experience in manifold ways. Due to possible favorable effects on clinical outcomes, therapeutic concepts that strengthen instrumental/agentic traits could be a feasible target for psychotherapeutic interventions in voice hearing, especially in women.
Highlights
Verbal auditory hallucinations (VAH) are a core symptom of schizophrenia spectrum disorders and constitute a major source of disease-related distress (Badcock et al 2011; Kumari et al 2013) as well as a substantial risk factor for suicidal or otherwise harmful behavior in many affected individuals (DeVylder and Hilimire 2015; Fujita et al 2015)
Investigating gender differences in voice appraisals in different constellations of voice-voice hearer dyads, we found that male voice hearers experience male voices as significantly more malevolent than female voices, while female voice hearers rated their voices high in malevolence irrespective of their gender
Considering the extensive evidence for positive clinical outcomes associated with voice hearers’ perceived relative power (Birchwood et al 2000; Barrowcliff and Haddock 2006; Paulik 2012) and the strong association between perceptions of power and instrumentality in our study, we suggest the integration of therapeutic components that strengthen instrumental traits into overall therapeutic concepts for voice hearing to be feasible targets for therapeutic interventions
Summary
Verbal auditory hallucinations (VAH) are a core symptom of schizophrenia spectrum disorders and constitute a major source of disease-related distress (Badcock et al 2011; Kumari et al 2013) as well as a substantial risk factor for suicidal or otherwise harmful behavior in many affected individuals (DeVylder and Hilimire 2015; Fujita et al 2015). In. femininity are known factors influencing various aspects of social interaction including power differentials and social appraisals (Eagly 1987; Maccoby, 1990; Rudman and Glick 2008; Ridgeway 2008), little is known about respective gender differences in the voice hearing experience. The only study explicitly investigating gender differences in voice appraisals and interrelating with voices in a quantitative design found more powerful emotional reactions to voices as well as a tendency to respond to them in a more resistant manner in women (Hayward et al 2016b). The study found that women appraised their voices as being more omnipotent, malevolent, and dominant compared to men (Hayward et al 2016b). The study had a number of methodical limitations, and gendered relating styles are not stable but depend strongly on the gender category membership of each interaction partner (Jacklin and Maccoby 1978), they did not account for differences due to variations in the interactional constellations, e.g., male voice hearer on male voice vs. male voice hearer on female voice, etc
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