What Is an Auditory Hallucination?

Auditory hallucinations are false perceptions of sound in the absence of an external stimulus. You basically hear voices talking to you or other noises or music, which others around you do not hear. It is a very common symptom among schizophrenics. As a percentage, about 70 percent of schizophrenic patients and about 15 percent of patients suffering from severe depression, mania, and mood disorders also experience auditory hallucinations.  

What are auditory hallucinations?

Auditory hallucinations are when you hear voices, noises, or music in the absence of an external auditory stimulus. This is a very common symptom among patients suffering from schizophrenia, but could also occur in patients with severe depression, mania, and mood disorders. However, it is possible for people without mental illness to have auditory hallucinations as well.

What are the different types of auditory hallucinations?

Auditory hallucinations can be classified into three different groups. They are:

1. Second person auditory hallucinations
2. Third person auditory hallucinations
3. Thought echo or repeating thoughts

Each type of auditory hallucination will be explained in detail below:  

Second person auditory hallucinations

Second person auditory hallucinations or second order auditory hallucinations refer to voices that address the person in the second person. For this reason, doctors address the patient as "you". For example, the voices may be telling the patient, “You are going to die." In some cases, these voices could even command individuals to do certain actions by hearing words such as “Kill him."

Second person hallucinations are not diagnostic of schizophrenia like in the third person hallucinations, but the content of the hallucinations and the way these patients react to these hallucinations can be useful in the diagnosis. Even though second person hallucinations may not be diagnostic, it is important to be aware of it because they carry a risk of harm to the patient as well as others. There is also a possibility that these patients may execute the commands they hear.

The content of the hallucinations will also help the psychiatrist to make a diagnosis of the mental condition the patient is suffering from. For instance, a patient with severe depression may hear auditory hallucinations such as:

• You are useless!
• You are worthless!
• Kill yourself!

In cases like these, the patient may accept these commands as being justified, whereas schizophrenics may refuse to accept such comments that the voices make. Therefore, interpreting the contents of their hallucinations may give an indication of the possible diagnosis.

Third person auditory hallucinations

In third person auditory hallucinations, the patient hears two or more voices talking about the patient. For example, the patient may hear voices that say, “He is an evil person.” Third person auditory hallucinations may also be heard as commentary voices, where he or she may hear voices that comment on every action that he or she is currently doing or is intended to do. Examples of such hallucinations are:

• She is opening the door now.
• She is going to sleep now.
• She wants to kill him.

These hallucinations are known as running commentaries. Third person hallucinations and running commentaries are very common and are suggestive of schizophrenia. Third person hallucinations are one of the symptoms based on Schneider’s first-rank symptoms, which is used to diagnose schizophrenia. The mere presence of third person hallucinations is highly suggestive of schizophrenia.

Thought echo or repeating thoughts

Thought echo or repeating thoughts are a type of auditory hallucinations where the patient hears their own thoughts spoken aloud. Their thoughts can either be simultaneously heard (at the same time they think of something) or soon after having the thought.

What causes auditory hallucinations?

1. Psychiatric conditions

Auditory hallucinations can be a result of many conditions, but the most commonly known psychiatric disease is schizophrenia. Other psychiatric conditions such as severe depression, mania, dissociative identity disorder, or bipolar disorder may also have symptoms of auditory hallucinations.

2. Organic brain disorders

If you have had a serious trauma to your head or are suffering from a medical condition that affects your brain, then you are more likely to develop auditory hallucinations. Many people who have experienced serious accidents have reported of hearing voices.

3. Stress

Mental stress alone is one cause of auditory hallucinations. A heavy load of stress can cause you to hear voices in your head. Sometimes, loss of a loved one can lead to hearing of voices. Isolation is also another factor that may trigger this problem, too.

4. Lack of sleep

Not having enough sleep can also be a triggering factor for hearing voices. If you haven’t had a good sleep for a long period of time, then this may also induce hallucinations in you.

5. Drugs

Hallucinations can also be a side effect of certain drugs, especially those that interfere with the neurotransmitters in the brain. You may hear voices when you start taking the drug or hear them soon after you withdraw from the drug.

How to Manage Auditory Hallucinations

Sometimes, the voices may only be heard a few times and a person could manage to live with them, but in other cases, hearing voices all the time, even when you are trying to get some sleep, could be very troublesome and annoying. In cases like these, patients will need some psychiatric help to manage the hallucinations.

The following methods may be helpful to control the auditory hallucinations:

• Antipsychotic drugs - These drugs are the most commonly used medications to control auditory hallucinations. Antipsychotic medications act by making changes to the dopamine levels in the brain, which will help get rid of the hallucinations. If you are hearing voices due to severe depression, then your psychiatrist may prescribe you appropriate medications such as antidepressants.

• Cognitive behavioral therapy (CBT) - This type of therapy is an effective way to decrease the intensity and frequency of the hallucinations you may be hearing.

• Electroconvulsive therapy (ECT) - ECT is a commonly used method to treat severe depression, schizophrenia, and mania. ECT is a biological treatment procedure that uses repetitive magnetic stimulations to the cranium, which alters the neural activity in your brain.

• Reframing - This method is a very effective way of managing auditory hallucinations. Reframing voices means that you bring those voices to your consciousness and make yourself aware that these voices are not real. Once you are able to do this and become comfortable with the voices you hear, then you will be able to reduce the intensity and frequency of these voices.