Voice Hearing and Life Events

There is a wealth of evidence linking distressing voices with adverse life events. The following is a selection of these studies and review articles.

The relationship between trauma and beliefs about hearing voices: A study of psychiatric and non-psychiatric voice hearers.

Authors: Andrew, E., Gray, N. & Snowden, R. (2008).

In: Psychological Medicine, 38(10), 1409-1417.

Background: The distress experienced by voice hearers is strongly influenced by beliefs about their voices, such as how powerful or hostile they are perceived to be.

Aims: To see whether traumatic events influence the development of negative beliefs about voices.

Method: Traumatic life events were compared between two groups of voice hearers: 22 patients with mostly negative beliefs about their voices and 21 non-patients with mostly positive beliefs. The groups were also compared on measures of posttraumatic stress.

Results: Both groups reported a high incidence of painful life events, although the patients were more likely to have experienced childhood sexual abuse. The patients were also significantly less likely to have resolved or worked through the impact of traumatic events. Signs of psychological trauma (e.g. posttraumatic stress symptoms) predicted negative beliefs about voices, including beliefs about perceived power, aggression and negativity.

Conclusion: Whether someone develops distressing beliefs about their voices appears to be influenced by traumatic life events, and the extent to which the psychological effects of the trauma remain unresolved.

Auditory hallucinations: A comparison between patients and nonpatients.

Authors: Honig, A., Romme, M., Ensink, B., Escher, S., Pennings, M. & deVries, M. (1998)

In: Journal of Nervous and Mental Disease, 186(10), 646-651.

Background: Voice hearing is generally seen as a symptom of serious mental illness. However, an alternative perspective is that voice hearing in itself is not a problem; rather it is a person’s inability to cope either with voice presence and/or the life events that provoked the voices that determines a need for psychiatric care.

Aims: To explore voice hearing characteristics (e.g., location, content) and the emotional impact of voices between different groups of patient and non-patient voice hearers in order to identify any important similarities or differences.

Method: Voice hearing experiences were compared across three groups: 18 patients diagnosed with schizophrenia, 15 patients diagnosed with a dissociative disorder, and 15 non-patients.

Results: Voice content and characteristics were similar across all three groups. For the majority of patients, their voices had begun during a period of acute psychological stress, or in response to a reminder of previous trauma(s). Non-patients were more likely to perceive their voices as positive and to feel more in control of them.

Conclusion: Psychological factors, such as the emotional impact of voices, appear to be a better predictor of distress than voice presence in itself. Voice hearers may also be more likely to need psychiatric help if voices reactivate the distress associated with traumatic life events.

Auditory hallucinations: Psychotic symptom or dissociative experience?

Authors: Moskowitz, A. & Corstens, D. (2007)

In: The Journal of Psychological Trauma, 6(2/3), 35-63.

Background: Dissociation is a psychological response to trauma, in which emotions, thoughts, and memories become disconnected from one another. Traditionally, psychiatry has suggested that different types of voice hearing exist, with voices in the context of dissociation (for example, patients diagnosed with posttraumatic stress disorder) different from that in patients with a diagnosis of psychosis, which is believed to have a mainly biological origin.

Aims: To determine whether all voice hearing experiences, regardless of diagnosis, can be understood as a dissociative experience rather than as a psychotic symptom.

Method: Existing research was examined that explores voice hearing experiences in different groups (non-patients, patients with psychosis, and patients with non-psychotic disorders), as well as research which has measured levels of dissociation in people who hear voices.

Results: There is compelling evidence for dissociation as an underlying mechanism for voice hearing in different groups of voice hearers.

Conclusion: Voice hearing should not be characterised as a psychotic symptom. Instead, voice hearing experiences can be most appropriately understood as a meaningful psychological response to events in the life of the voice hearer, with the concept of dissociation a helpful way of understanding this process.

The contribution of early traumatic events to schizophrenia in some patients: A traumagenic neurodevelopmental model.

Authors: Read, J., Perry, B.D., Moskowitz, A. & Connolly, J. (2001).

In: Psychiatry, 64(4), 319-345.

Background: The ‘stress-vulnerability’ model of schizophrenia is often used in a way that suggests heightened vulnerability to stress is inherited through genetic deficits. However, a more psychological version of the stress-vulnerability model suggests that life events do not ‘trigger’ an underlying genetic problem; but rather that adverse experiences create a vulnerability to stress.

Aims: To determine whether sensitivity to stress can be acquired as a result of adverse childhood experiences.

Method: To explore the neurological impact of childhood trauma, and how this corresponds to heightened susceptibility to stress as an adult. Rather than a biological illness process, these changes may be more appropriately seen as acquired through exposure to a distressing environment.

Results: The ‘traumagenic neurodevelopmental’ model of psychosis demonstrates how the biological changes evident in people diagnosed with schizophrenia (e.g. dopamine irregularities, structural brain changes) are overwhelmingly similar to the impact of trauma on the developing brain.

Conclusion: Many of the symptoms considered typical of schizophrenia, including voice hearing, can be explained in terms of the impact of chronic stress during childhood. Mental health workers should explore the possibility of painful childhood experiences in their clients’ lives in order to intervene in the most helpful and appropriate way.

Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications.

Authors: Read, J., van Os, J., Morrison, A., & Ross, C. (2005)

In: Acta Psychiatrica Scandinavica, 112(5), 330-350.

Background: Although psychosis is most commonly portrayed within biomedical frameworks, increasing evidence suggests the crucial role of life events in creating a risk for psychotic experience.

Aims: To examine associations between childhood trauma and psychosis, including schizophrenia.

Method: A literature review was undertaken to identify existing research studies.

Results: Experiences considered ‘psychotic’, including voice hearing, visions and unusual beliefs (‘delusions’) have a strong association with sexual, physical and/or emotional abuse in childhood. This association was most apparent for voice hearing. More severe abuse is also associated with more severe mental health problems (a ‘dose-response’ effect).

Conclusion: These findings present important theoretical and clinical implications, including the need for models of psychosis that incorporate psychological and social factors, and the importance of providing mental health staff with sufficient expertise to support clients who have been abused or neglected in childhood.

Childhood adversity and hallucinations: A community-based study using the National Comorbidity Survey Replication.

Authors: Shevlin, M., Murphy, J., Read, J., Mallett, J., Adamson, G. & Houston, J. E. (2011).

In: Social Psychiatry and Psychiatric Epidemiology, 46(12), 1203-1210.

Background: Increasing evidence suggests that experiences traditionally considered to be biologically-based symptoms of illness can be better accounted for in terms of distressing life events.

Aims: To examine whether hearing voices and seeing visions are associated with traumatic childhood experiences.

Method: 2,353 adults in the general population were asked about possible experiences of rape, sexual assault, or physical assault before the age of 16. Their experience of hearing voices or seeing visions was also assessed.

Results: All three traumatic events were significantly related to later experiences of voices and visions. More severe abuse was also associated with more severe mental health problems (a ‘dose-response’ effect).

Conclusion: Traumatic childhood events are directly related to subsequent experiences of hearing voices and seeing visions, and this should be taken into account by psychiatric staff.

Adverse childhood experiences and hallucinations.

Authors: Whitfield, C., Dube, S., Felitti, V. & Anda, R. (2005).

In: Child Abuse and Neglect, 29(7), 797-810

Background: Adverse childhood events appear to affect the likelihood of experiencing sensory hallucinations in adulthood (e.g., hearing voices, seeing visions, feeling, smelling, or tasting things which are not there).

Aims: To assess the relationship between painful life events and the experience of hallucinations in a large-scale survey.

Method: 17,337 adults answered questions about childhood events (e.g., sexual, physical and/or emotional abuse, witnessing domestic violence) and their current experiences of hallucinations.

Results: Childhood trauma significantly increased the likelihood of experiencing adulthood hallucinations. Individuals reporting seven or more distressing childhood events were five-times more likely to experience hallucinations than adults with no adverse childhood experiences.

Conclusion: There is a significant association between distressing events in childhood and the likelihood of adulthood hallucinations, and this should be taken into account by mental health professionals.

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