Voice Hearing & Trauma

What is the significance of trauma when understanding voice hearing?

Trauma = Beyond the coping capacity of the individual

As the field of psychology progresses, so does our knowledge of the significance that an individual’s experiences have on emotional health and behavior. Trauma could be both a risk factor and a consequence of psychosis.

Research Findings:

In a sample of 2,608 individuals who were diagnosed with psychotic-based disorders, the rate of individuals who met the criteria for PTSD was 16% (Giannopoulo et al., 2023).
Rates of trauma exposure are higher in individuals who experience psychosis, with estimates ranging from 38-78%.
Symptoms of psychosis 3x higher for someone who experienced childhood trauma than for those who did not, with the overall risk being 33% (Giannopoulou et al., 2023; Bloomfield et al., 2021).
Childhood trauma was also associated with increased symptom severity and worse functional outcomes than psychosis alone (Bloomfield et al., 2021).
Traumatic experiences that involve potential harm to the individual signify an increased risk of psychotic-like experiences (PLE). These include bullying, sexual abuse, domestic violence, and neglect, which were also significant precursors to the development of PLEs.
The age associated with the onset of psychotic experiences can also vary depending on the type of adverse childhood experience (ACE) that the individual endured.
For example, individuals who experienced general ACE are more likely to develop PCEs during adolescence, while individuals who had experienced sexual abuse are at increased risk of developing psychotic symptoms in childhood (4-12).
In studies examining non-clinical participants (18-22), researchers have found a link between sexual abuse and symptoms of disorganized speech, while survivors of childhood neglect were more likely to exhibit persecutory beliefs.
In individuals who were deemed “ultra-high risk” of developing psychotic symptoms, their physical abuse was associated with increased levels of suspiciousness, visual hallucinations, depressed mood, and grandiosity in comparison to controls. For individuals who experienced childhood sexual trauma, they were more likely to experience hallucinations that were associated with the abuse they endured (Giannopoulou et al., 2023).

Trauma's impact on the content of hallucinations:

In one study of 35 patients, nearly three-quarters were able to identify a connection between their visual hallucinations and past traumatic experiences.
Some individuals reported hallucinations that closely reflected their trauma, such as seeing an image that symbolized an abuser.
These personal accounts suggest that trauma can directly shape the content and themes of some psychotic experiences.
Research on psychosis more often focuses on auditory hallucinations, since hearing voices is more common than visual hallucinations.
In a study of 199 people who hear voices:
- 12% reported voices that exactly repeated past conversations
- 31% reported voices that were similar but not identical to past conversations
- In this study, the voices were not directly linked to traumatic events.
Because direct links are not always clear, researchers also study thematic or emotional connections between trauma and hallucinations.
A thematic relationship refers to shared emotional content rather than exact memories.
For example, trauma that caused fear or shame may later be reflected in voices that criticize, threaten, or shame the person.
In a study of 40 participants:
- 12.5% reported a direct link between trauma and hallucination content
- 45% reported an indirect emotional link between trauma and hallucination content
These findings suggest that trauma often influences hallucinations through emotional themes rather than exact replay of events (Steele, 2015).
Although this appears to fall in line with “flashbacks” in individuals with post-traumatic experiences, researchers believe that this phenomenon is distinct from PTSD-related symptoms.
When examining case records of 100 patients diagnosed with schizophrenia, researchers found that half of the content recorded was related to childhood abuse. Of the 35 patients who were interviewed, 74.3% were able to identify a connection between their visual hallucinations and the trauma they experienced. For example, an individual who reported experiencing childhood sexual abuse shared that she had seen an image of a bearded man who represented her attacker (Steele 2015). Although subjective, these types of personal accounts demonstrate the ways in which specific trauma directly influences the theme of the psychotic experience.

Distinction between “psychosis” flashbacks and PTSD:

Re-experiencing the trauma in PTSD is considered to be more of an intrusive thought that feels real rather than experiencing a genuine alteration of visual or auditory perception (Steele, 2015).
Considerable comorbidity between the two diagnoses

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Sources:

Bloomfield, M. A. P., Chang, T., Woodle, M. J., Lyons, L. M., Cheng, Z., Bauer‐Staeb, C., Hobbs, C., Bracke, S., Kennerley, H., Isham, L., Brewin, C., Billings, J., Greene, T., & Lewis, G. (2021). Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: A systematic review and meta‐analysis. World Psychiatry, 20(1), 107–123.

Giannopoulou, I., Georgiades, S., Stefanou, M.-I., Spandidos, D., & Rizos, E. (2023). Links between trauma and psychosis (review). Experimental and Therapeutic Medicine, 26(2). https://doi.org/10.3892/etm.2023.12085

Larøi, F., Thomas, N., Aleman, A., Fernyhough, C., Wilkinson, S., Deamer, F., & McCarthy-Jones, S. (2019). The ice in voices: Understanding negative content in auditory-verbal hallucinations. Clinical Psychology Review, 67, 1–10. https://doi.org/10.1016/j.cpr.2018.11.001

Piesse, E., Paulik, G., Mathersul, D., Valentine, L., Kamitsis, I., & Bendall, S. (2023). An exploration of the relationship between voices, Dissociation, and post‐traumatic stress disorder symptoms. Psychology and Psychotherapy: Theory, Research and Practice, 96(4), 1015–1028. https://doi.org/10.1111/papt.12493

Steel C. (2015). Hallucinations as a trauma-based memory: implications for psychological interventions. Frontiers in Psychology, 6, 1262. https://doi.org/10.3389/fpsyg.2015.01262