Hearing Voices, or Auditory Hallucinations, in Schizophrenia

Auditory hallucinations, or hearing voices, is a common symptom in people living with schizophrenia. In fact, an estimated 70 to 80% of people with schizophrenia hear voices. These voices can call your name, argue with you, threaten you, come from inside your head or via outside sources, and can begin suddenly and grow stronger over time.

People living with other mental illnesses, including bipolar disorder, borderline personality disorder, major depressive disorder, post-traumatic stress disorder, and schizoaffective disorder, also experience hearing voices.

Auditory perceptual illusions are not as uncommon as we once thought. In fact, up to 10% of the general population have had the experience of hearing one’s name called, especially during the twilight times of falling asleep (hypnopompic) or waking up (hypnagogic).

For some, auditory hallucinations appear suddenly. T. M. Luhrman, a professor of anthropology at Stanford and author of Living With Voices, described the experience of a young man who started hearing the sound of rats scratching behind his ears. His auditory hallucinations began rapidly and soon after he destroyed a number of rats nests. Another young man started to suddenly hear a voice coming from outside his apartment that sounded like a woman screaming; she was raped and begging for help.

Many times the voices can start gradually and are often described as a vague or fleeting impression of hearing your name called or people talking about you. For example, "Someone just called my name” or “people were talking in the hallway,” or “I thought I heard something but then I am not sure.”

A few examples of the type sounds that might be heard:

• Repetitive, screeching sounds suggestive of rats
• Painfully loud, thumping music themes
• Voices of people blasting mean orders or comments
• People talking about you as if you were not even present

As Eleanor Longden, a research psychologist with a diagnosis of schizophrenia explains, the voices can order you to do completely nonsensical things, such as taking a glass of water and pouring it over your head. Due to their repetitive, incessant, annoying quality, the voices can make people profoundly distracted and overwhelmed to the point of choosing to follow their orders.

Voices giving orders to harm oneself or others need to be approached with great caution. This type of auditory hallucination can be extremely frightening as the orders tend to be screamed non-stop.

Some people hear persuasive, repetitive voices by a secret organization, for example, that threaten death or harm. Again, these voices are frightening and increase a person's risk of self-harm or violence.

Treatment for schizophrenic voices typically requires a combination of medications, therapy, and other procedures for those who are treatment-resisted.

• Antipsychotics: These medications are often the first line of treatment and have been study-proven to rapidly decrease the severity of auditory hallucinations.
• Cognitive-behavioral therapy (CBT): When used in combination with medication, CBT can help reduce the emotional distress of schizophrenic voices and help people develop skills to cope with and quiet the voices. For example, humming the "Happy Birthday" song or reading a paragraph backward when the voices begin.
• Repetitive transcranial magnetic stimulation (rTMS): Also known as Repetitive TMS, this relatively non-invasive procedure involves placing a small magnetic device directly on the skull. It has been shown to reduce the frequency and severity of auditory hallucinations in people with schizophrenia.
• Electroconvulsive therapy (ECT): Considered a last-resort treatment for reducing the severity of auditory hallucinations, ECT involves the application of a brief electrical pulse to the scalp in order to produce a seizure.

Coping with a loved one who is struggling with schizophrenic voices can take a toll—but try not to lose hope. With the right treatment, your loved one may be able to control the frequency and severity of these voices. You also may consider family therapy, which can help you and your loved one recognize these auditory hallucinations and develop strategies to better cope.