Exploring the relationship between auditory hallucinations, trauma and dissociation

Abstract

Background It is clinically imperative to better understand the relationship between trauma, auditory hallucinations and dissociation. The personal narrative of trauma has enormous significance for each individual and is also important for the clinician, who must use this information to decide on a diagnosis and treatment approach. Aims To better understand whether dissociation contributes in a significant way to hallucinations in individuals with and without trauma histories. Method Three groups of participants with auditory hallucinations were recruited, with diagnoses of: schizophrenia (without trauma) (n = 18), post-traumatic stress disorder (PTSD, n = 27) and comorbid schizophrenia and PTSD (SCZ+PTSD), n = 26). Clinician-administered measures included the PTSD Symptoms Scale Interview (PSSI-5), the Clinician-Administered Dissociative States Scale (CADSS) and the Psychotic Symptom Rating Scales (PSYRATS). Results Dissociative symptoms were significantly higher in participants with trauma histories (PTSD and SCZ+PTSD groups) and significantly correlated with hallucinations in trauma-exposed participants, but not in participants with schizophrenia (without trauma history). Hallucination severity was correlated with the CADSS amnesia subscale score, but depersonalisation and derealisation were not. Conclusions Dissociation may be a mechanism in trauma-exposed individuals who hear voices, but it does not explain all hallucinatory experiences. The SCZ+PTSD group were in an intermediary position between schizophrenia and PTSD on dissociative and hallucination measures. The PTSD and SCZ+PTSD groups experienced dissociative phenomena much more frequently than the schizophrenia group, with a significant trend towards the amnesia subtype of dissociation.

Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: a systematic review and meta‐analysis

“…Within this context, non‐integrated trauma memories may be externally attributed as “voices” rather than “memories” 63 . In fact, there is recent evidence that dissociation may be a marker of comorbidity of psychosis with PTSD 64 . A further possibility is that voice‐hearing in the context of trauma is dissociative rather than psychotic in nature.…”

Remission of schizophrenia after an EMDR session

“…Today, dissociation appears to be an adaptive mechanism of the human psyche when confronted with trauma (Hardy et al, 2016 , Longden et al, 2015 , Waters et al, 2020 , Wearne et al, 2020 ). A recent meta-analysis of the cognitive mechanisms involved in the genesis of hallucinations in early trauma patients (Bloomfield et al, 2021 ) suggests that dissociation is an automatic coping mechanism for traumatic exposure: “dissociation may contribute to the development of hallucinations by diminishing a subject’s ability to judge the reality of internal experiences, presumably in the form of source attribution error”.…”

“…The role of dissociation appears to be central to the occrrence of hallucinations in trauma subjects (Bloomfield et al, 2021 ; Wearne et al, 2020 ; Bortolon et al, 2017 ). In a recent meta-analysis, Longden et al ( 2015 ) show that ‘dissociative phenomena are not only strongly linked to hallucinations, but also to multiple positive symptoms, and less strongly linked to negative symptoms’.…”

Traumatic events and psychotic experiences: a nationally representative study in Thailand

“…Based on the strong link between traumatic events and psychotic experiences, some researchers call for a distinction to be made between trauma-related psychotic experiences and such experiences in people who were not exposed to trauma (Hardy, 2017 ; Wearne et al ., 2020 ), with major implications for diagnosis and treatment (Alameda et al ., 2020 ). Research investigating potential causal pathways of the association between trauma and psychosis found dissociation – a symptom of post-traumatic stress – to be associated with psychotic experiences (Longden et al ., 2020 ; Wearne et al ., 2020 ) and may be a putative mechanism underlying the association (Perona-Garcelán et al ., 2012 ; Varese et al ., 2012 ; Schalinski et al ., 2019 ; Alameda et al ., 2020 ). Additionally, trauma-related beliefs as well as negative cognitive schemas may serve as such putative mechanisms (Alameda et al ., 2020 ; Hardy et al ., 2020 ).…”