Auditory Hallucinations in Chronic Trauma Disorders: Phenomenology and Psychological Mechanisms

  • Martin J. Dorahy
  • Rachael C. W. Palmer
Reference work entry


Auditory hallucinations are relatively common in those with chronic trauma disorders (12–98 %). They typically begin after a traumatic event and following the development of trauma-related disorders. They often contain themes related to trauma. Auditory hallucinations in chronic trauma disorders are commonly negative in content, heard inside the head or both inside and outside the head, occur relatively frequently, and cause distress. Those with PTSD who experience auditory hallucinations often have experienced more severe trauma and have a more severe symptom presentation than those who do not experience them. Dissociation, especially depersonalization, has been routinely linked to post-traumatic auditory hallucinations. As a phenomenon, depersonalization may transform mental activity into strange and foreign experiences that manifest as auditory hallucinations. Yet, depersonalization seems unable to account for many of the key features of auditory hallucinations. Structural dissociation at the level of personality, either in isolation or in combination with depersonalization, seems to offer a more complete account of auditory hallucinations in chronic trauma disorders.


Auditory hallucinations Voices Trauma Dissociation Depersonalization 

List of Abbreviations


American Psychiatric Association


Dissociative identity disorder


Diagnostic and statistical manual of mental disorders


Post-traumatic stress disorder


  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publication; 2013.Google Scholar
  2. Anketell C, Dorahy MJ, Shannon M, et al. An exploratory analysis of voice hearing in chronic PTSD: potential associated mechanisms. J Trauma Dissociation. 2010;11:93–107.CrossRefPubMedGoogle Scholar
  3. Anketell C, Dorahy MJ, Curran D. A preliminary qualitative investigation of voice hearing and its association with dissociation in chronic PTSD. J Trauma Dissociation. 2011;12:88–101.CrossRefPubMedGoogle Scholar
  4. Beavan V. Towards a definition of “hearing voices”: a phenomenological approach. Psychosis. 2011;3:63–73.CrossRefGoogle Scholar
  5. Beavan V, Read J, Cartwright C. The prevalence of voice-hearers in the general population: a literature review. J Ment Health. 2011;20:281–92.CrossRefPubMedGoogle Scholar
  6. Bentall RP. The illusion of reality: a review and integration of psychological research on hallucinations. Psychol Bull. 1990;107:82–95.CrossRefPubMedGoogle Scholar
  7. Bleich A, Moskowits L. Post traumatic stress disorder with psychotic features. Croat Med J. 2000;41:442–5.PubMedGoogle Scholar
  8. Braakman MH, Kortmann FAM, Van den Brink W, et al. Posttraumatic stress disorder with secondary psychotic features: neurobiological findings. Prog Brain Res. 2008;167:299–302.CrossRefPubMedGoogle Scholar
  9. Brewin CR, Patel T. Auditory hallucinations in United Kingdom war veterans and civilians with posttraumatic stress disorder. J Clin Psychiatry. 2010;71:419–25.CrossRefPubMedGoogle Scholar
  10. Brunet K, Birchwood M, Upthegrove R, et al. A prospective study of PTSD following recovery from first-episode psychosis: the threat from persecutors, voices, and patienthood. Br J Clin Psychol. 2012;51(4):418–33.CrossRefPubMedGoogle Scholar
  11. Butler RW, Mueser KT, Sprock J, et al. Positive symptoms of psychosis in posttraumatic stress disorder. Biol Psychiatry. 1996;39(10):839–44.CrossRefPubMedGoogle Scholar
  12. Crowner M. Hearing voices, time traveling and being hit with a high heel shoe. Curr Psychiatry. 2014;13:57–62.Google Scholar
  13. Daalman K, Diederen KMJ, Derks EM, et al. Childhood trauma and auditory verbal hallucinations. Psychol Med. 2012;42:2475–84.CrossRefPubMedGoogle Scholar
  14. David AS. The cognitive neuropsychiatry of auditory hallucinations: an overview. Cogn Neuropsychiatry. 2004;9:107–23.CrossRefPubMedGoogle Scholar
  15. David D, Kutcher GS, Jackson EI, et al. Psychotic symptoms in combat-related posttraumatic stress disorder. J Clin Psychiatry. 1999;60(1):29–32.CrossRefPubMedGoogle Scholar
  16. De Leede-Smith S, Barkus E. A. comprehensive review of auditory verbal hallucinations: lifetime prevalence, correlates and mechanisms in healthy and clinical individuals. Front Hum Neurosci. 2013;7:1–25.Google Scholar
  17. Dell PF. Understanding dissociation. In: Dell PF, O’Neil JA, editors. Dissociation and the dissociative disorders: DSM–V and beyond. New York: Routledge; 2009. p. 709–825.Google Scholar
  18. Dorahy MJ, Shannon C, Seagar L, et al. Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: similarities and differences. J Nerv Ment Dis. 2009;197:892–8.CrossRefPubMedGoogle Scholar
  19. Freeman D, Fowler D. Routes to psychotic symptoms: trauma, anxiety and psychosis-like experiences. Psychiatry Res. 2009;169:107–12.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Gaudiano BA, Zimmerman M. Evaluation of evidence for the psychotic subtyping of post-traumatic stress disorder. Br J Psychiatry. 2010;197(4):326–7.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Graux J, Lemoine M, El Hage W, et al. From depersonalization to hallucinations. Psychopathology. 2012;45:42–52.CrossRefPubMedGoogle Scholar
  22. Hamner MB. Psychotic features and combat-associated PTSD. Depress Anxiety. 1997;5(1):34–8.CrossRefPubMedGoogle Scholar
  23. Hamner MB. Psychotic symptoms in posttraumatic stress disorder. Focus: J Lifetime Learn Psychiatry. 2011;9:278–85.CrossRefGoogle Scholar
  24. Hamner MB, Frueh BC, Ulmer HG, et al. Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder. Biol Psychiatry. 1999;45(7):846–52.CrossRefPubMedGoogle Scholar
  25. Hardy A, Fowler D, Freeman D, et al. Trauma and hallucinatory experience in psychosis. J Nerv Ment Dis. 2005;193:501–7.CrossRefPubMedGoogle Scholar
  26. Honig A, Romme MA, Ensink BJ, et al. Auditory hallucinations: a comparison between patients and nonpatients. J Nerv Ment Dis. 1998;186(10):646–51.CrossRefPubMedGoogle Scholar
  27. Jessop M, Scott J, Nurcombe B. Hallucinations in adolescent inpatients with post-traumatic stress disorder and schizophrenia: similarities and differences. Australas Psychiatry. 2008; 16(4):268–72.CrossRefPubMedGoogle Scholar
  28. Kastelan A, Francisković T, Moro L, et al. Psychotic symptoms in combat-related post-traumatic stress disorder. Mil Med. 2007;172(3):273–7.CrossRefPubMedGoogle Scholar
  29. Kilcommons AM, Morrison AP. Relationship between trauma and psychosis: an exploration of cognitive and dissociative factors. Acta Psychiatr Scand. 2005;112:351–9.CrossRefPubMedGoogle Scholar
  30. Kluft RP. First rank symptoms as a diagnostic clue to multiple personality disorder. Am J Psychiatry. 1987;144:293–8.CrossRefPubMedGoogle Scholar
  31. Kozarić-Kovačić D, Borovečki A. Prevalence of psychotic comorbidity in combat-related post-traumatic stress disorder. Mil Med. 2005;170:223–6.CrossRefPubMedGoogle Scholar
  32. Laddis A, Dell PF. Dissociation and psychosis in dissociative identity disorder and schizophrenia. J Trauma Dissociation. 2012;13:397–413.CrossRefPubMedGoogle Scholar
  33. Lindley SE, Carlson EB, Hill KR. Psychotic-like experiences, symptom expression, and cognitive performance in combat veterans with posttraumatic stress disorder. J Nerv Ment Dis. 2014;202:91–6.CrossRefPubMedGoogle Scholar
  34. Longden E, Madill A, Waterman MG. Dissociation, trauma, and the role of lived experience: toward a new conceptualization of voice hearing. Psychol Bull. 2012;138:28–76.CrossRefPubMedGoogle Scholar
  35. McCarthy-Jones S. Hearing voices: the history, causes and meanings of auditory verbal hallucinations. Cambridge: Cambridge University Press; 2012.CrossRefGoogle Scholar
  36. Middleton W, Butler J. Dissociative identity disorder: an Australian series. Aust NZ J Psychiatry. 1998;32:794–804.CrossRefGoogle Scholar
  37. Morrison AP, Haddock G. Self-focused attention in schizophrenic patients with and without auditory hallucinations and normal subjects: a comparative study. Personal Individ Differ. 1997;23:937–41.CrossRefGoogle Scholar
  38. Moskowitz A, Corstens D. Auditory hallucinations: psychotic symptom or dissociative experience? J Psychol Trauma. 2007;6:35–63.CrossRefGoogle Scholar
  39. Moskowitz A, Nadel L, Watts P, et al. Delusional atmosphere, the psychotic prodrome and decontextualized memories. In: Moskowitz A, Schäfer I, Dorahy MJ, editors. Psychosis, trauma and dissociation: emerging perspectives on severe psychopathology. Chichester: Wiley; 2008. p. 65–78.CrossRefGoogle Scholar
  40. Moskowitz A, Read J, Farrelly S, et al. Are psychotic symptoms traumatic in origin and dissociative in kind. In: Dell PF, O’Neil JA, editors. Dissociation and the dissociative disorders: DSM–V and beyond. New York: Routledge; 2009. p. 521–34.Google Scholar
  41. Mueser KT, Butler RW. Auditory hallucinations in combat-related chronic posttraumatic stress disorder. Am J Psychiatry. 1987;144:299–302.CrossRefPubMedGoogle Scholar
  42. Nijenhuis ERS, Van der Hart O. Dissociation in trauma: a new definition and comparison with previous formulations. J Trauma Dissociation. 2011;12:416–45.CrossRefPubMedGoogle Scholar
  43. Norredam M, Jensen M, Ekstrøm M. Psychotic symptoms in refugees diagnosed with PTSD: a series of case reports. Nord J Psychiatry. 2011;65:283–8.CrossRefPubMedGoogle Scholar
  44. Perona-Garcelán S, Cuevas-Yust C, García-Montez JM, et al. Relationship between self-focused attention and dissociation in patients with and without auditory hallucinations. J Nerv Ment Dis. 2008;196:190–7.CrossRefPubMedGoogle Scholar
  45. Perona-Garcelán S, Carrascoso-López F, García-Montez JM, et al. Depersonalization as a mediator in the relationship between self-focused attention and auditory hallucinations. J Trauma Dissociation. 2011;12:535–48.CrossRefPubMedGoogle Scholar
  46. Perona-Garcelán S, Carrascoso-López F, García-Montez JM, et al. Dissociative experiences as mediators between childhood trauma and auditory hallucinations. J Trauma Stress. 2012a;25:1–7.CrossRefGoogle Scholar
  47. Perona-Garcelán S, García-Montez JM, Ductor-Recuerda MJ, et al. Relationship between metacognition, absorption, and depersonalization in patients with auditory hallucinations. Br J Clin Psychol. 2012b;51:100–18.CrossRefPubMedGoogle Scholar
  48. Read J, Van Os J, Morrison AP, et al. Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatr Scand. 2005;112:330–50.CrossRefPubMedGoogle Scholar
  49. Ross CA. Schizophrenia: innovations in diagnosis and treatment. Birmingham: Haworth Press; 2004.Google Scholar
  50. Ross CA, Norton GR, Wozney K. Multiple personality disorder: an analysis of 236 cases. Can J Psychiatry. 1989a;34:413–8.PubMedGoogle Scholar
  51. Ross CA, Ryan L, Anderson G, et al. Dissociative experiences in adolescents and college students. Dissociation. 1989b;2:239–42.Google Scholar
  52. Ross CA, Miller SD, Reagor P, et al. Schneiderian symptoms in multiple personality disorder and schizophrenia. Compr Psychiatry. 1990;31:111–8.CrossRefPubMedGoogle Scholar
  53. Sareen J, Cox BJ, Goodwin RD, et al. Co-occurrence of posttraumatic stress disorder with positive psychotic symptoms in a nationally representative sample. J Trauma Stress. 2005;18(4):313–22.CrossRefPubMedGoogle Scholar
  54. Scott JG, Nurcombe B, Sheridan J, et al. Hallucinations in adolescents with post-traumatic stress disorder and psychotic disorder. Australas Psychiatry. 2007;15:44–8.CrossRefPubMedGoogle Scholar
  55. Shevlin M, Murphy J, Read J, et al. Childhood adversity and hallucinations: a community-based study using the National Comorbidity Survey Replication. Soc Psychiatry Psychiatr Epidemiol. 2011;46:1203–10.CrossRefPubMedGoogle Scholar
  56. Sierra M. Depersonalization: a new look at a neglected syndrome. Cambridge: Cambridge University Press; 2009.CrossRefGoogle Scholar
  57. Simeon D, Abugel J. Feeling unreal: depersonalization and the loss of the self. Oxford: Oxford University Press; 2006.Google Scholar
  58. Van der Hart O, Nijenhuis E, Steele K. The haunted self: structural dissociation and the treatment of chronic traumatization. New York: W. W. Norton; 2006.Google Scholar
  59. Van Putten T, Emory WH. Traumatic neuroses in Vietnam returnees: a forgotten diagnosis? Arch Gen Psychiatry. 1973;29:695–8.CrossRefPubMedGoogle Scholar
  60. Varese F, Bentall RP. The metacognitive beliefs account of hallucinatory experiences: a literature review and meta-analysis. Clin Psychol Rev. 2011;31(5):850–64.CrossRefPubMedGoogle Scholar
  61. Varese F, Udachina A, Myin-Germeys I, et al. The relationship between dissociation and auditory verbal hallucinations in the flow of daily life of patients with psychosis. Psychosis. 2011;3:14–28.CrossRefGoogle Scholar
  62. Wilcox J, Briones D, Suess L. Auditory hallucinations, posttraumatic stress disorder, and ethnicity. Compr Psychiatry. 1991;32:320–3.CrossRefPubMedGoogle Scholar
  63. Yee L, Korner AJ, McSwiggan S, et al. Persistent hallucinosis in borderline personality disorder. Compr Psychiatry. 2005;46:147–54.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of CanterburyChristchurchNew zealand

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