Hearing voices and other altered perceptual experiences across psychotic, mood, and anxiety disorders: from phenomenology and mechanisms to future directions.
Wei Lin Toh, Sophie Richards, Charles Fernyhough, Eleanor Longden, Peter Moseley, Padmavati Ramachandran, Neil Thomas, Susan Lee Rossell
Schizophrenia (Heidelberg, Germany) September 29, 2025 Peer reviewed DOI: 10.1038/s41537-025-00673-3 via PubMed
Summary
Altered perceptual experiences, such as hearing voices, occur across psychotic, mood, and anxiety disorders, not just in psychosis. A narrative review of the literature found that these experiences are phenomenologically diverse, often involving multiple senses, and that existing research focuses heavily on trauma and neurocognition in voice-hearing. Current explanatory models and interventions are largely centered on voices, indicating a need for broader approaches. Quality assessment rated the review 12 out of 12. Future work requires better assessment tools, methodological consistency, and integration of lived experience and transcultural perspectives.
Study at a glance
| Design | narrative literature review |
|---|---|
| Key finding | Altered perceptual experiences across psychotic, mood, and anxiety disorders show phenomenological heterogeneity and multisensory features, with mechanistic studies focusing mainly on trauma and neurocognition in voices, and a need for broader explanatory models and interventions. |
Abstract
While voice-hearing in psychosis has received much attention, perceptual experiences in other sensory modalities and psychiatric conditions have remained relatively overlooked. The present review aimed to address this gap by providing an overview of voices/altered perceptual experiences (APE) across psychotic, mood and anxiety disorders in terms of phenomenological characteristics, biopsychosocial mechanisms, etiological models and therapeutic interventions. Where possible, lived experience perspectives and transcultural considerations were embedded. A narrative literature review was conducted. Knowledge pertaining to voices in psychosis formed the foundation, broadened to include other sensory modalities and diagnostic conditions. Quality assessment demonstrated an excellent rating of 12/12. Notable findings related to: (i) phenomenological heterogeneity in voices/APE within individuals and across diagnostic conditions, with multisensory/multimodal experiences relatively widespread; (ii) existing mechanistic studies mainly focusing on the role of trauma and neurocognition in voices; (iii) prevailing explanatory models mostly focusing on voices; (iv) a need for emerging interventions to extrapolate to encompass broader therapeutic applications; and (v) wide-ranging specificity issues and transcultural considerations to be addressed. Future research should invest in appropriate assessment tools as well as ensuring methodological consistency in mechanistic studies. Incorporating lived experience perspectives and meaningfully embedding transcultural considerations in theoretical and empirical ways are also essential.