Auditory hallucinations (AH) are common symptoms in psychotic disorders. However, knowledge regarding the phenomenology and causes remains insufficient. Nayani and David’s 1996 work is considered to be a key contribution to this area. Lack of large-scale studies on phenomenology in the ensuing period prevent evaluation of newer models / ideas regarding AH.
Simon McCarthy-Jones et al used Mental Health Research Institute Unusual Perceptions Schedule (MUPS, has 365 questions) to study AH in 199 individuals with psychiatric disorders.Most had schizophrenia (81%). Authors explored the internal structure of AH phenomenology using hierarchical cluster analysis .
28% of patients reported having uncountable number of voices. In the remaining, a mean of 4.3 voices were heard. Location is equally likely to be internal/external or both. Externally located are heard in both ears.
Of those who could remember the first voice, in half it was treated as a ‘voice’, in one-third it was a non verbal AH. Half reported negative tone. voices were typically clear. 85% experienced the AH as very real.
First and third person AH were the commonest form. One third often or sometimes had command hallucinations.75% of those who head commands were able to resists them. Content of voice do not change over time. 39% believed that their voices were in some way replays of their previous experiences. Majority experienced AHs for hours at a time. Majority also reported that duration varied throughout the day.
Cluster analysis suggest subtypes of AH. This include 1. Constant Commanding and Commenting AVHs 2.Own Thought AVHs 3. Nonverbal AHs 4. Replay AVHs.
These findings may help to inform some interventions. For example: Would replay AVH benefit from models used in PTSD?. Would anti obsessional approaches help in repetitive AH?. Half of the participants believed that their voices may be thoughts they themselves had, and over half believed that the voice was linked to someone who is influential in their lives. Would exploring links between identity and voices help to reduce distress?It is important to note that many patients had many subtypes of AH while considering any focus work around AH.
Conclusion: This phenomenological study provides some support for subtypes of AH.
Summary of the article:
A new phenomenological survey of auditory hallucinations: evidence for subtypes and implications fortheory and practice.McCarthy-Jones S, Trauer T, Mackinnon A, Sims E, Thomas N, Copolov DL.Schizophr Bull. 2014 Jan;40(1):231-5.