Trauma and Hallucinatory Experience in Psychosis

Institute of Psychiatry, Kings College London, London, United Kingdom.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 09/2005; 193(8):501-7. DOI: 10.1097/01.nmd.0000172480.56308.21
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Recent research indicates that there may be phenomenological, symptom, and diagnostic associations between trauma and hallucinations. However, the nature of the relationship is poorly understood from a psychological perspective. We report a theoretically informed phenomenological study. From descriptions of reported traumas and hallucinations, we assessed the rates of four types of hypothesized association between traumas and hallucinations (direct, indirect, stress, and none) in 75 participants with nonaffective psychosis. In a subgroup who had experienced trauma (N = 40), 12.5% had hallucinations with similar themes and content to their traumas, 45% had hallucinations in which the themes were the same but not the content, and 42.5% had no identifiable associations between their hallucinations and previously experienced trauma. Traumas rated as intrusive were significantly associated with hallucinations rated as intrusive, although intrusive hallucinations were not associated with traumas in general. The traumas most likely to be associated with hallucinations were sexual abuse and bullying.

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    • "40%ofPTSDpatientsdirectlyrelatedtheirvoicestopast experiencesofabuseortrauma.Forexample,onepatientwho hadbeenphysicallyassaultedbytwomensubsequentlyheard thevoicesoftwomensaying,"We'llkillyou."Forothers,the linkbetweenthecontentofthetraumaandtheAVHwasnot immediatelyevident,withonemanwhohadsufferedphysical andsexualabusereportingthreedistinctvoicesall"making acaseforself-harmandsuicide"thatappearedtoreflectthe internalizedmessagegiventohimbytheabuser.Thisechoesthe indirect,thematiclinkfoundbetweenmanySZ-AVHandtrauma byHardyetal.(2005).However,methodologicalsafeguardsto validityandreliability,asemployedbyHardyetal.(2005)were notemployedinthisstudy. "
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    ABSTRACT: Auditory verbal hallucinations (AVH: 'hearing voices') are found in both schizophrenia and post-traumatic stress disorder (PTSD). In this paper we first demonstrate that AVH in these two diagnoses share a qualitatively similar phenomenology. We then show that the presence of AVH in schizophrenia is often associated with earlier exposure to traumatic/emotionally overwhelming events, as it is by definition in PTSD. We next argue that the content of AVH relates to earlier traumatic events in a similar way in both PTSD and schizophrenia, most commonly having direct or indirect thematic links to emotionally overwhelming events, rather than being direct re-experiencing. We then propose, following cognitive models of PTSD, that the reconstructive nature of memory may be able to account for the nature of these associations between trauma and AVH content, as may threat-hypervigilance and the individual's personal goals. We conclude that a notable subset of people diagnosed with schizophrenia with AVH are having phenomenologically and aetiologically identical experiences to PTSD patients who hear voices. As such we propose that the iron curtain between AVH in PTSD (often termed 'dissociative AVH') and AVH in schizophrenia (so-called 'psychotic AVH') needs to be torn down, as these are often the same experience. One implication of this is that these trauma-related AVH require a common trans-diagnostic treatment strategy. Whilst antipsychotics are already increasingly being used to treat AVH in PTSD, we argue for the centrality of trauma-based interventions for trauma-based AVH in both PTSD and in people diagnosed with schizophrenia.
    Frontiers in Psychology 07/2015; 6. DOI:10.3389/fpsyg.2015.01071 · 2.80 Impact Factor
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    • "This is akin to the distressing, repetitive ego-dystonic intrusive thoughts classed as obsessions in OCD. Third, other voices are identical or thematically related to memories of trauma.59 Intrusive, vivid memories of trauma play a central role in cognitive models of PTSD where failure to adequately process trauma memories results in repeated, intrusive memories,61 and AVH related to trauma could be similarly conceptualized.30 "
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    ABSTRACT: The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted for by any model based around a single mechanism. This has led to the proposal that there may be distinct AVH subtypes, which each possess unique (as well as shared) underpinning mechanisms. This could have important implications both for research design and clinical interventions because different subtypes may be responsive to different types of treatment. This article explores how AVH subtypes may be identified at the levels of phenomenology, cognition, neurology, etiology, treatment response, diagnosis, and voice hearer's own interpretations. Five subtypes are proposed; hypervigilance, autobiographical memory (subdivided into dissociative and nondissociative), inner speech (subdivided into obsessional, own thought, and novel), epileptic and deafferentation. We suggest other facets of AVH, including negative content and form (eg, commands), may be best treated as dimensional constructs that vary across subtypes. After considering the limitations and challenges of AVH subtyping, we highlight future research directions, including the need for a subtype assessment tool.
    Schizophrenia Bulletin 07/2014; 40 Suppl 4(Suppl 4):S275-84. DOI:10.1093/schbul/sbu018 · 8.45 Impact Factor
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    • "In considering this, one key area in need of development is to establish methods for addressing the observed relationship between trauma and voices.73,74,78–80 A recent meta-analysis has shown that childhood abuse is associated with adult psychotic disorder with an estimated population attributed fraction of 33%,83 and different childhood adversities are associated with different symptoms, with sexual abuse specifically associated with auditory hallucinations.80 "
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    ABSTRACT: This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation.
    Schizophrenia Bulletin 06/2014; 40(Suppl 4):S202-S212. DOI:10.1093/schbul/sbu037 · 8.45 Impact Factor
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