Internal versus external auditory hallucinations in schizophrenia: symptom and course correlates

Abstract

Introduction The auditory hallucinations associated with schizophrenia are phenomenologically diverse. “External” hallucinations classically have been considered to reflect more severe psychopathology than “internal” hallucinations, but empirical support has been equivocal. Methods We examined associations of “internal” v. “external” hallucinations with (a) other characteristics of the hallucinations, (b) severity of other symptoms, and (c) course of illness variables, in a sample of 97 stable outpatients with schizophrenia or schizoaffective disorder who experienced auditory hallucinations. Results Patients with internal hallucinations did not differ from those with external hallucinations on severity of other symptoms. However, they reported their hallucinations to be more emotionally negative, distressing, and long-lasting, less controllable, and less likely to remit over time. They also were more likely to experience voices commenting, conversing, or commanding. However, they also were more likely to have insight into the self-generated nature of their voices. Patients with internal hallucinations were not older, but had a later age of illness onset. Conclusions Differences in characteristics of auditory hallucinations are associated with differences in other characteristics of the disorder, and hence may be relevant to identifying subgroups of patients that are more homogeneous with respect to their underlying disease processes.

Psychological resilience in people experiencing schizophrenia and suicidal thoughts and behaviours

“…Negative stressors exacerbate the harmful psychological effects of this mental health problem (Bolton, Gooding, Kapur, Barrowclough, & Tarrier, 2007). Such stressors may be external, for example, financial pressures (Beebe, 2002); internal, for example, different types of hallucinations (Docherty et al, 2015); or societal, for example, stigma (Ruesch et al, 2014) and hospitalisation procedures (Berry, Ford, Jellicoe-Jones, & Haddock, 2013, 2015. In addition, negative stressors are typically one of the first stages in pathways leading to suicidal thoughts and behaviours (Williams, 1997) with death by suicide and multiple suicide attempts being highly prevalent in people experiencing schizophrenia (Mork et al, 2012;Qin, 2011).…”

The phenomenology of auditory verbal hallucinations in schizophrenia and the challenge from pseudohallucinations

“…In any case, the incorporation of the inner/outer distinction into the phenomenological heterogeneity and temporally evolving nature of auditory verbal hallucinatory phenomena is a strategy we have openly supported ( 28 ). According to Docherty et al ( 50 ), patients with internal hallucinations (experienced in the internal field of awareness like the ones described by Jaspers as pseudohallucinations) do not differ from those with external hallucinations on the severity of other symptoms. However, they reported their hallucinations to be more emotionally distressing, longer-lasting, less controllable, and less likely to remit over time.…”

Insight-related beliefs and controllability appraisals contribute little to hallucinated voices: a transdiagnostic network analysis study

“…However, appraisals regarding perceived controllability of voices themselves, rather than thoughts in general, have been found to characterise clinical as opposed to non-clinical voice hearers [14] (i.e. people not distressed or impaired by their voices), patients with first episode psychosis [1] and patients with more severe voice hearing symptoms [7].…”

“…The importance of location appraisals for judging hallucination severity has received mixed support. Stephane et al [ 6 ] found that patients with schizophrenia who heard hallucinations inside their head were more likely to demonstrate memory source monitoring deficits, while Docherty et al [ 7 ] found that internally located hallucinations were more intrusive and distressing. However, no reliable associations were found by Copolov et al [ 4 ] in large sample of patients with psychotic disorders, neither were they found by Oulis et al’s [ 8 ] study on patients admitted with acute psychosis, and they were only associated with number of hallucinated words and utterances in a study by Nayani and David [ 9 ].…”