Auditory hallucinations: Description, Causes and Risk Factors:
A symptom frequently observed in a schizophrenic disorder consisting, in the absence of an external source, of hearing a voice or other auditory stimulus that other individuals do not perceive.
Hallucinations are defined as "any percept-like experience which occurs in the absence of an appropriate stimulus, has the full force or impact of the corresponding actual perception, and is not amenable to direct and voluntary control by the experiencer."
Auditory hallucinations are among the most prominent and distressing symptoms of a psychotic episode. It has been hypothesized that patients who view their voices as coming from inside the head may have a less distorted sense of reality, and they may be healthier if they are aware that it is their own thoughts they are hearing.
Auditory hallucinations feature prominently in many psychiatric disorders. It has been estimated that approximately 75% of people with schizophrenia experience auditory hallucinations. These hallucinations are also relatively common in bipolar disorder (20% to 50%), in major depression with psychotic features (10%), and in posttraumatic stress disorder (40%).
Auditory hallucinations are considered by many medical professionals to be the most frequent and reliable symptom of psychosis. More than 70 percent of diagnosed schizophrenics suffer from them at some point in the course of their disease. In Frontiers in Neuroscience, Kenneth Hugdahl and a group of researchers at the University of Bergen, Norway, published a recent study of temporal disturbances during auditory hallucinations. The main question the scientists sought to answer was whether there are identifiable brain tissue abnormalities in schizophrenic patients who frequently hear voices. Hugdahl's group found significantly reduced grey matter density in the left peri-Sylvian region, an area of the cerebral cortex that includes Broca's Area, Wernicke's Area, and other language-processing structures. Lesions to the so-called peri-Sylvian region of the left superior temporal gyrus can cause loss of language capabilities. The researchers found that "hallucinating patients had significantly reduced grey matter density in the left superior temporal gyrus, the medial prefrontal cortex in peri-ventricular areas, and in the thalamus."
Schizophrenics characteristically have auditory hallucinations. A common type of auditory hallucination of a schizophrenic is a voice which refers to the patient in the third voice calling him/her worthless or useless and no-good. Sometimes there is a running commentary and at other times there are whispers. Sometimes auditory hallucinations may take on the form of imperative statements asking the patient to kill someone or themselves. One type of auditory hallucination that is peculiar to schizophrenics is called "echo de pensees which is the type of hallucination where a patient hears his own thoughts out loud and feels that everyone can hear him thinking. Auditory hallucinations are very weird. Ralph Hoffman at the Yale University medical school has proposed a theory that since the development of feeling which are not physically present happens in normal people all the time during dreams, that it is probably not just the presence of voices that cause create problems for schizophrenics, but that it is the conflict between the voices and the will of the schizophrenic patients that make the symptom so aversive.
Another theory about the development of auditory hallucinations has been proposed to be caused by agitated arousal leading to mia attribution of internal thoughts to external voices.
Different factors have been found that increase the chances of an auditory hallucination happening. Psychological stress, certain predisposing factors, environmental stimulation and some types of reinforcement are some of the factors that have been found to make the chance of getting auditory hallucinations more probable. Lets look at what these factors really mean.
Psychological stress could come in many forms. For some, it may be the stress of turning in a project on time, for others it may be whether you get nominated for prom king or queen. Other people may have a fear of flying or of the dark. Stress could also be as a result of disease like infections and other types of illness. Stress could also be anything that causes a psychological impact such as anxiety or fear even if it is unfounded. As we said before, you could be afraid of going into your garage at night because you just watched "scream," and you are sure that there is a murderer in there. This is a form of stress even though you know in the back of your mind that there probably isn't a real murderer in your garage.
As we know, we sometimes feel that it takes us hours or days to learn things that we feel that it takes some other people a short time to learn and to perform well in. Some people believe that different people have inborn predispositions to be able to do things better or faster than others with less practice. An example of this are musical prodigies who are able to play Handel's "Messiah" when they are four. These kids are thought to have some kind of innate affinity for being able to play these instruments and can be said to be predisposed to do that. In the same way some have theorized that everybody may have a predisposition to different things and that some people are predisposed to having auditory hallucinations.
The effect of the environment also plays a big part in the development of auditory hallucinations. Many cases of auditory hallucinations have occurred when there was a low amount of environmental sensory deprivation. By this we mean that if it is very quiet and there is no source of sound stimulation available it is more likely that a person will develop an auditory hallucination. This may be a reason that there are many reports of auditory hallucinations by people who are placed in solitary confinement or isolation. Sensory deprivation as a factor contributing to the cause of auditory hallucinations is evidenced by the phenomenon that people hear auditory hallucinations more often when it is quiet than in a noisy area.
The other variable which may contribute to the auditory hallucination is the factor of the reinforcing nature of an auditory hallucination. Granted when we think of auditory hallucinations, many of us would think of a loud banging or clanking noise which is agitating ang annoying and which you would do anything to be rid of. Well, consider if your auditory hallucination was one where you hear the voice of a member of the opposite sex saying how handsome or cute you are and a lot of other nice things about you. You would probably want to hear that voice a whole lot more, because it would make you feel good. Well, when auditory hallucinations make the person having them feel good, they are said to be reinforcing. It is not unusual to come across people who do have auditory hallucinations and want to continue to have them because of this effect.
Conditions which trigger the auditory hallucinations may include:
- Medication side effects.
- Seizure disorders.
- Severe fatigue.
- Sleep deprivation.
- Substance abuse.
Auditory hallucinations can range from primitive noises such as bangs, whistles, claps, screams, ticks, and others to speech and music.Commonly people who have auditory hallucinations hear voices which utter short comprehensible phrases. Sometimes the person may recognize the voice as one of a family member or deceased friend and sometimes it may be the voice of a stranger or even God. The voices or sounds can be thought to originate from anywhere. The walls, the ground, trees, a shoe are all possible origins of hallucinatory sounds.
To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your hearing voices including:
When did you first hear voices?
- What do the voices say?
- Did any events or stresses occur before you started hearing voices?
- Do you have any other symptoms?
- Do you have any psychiatric or medical problems?
- What medications are you taking?
- Do you drink any alcohol?
- Are you using any illicit drugs?
Because of the multiple causes of auditory hallucinations, physicians must take care to obtain detailed histories from the patient, to assess for mood and psychotic symptoms, and to obtain collateral information. Laboratory tests and brain scans can also offer further clues to the underlying cause of the auditory hallucinations.
Many therapies have been tried with varying success, and here we want to present the various methods which have proved successful to some idea. Please realize that there are many different forms of these auditory hallucinations and these therapies are not able to cure all auditory hallucinations.
Drug therapies are based on the assumption that the auditory hallucinations are as a result of some other condition. Therefore, the drugs used to treat other disorders are used to treat the hallucinations also. The neuroleptics such as dopamine antagonists have been used to calm the auditory hallucination effects of schizophrenics. In general, drug treatments have had varying effects on different hallucinatory symptoms and when drugs have failed psychological methods have been used.
Other Treatment Options:
Operant procedures refers to the use of different environmental contingencies to alter the behavior produced. Let's break this down a little more. Things that happen to us in our environment affect the way we behave. If you are interested in watching a particularly exciting program on the television you may be under a contingency that you must finish your homework before you can watch TV. If you really want to watch the TV program, you will make sure that you complete your homework before the program comes on. This is an example of the environmental contingency controlling your behavior. A reinforcing event (like watching the TV) can promote another behavior or response when your watching TV is placed under the contingency of the other response. Operant procedures are the use of contingencies on personally reinforcing events to make you behave in a particular way. So, this method was used on people suffering from auditory hallucinations to cause them to stop hallucinations.
- Systematic desensitization is also a technique used to treat auditory hallucinations. This entails the relation of a bad environmental condition (aversive stimulus) with a more pleasant and less aversive result. This usually causes a decreased aversive reaction to the bad condition and all the responses as a result of that. This system is used especially in auditory hallucinations which seem to brought on by stressful situations. Associated peripherally with this is also the newly developed satiation treatment whereby a person with hallucinations would record the number of times the hallucination occurred and would consciously pay attention to it. It has been found to be useful for patients which do not respond to systematic desensitization.
- Thought stopping is another procedure which uses an aversive condition to stop the hearing of auditory hallucinations. This therapy entails punishing the patient for hearing those auditory hallucinations.
- Counter stimulation has been found to be an effective way of reducing the occurrence of auditory hallucinations. During this treatment, other auditory stimuli are presented whenever there are auditory hallucinations. We don't think this therapy is very practical. Imagine what would happen if a person with an auditory hallucination was trying to combat their hallucinations in a public place. The louder the hallucinations were, the more he would have to turn up a real sound stimuli. When the sound stimuli are high enough, any auditory hallucination that is received would require him to increase the external sound even more. This could become very disturbing to those around.
One of the theories of auditory hallucinations was proposed by Paul Green (1978). He proposed that auditory hallucinations represent verbal activity originating in the non-dominant hemisphere and that the dominant hemisphere perceived this verbal activity as foreign, due to a dissociation of the hemispheres in schizophrenia
. Some evidence which supports his theory was obtained in an experiment which shows that researchers have found that it is possible to decrease the frequency of auditory hallucinations by providing ear plugs in one side of the ear. He proposed that auditory hallucinations in schizophrenics occurred as a result of defective "interhemispheric integration" in the brain. His therapy was shown to have immediate dramatic effects.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.