How Do People Experience Hearing Voices in Non-Psychotic Conditions?

What you need to know

• Hearing voices (auditory verbal hallucinations) is common in non-psychotic conditions like personality disorders and PTSD
• Voices had variable auditory qualities and were often personified as distinct characters
• There was an intimate, two-way connection between the voice hearer’s mood/circumstances and the voices

The experience of hearing voices

Hearing voices, or auditory verbal hallucinations (AVH), is often associated with psychotic disorders like schizophrenia. However, this experience is also common in other mental health conditions that are not considered psychotic, like personality disorders and post-traumatic stress disorder (PTSD). Despite how frequently it occurs, there has been little in-depth research on what it’s actually like to hear voices in these non-psychotic conditions.

This study aimed to explore the subjective experience of hearing voices in young people with emotionally unstable personality disorder (EUPD) or PTSD. The researchers conducted in-depth interviews with 10 participants aged 17-31 who frequently heard voices. They used techniques like photo-elicitation and walking interviews to get rich, detailed accounts of the voice hearing experience.

Qualities of the voices

Participants described voices with various auditory qualities:

• Volume: Voices could be loud or quiet, ranging from shouts to whispers. The volume often related to how much attention the person was paying to the voice.

• Clarity: Some voices were clear while others were muffled or hard to make out. Multiple voices speaking over each other could make them less clear.

• Reality: Many participants said the voices seemed very real, as if an actual person was speaking. Some would look around to check if anyone was there.

• Multiple voices: All participants heard more than one voice. These could occur separately or simultaneously.

• Own voice: Some voices sounded like the participant’s own voice, but with a different tone or temperament.

Interestingly, some participants described confusion between their thoughts and the voices, suggesting the voices didn’t always have all the qualities of a real, external sound. However, they still described the experience as “hearing voices.”

Personification of voices

A key finding was that participants often personified their voices, viewing them as distinct entities or characters:

• Identity: Over half gave their voices names or identities like “Little Girl” or “Scary.” Voices had specific traits like gender, age, and sound qualities.

• Temperament: Voices were described as having personalities, usually negative and abusive but occasionally positive and encouraging.

• Relationship: Some participants felt attached to their voices, viewing them as friends they had grown up with. Others resented the voices and wished they would stop.

• Interaction: Several participants described verbally interacting with their voices, responding to or arguing with them.

This personification allowed participants to form complex relationships with their voices, despite knowing they weren’t real.

Connection between voice and voice-hearer

The study revealed an intimate, two-way connection between participants and their voices:

Voices reflecting the person:

• Mood: Voice content and presence was often tied to the participant’s mood. Voices tended to be absent when participants were happy and present when they were stressed or upset.

• Insecurities: Voices seemed to have insight into participants’ private insecurities, using these to criticize or insult them.

• Circumstances: Voice content often related to what was currently challenging or difficult in the participant’s life.

Voices provoking responses:

• Emotional disturbance: All participants described voices causing a range of emotions like fear, annoyance, guilt, and heartbreak.

• Physical disturbance: Some experienced physical responses like sweating, headaches, or pain in response to voices.

• Actions: Voices could lead to behaviors, either through explicit commands or by influencing decision-making.

This bi-directional relationship was a key feature of the voice hearing experience for these participants.

How this compares to voices in psychosis

While there were many similarities to how voices are described in psychotic disorders, some key differences emerged:

Similarities:

• Hearing multiple voices with distinct characters
• Combination of pleasant and unpleasant voices
• Derogatory remarks and commands
• Complex auditory experience
• Physical sensations associated with voices

Differences:

• Stronger connection between mood/circumstances and voices
• Ability to ignore or distract from voices
• Less sense of voices being imposed or inescapable
• Confusion between thoughts and voices for some

The intimate connection between the person’s emotional state and the voices was particularly notable. While emotional reactions to voices occur in psychosis, this study found a more bi-directional relationship in non-psychotic voice hearing.

Implications for understanding and treatment

These findings have several implications:

1. Clinical significance: The distressing and meaningful nature of these voices challenges the idea that they are less clinically important than psychotic voices.

2. Self-critical content: The often self-critical content of voices could inform psychological therapies.

3. Emotional regulation: The connection between emotional distress and voices suggests targeting emotional regulation could help manage voice hearing.

4. Personification: Understanding how people personify voices may open new avenues for therapeutic approaches.

5. Diagnostic considerations: The complex nature of these voices challenges current diagnostic criteria that describe them as brief or transient experiences.

Conclusions

• Hearing voices in non-psychotic conditions is a complex, meaningful experience that significantly impacts people’s lives.
• There is an intimate connection between a person’s emotional state, life circumstances, and their voice hearing experiences.
• While there are similarities to psychotic voice hearing, some key differences emerged, particularly in the bi-directional relationship between person and voice.
• These findings suggest new avenues for understanding and treating voice hearing in conditions like personality disorders and PTSD.

This study provides valuable insights into the subjective experience of hearing voices in non-psychotic conditions. By better understanding this phenomenon, mental health professionals may be able to develop more targeted and effective treatments for those struggling with distressing voices. Further research with larger and more diverse samples could help confirm and expand on these findings.