Experiential features used by patients with schizophrenia to differentiate voices from ordinary verbal thought
Abstract
BACKGROUND: Determining how patients distinguish auditory verbal hallucinations (AVHs) from their everyday thoughts may shed light on neurocognitive processes leading to these symptoms. METHOD: Fifty patients reporting active AVHs ('voices') with a diagnosis of schizophrenia or schizo-affective disorder were surveyed using a structured questionnaire. Data were collected to determine: (a) the degree to which patients distinguished voices from their own thoughts; (b) the degree to which their thoughts had verbal form; and (c) the experiential basis for identifying experiences as voices versus their own verbal thoughts. Six characteristics of acoustic/verbal images were considered: (1) non-self speaking voice, (2) loudness, (3) clarity, (4) verbal content, (5) repetition of verbal content, and (6) sense of control. RESULTS: Four subjects were eliminated from the analysis because they reported absent verbal thought or a total inability to differentiate their own verbal thoughts from voices. For the remaining 46 patients, verbal content and sense of control were rated as most salient in distinguishing voices from everyday thoughts. With regard to sensory/perceptual features, identification of speaking voice as non-self was more important in differentiating voices from thought than either loudness or clarity of sound images. CONCLUSIONS: Most patients with schizophrenia and persistent AVHs clearly distinguish these experiences from their everyday thoughts. An adequate mechanistic model of AVHs should account for distinctive content, recognizable non-self speaking voices, and diminished sense of control relative to ordinary thought. Loudness and clarity of sound images appear to be of secondary importance in demarcating these hallucination experiences.
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Patients rely on aspects of AVH experience other than vividness or loudness to distinguish AVHs from typical inner speech.
“A phenomenological study found, however, that patients rely on other aspects of AVH experience to distinguish them from their typical inner speech (9).”
From Elevated functional connectivity along a corticostriatal loop and the mechanism of auditory/verbal hallucinations in patients with schizophrenia (2011) · cites this paper as [9]
A second distinguishing feature of AVHs is verbal content experienced as uncharacteristic of the patient's own inner speech.
“A second distinguishing feature of AVHs is verbal content experienced as uncharacteristic of the patient’s own inner speech.”
From Elevated functional connectivity along a corticostriatal loop and the mechanism of auditory/verbal hallucinations in patients with schizophrenia (2011) · cites this paper as [9]
AVHs are generally cast in distinct, nonself speaking voices, whereas inner speech is typically cast in the first-person voice.
“For instance, AVHs generally are cast in distinct, nonself speaking voices, whereas inner speech is typically cast in the first-person voice.”
From Elevated functional connectivity along a corticostriatal loop and the mechanism of auditory/verbal hallucinations in patients with schizophrenia (2011) · cites this paper as [9]
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Esse est percipi: A Neurophilosophical Model of Psychosis
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Voces que No lo Son: Los Problemas del Concepto Pseudoalucinación
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Reduced attention-driven auditory sensitivity in hallucination-prone individuals
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High Royds Hospital, Menston, Ilkley
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Letter to the Editor: Auditory-verbal hallucinations and ordinary verbal thought
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Alien Intentionality in Schizophrenia
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- Authors
- Hoffman, R. E., Varanko, M., Gilmore, J., & Mishara, A. L.
- Affiliations
- Yale University (US)
- Corresponding author
- Hoffman, R. E.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2007-11-30
- Volume
- 38
- Issue
- 8
- Pages
- 1167-1176
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2170364559
- Cited by
- 79
- References
- 39
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 5 · 2015: 8 · 2014: 10 · 2013: 11 · 2012: 9
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R21MH063326, R21 MH 63326)
- National Center for Research Resources (M01RR000125, RR00125)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- auditory verbal hallucinations, schizophrenia, schizoaffective disorder, voice, perceived control, verbal content
- MeSH terms
- Adult, Female, Hallucinations, Humans, Male, Surveys and Questionnaires, Schizophrenia, Semantics, Thinking, Verbal Behavior, Self Efficacy, Transcranial Magnetic Stimulation
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