Trauma can contribute to voice-hearing but is not necessary for it. This article uses ethnographic and other data to show multiple pathways to voice-hearing in both clinical and nonclinical populations, excluding known causes like drugs or epilepsy. Trauma sometimes plays a major role, sometimes a minor role, and sometimes no role at all. Distinct phenomenological patterns in voice-hearing may reflect different salience of trauma for those who hear voices.
Psychosis is typically preceded by a prodrome, which begins with nonspecific symptoms like anxiety and depression before more specific negative and attenuated positive symptoms emerge. Prospective diagnostic criteria, developed from retrospective studies, show high reliability in research settings. Individuals assessed as at clinical high risk (CHR) are five to seven times more likely to progress to psychosis than those not at risk, and they also experience functional and cognitive impairment and distress. CHR diagnosis rates are low in general epidemiology studies, supporting validity, but substantially higher in clinical epidemiology studies, indicating CHR is an important but often overlooked clinical entity. Several areas needing additional research are identified.