Abstract
SummaryBackgroundAuditory hallucinations—or voices—are a common feature of many psychiatric disorders and are also experienced by individuals with no psychiatric history. Understanding of the variation in subjective experiences of hallucination is central to psychiatry, yet systematic empirical research on the phenomenology of auditory hallucinations remains scarce. We aimed to record a detailed and diverse collection of experiences, in the words of the people who hear voices themselves.MethodsWe made a 13 item questionnaire available online for 3 months. To elicit phenomenologically rich data, we designed a combination of open-ended and closed-ended questions, which drew on service-user perspectives and approaches from phenomenological psychiatry, psychology, and medical humanities. We invited people aged 16–84 years with experience of voice-hearing to take part via an advertisement circulated through clinical networks, hearing voices groups, and other mental health forums. We combined qualitative and quantitative methods, and used inductive thematic analysis to code the data and χ2 tests to test additional associations of selected codes.FindingsBetween Sept 9 and Nov 29, 2013, 153 participants completed the study. Most participants described hearing multiple voices (124 [81%] of 153 individuals) with characterful qualities (106 [69%] individuals). Less than half of the participants reported hearing literally auditory voices—70 (46%) individuals reported either thought-like or mixed experiences. 101 (66%) participants reported bodily sensations while they heard voices, and these sensations were significantly associated with experiences of abusive or violent voices (p=0·024). Although fear, anxiety, depression, and stress were often associated with voices, 48 (31%) participants reported positive emotions and 49 (32%) reported neutral emotions. Our statistical analysis showed that mixed voices were more likely to have changed over time (p=0·030), be internally located (p=0·010), and be conversational in nature (p=0·010).InterpretationThis study is, to our knowledge, the largest mixed-methods investigation of auditory hallucination phenomenology so far. Our survey was completed by a diverse sample of people who hear voices with various diagnoses and clinical histories. Our findings both overlap with past large-sample investigations of auditory hallucination and suggest potentially important new findings about the association between acoustic perception and thought, somatic and multisensorial features of auditory hallucinations, and the link between auditory hallucinations and characterological entities.FundingWellcome Trust.
Highlights
Auditory hallucinations—or voices—are a common feature of schizophrenia
Understanding of subjective experiences of hallucination—and how they vary between different populations—is a central concern of psychiatry, and can help with the development of new causal accounts of auditory hallucination and more effective therapeutic interventions.[2,3]
The investigators concluded that auditory hallucinations in this population are typically repetitive emotive utterances that increase in number and complexity over time
Summary
Auditory hallucinations—or voices—are a common feature of schizophrenia. They occur in other disorders and in individuals with no psychiatric history.[1] Understanding of subjective experiences of hallucination—and how they vary between different populations—is a central concern of psychiatry, and can help with the development of new causal accounts of auditory hallucination and more effective therapeutic interventions.[2,3]. Nayani and David’s 1996 study[5] analysed clinical interview data from 100 patients with psychosis with auditory hallucinations (61% of 100 individuals had ICD-10 schizophrenia diagnoses). Cluster analysis of these findings suggested four common factors: voices that were repetitive, commanding or involved running commentary (86%); voices similar to a person’s own thoughts (36%); voices that were clearly reminiscent of specific memories (12%); and non-verbal auditory hallucinations (42%).[6]
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