Visual and Auditory Verbal Hallucinations in Schizophrenia and Their Relation to Self-Disorders.

Most people with schizophrenia who hear or see things that others do not describe these experiences as being like ordinary perception, and they often occur alongside a disturbed sense of self. In interviews with twenty patients, auditory and visual hallucinations were linked to alterations in the structure of sensory experience, such as changes in spatiality, and were felt to be private rather than publicly accessible. Compared to a control group, those with hallucinations had higher levels of basic self-disorders, earlier onset of mental health problems, and lower IQ. The findings suggest that hallucinations in schizophrenia may stem from a fundamental disturbance in the sense of self, and that visual hallucinations may also be related to this disturbance.

Study at a glance

Abstract

The current definition of hallucinations as perception-like experiences has been criticized for neglecting their experiential character and context. This study examined the phenomenology of auditory verbal hallucinations (AVHs) and visual hallucinations (VHs) in schizophrenia and their relation to other psychopathology, particularly basic self-disorders. Twenty patients with schizophrenia-spectrum psychosis and hallucinations participated in phenomenologically oriented, semi-structured interviews exploring the experiential characteristics and context of AVH and VH as well as a comprehensive psychopathological examination, including the Examination of Anomalous Self-Experience (EASE). The far majority of participants considered their hallucinations distinct from perceptual experience and described alterations of the ordinary experiential structure of sensory experience. Generally, both AVH and persistent VH were experientially intertwined with self-disorders and other subjective pathological phenomena. Moreover, AVHs were characterized by alterations of spatiality and experienced as private, i.e., not being accessible to others. Compared to a control group, the participants with hallucinations had significantly higher levels of self-disorders, earlier onset of psychopathology, and lower IQ. The findings align with prior research proposing that most AVHs in schizophrenia reflect an underlying alteration of the structure of subjectivity (i.e., disorder of basic self). We report novel findings suggesting that a similar link between self-disorders and VH should be further investigated. Our study highlights the importance of assessing hallucinations within the broader context of the patient's psychopathology for adequate differential diagnostic evaluation and understanding of lived experience.