Dissociation, trauma, and the role of lived experience: Toward a new conceptualization of voice hearing.

Longden, Eleanor; Madill, Anna; Waterman, Mitch G.

doi:10.1037/a0025995

Cited by 248Psychosomatic Disorders and Their TreatmentsHallucinations in medical conditionsSchizophrenia research and treatment

Dissociation, trauma, and the role of lived experience: Toward a new conceptualization of voice hearing.

Longden, Eleanor, Madill, Anna, Waterman, Mitch G.·2012·Psychological Bulletin

DOI 10.1037/a0025995

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Abstract

Voice hearing (VH) is often regarded as pathognomic for schizophrenia. The purpose of this article is to review and integrate historical, clinical, epidemiological, and phenomenological evidence in order to suggest that VH may be more appropriately understood as a dissociative rather than a psychotic phenomenon. First, we discuss the lifetime prevalence of VH in the general population, which is estimated to range between 1% and 16% for adult nonclinical populations and 2% and 41% in healthy adolescent samples. Second, we demonstrate how the ubiquity of VH phenomenology, including variables like voice location, content, and frequency, limits its diagnostic and prognostic utility for differentiating psychotic from trauma-spectrum and nonclinical populations. Finally, we report on the empirical associations between VH, measures of dissociation, and trauma particularly (though not exclusively) childhood sexual abuse. There are 2 main conclusions from this review. First, we argue that available evidence suggests that VH experiences, including those in the context of psychotic disorders, can be most appropriately understood as dissociated or disowned components of the self (or self-other relationships) that result from trauma, loss, or other interpersonal stressors. Second, we provide a rationale for clinicians to use psychotherapeutic methods for integrating life events as precipitating and/or maintaining factors for distressing voices. Potential mechanisms for the relationship between trauma, dissociation, VH, and clinical diagnosis are described, including the relevance of literature from the field of attachment in providing a diathesis for dissociation. Suggestions for future research are also discussed.

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Voice hearing in individuals with trauma-related disorders does not differ significantly from that observed in individuals with schizophrenia.
“a recent review suggested that voice hearing in individuals with trauma-related disorders does not differ significantly from that observed in individuals with schizophrenia (Longden et al., 2012).”
From A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions (2016) · cites this paper as Longden et al., 2012
Dissociation has long been considered a psychological defence mechanism to protect the individual against intolerable events such as trauma.
“Dissociation has long been considered a psychological defence mechanism to protect the individual against intolerable events such as trauma (see [14]).”
From A brief CBT intervention for depersonalisation/derealisation in psychosis: Study protocol for a feasibility randomised controlled trial (2016) · cites this paper as [14]
Dissociation has been linked to AVH.
“Given that intrusive thoughts (Morrison and Baker, 2000; Jones and Fernyhough, 2006), intrusions from memory (Brébion et al., 2010; Waters et al., 2012), and dissociation (Longden et al., 2012; Varese et al., 2012; Pilton et al., 2015) have all been linked to AVH”
From Is Shame Hallucinogenic? (2017) · cites this paper as Longden et al., 2012

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From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms
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A comprehensive review of auditory verbal hallucinations: lifetime prevalence, correlates and mechanisms in healthy and clinical individuals
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Embodiment, Enaction, and Culture
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Posttraumatic Stress Disorder in Older Adults: A Conceptual Review
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Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research
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Better Than Mermaids and Stray Dogs? Subtyping Auditory Verbal Hallucinations and Its Implications for Research and Practice
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Auditory verbal hallucinations in bipolar disorder (BD) and major depressive disorder (MDD): A systematic review
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Social Adversity in the Etiology of Psychosis: A Review of the Evidence
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Hallucinations Beyond Voices: A Conceptual Review of the Phenomenology of Altered Perception in Psychosis
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A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions
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“…important to note the association between early psychological trauma histories and voice hearing where a recent review suggested that voice hearing in individuals with trauma-related disorders does not differ significantly from that observed in individuals with schizophrenia (Longden et al., 2012).”
Psychological trauma, posttraumatic stress disorder and trauma-related depression: A mini-review
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Similarities and Differences in Borderline Personality Disorder and Schizophrenia With Voice Hearing
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Beyond Trauma: A Multiple Pathways Approach to Auditory Hallucinations in Clinical and Nonclinical Populations
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Hallucinations as a trauma-based memory: implications for psychological interventions
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“Lord, Teach Us to Pray”: Prayer Practice Affects Cognitive Processing
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Cognitive–behaviour therapy for post-traumatic stress in schizophrenia. A randomized controlled trial
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Trauma-Related Altered States of Consciousness: Exploring the 4-D Model
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Psychosomatische Medizin
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Voice-Hearing and Personification: Characterizing Social Qualities of Auditory Verbal Hallucinations in Early Psychosis
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Cognitive Attachment Model of Voices: Evidence Base and Future Implications
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Diversity Within the Psychotic Continuum
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Accepting and Working with Voices: The Maastricht Approach
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The Complexity of Adaptation to Childhood Polyvictimization in Youth and Young Adults: Recommendations for Multidisciplinary Responders
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Relationship between childhood trauma, mindfulness, and dissociation in subjects with and without hallucination proneness
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Childhood trauma, dissociation, and the internal eating disorder ‘voice’
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Auditory verbal hallucinations and the differential diagnosis of schizophrenia and dissociative disorders: Historical, empirical and clinical perspectives
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Trauma, Dissociation, Attachment and Neuroscience: A New Paradigm for Understanding Severe Mental Distress
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Attachment in psychosis: A latent profile analysis of attachment styles and association with symptoms in a large psychosis cohort
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The revised Psychosis Attachment Measure: Measuring disorganized attachment
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Hearing voices as a feature of typical and psychopathological experience
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High Betrayal Child Sexual Abuse and Hallucinations: A Test of an Indirect Effect of Dissociation
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Is Shame Hallucinogenic?
McCarthy-Jones, S. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01310 · Cited by 40 · see citing works
Does childhood trauma play a role in the aetiology of psychosis? A review of recent evidence
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Unravelling psychosis: psychosocial epidemiology, mechanism, and meaning.
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Prevalence and dimensionality of hallucination-like experiences in young adults
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Misattributing the Source of Self-Generated Representations Related to Dissociative and Psychotic Symptoms
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Dissociation mediates the relationship between peer victimization and hallucinatory experiences among early adolescents
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The internal ‘anorexic voice’: a feature or fallacy of eating disorders?
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Exploration of trauma, dissociation, maladaptive schemas and auditory hallucinations in a French sample
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Assessing Voice Hearing in Trauma Spectrum Disorders: A Comparison of Two Measures and a Review of the Literature
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“VH, while distinct from flashbacks, is one form in which such dissociated traumatic content can be reactivated into conscious awareness (2, 125).”
Background
Hallucinations et trouble de personnalité borderline : une revue de littérature
Gras, A., Amad, A., Thomas, P., & Jardri, R. (2014) · L Encéphale · doi:10.1016/j.encep.2014.07.002 · Cited by 31 · see citing works
What’s in a Betrayal? Trauma, Dissociation, and Hallucinations Among High-Functioning Ethnic Minority Emerging Adults
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Does insecure attachment mediate the relationship between trauma and voice-hearing in psychosis?
Pilton, M., Bucci, S., McManus, J., Hayward, M., Emsley, R., & Berry, K. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.10.050 · Cited by 30 · see citing works
Dissociation and social cognition in schizophrenia spectrum disorder
Renard, S. B., Pijnenborg, M., & Lysaker, P. H. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2012.02.001 · Cited by 29 · see citing works
Childhood Polyvictimization and Mental Health Issues among Incarcerated Women
Kennedy, S. C., Mennicke, A. M., & Paul, R. (2020) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2020.1774693 · Cited by 28 · see citing works
Impact of an auditory hallucinations simulation on trainee and newly qualified clinical psychologists: A mixed‐methods cross‐sectional study
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Associations between nonauditory hallucinations, dissociation, and childhood adversity in first-episode psychosis
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The Challenges of New Biopsychosocialities: Hearing Voices, Trauma, Epigenetics and Mediated Perception
Blackman, L. M. (2016) · The Sociological Review Monographs · doi:10.1002/2059-7932.12024 · Cited by 26 · see citing works
Listening to the Voices People Hear: Auditory Hallucinations Beyond a Diagnostic Framework
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Self-citation
What does attachment theory tell us about working with distressing voices?
Berry, K., & Bucci, S. (2015) · Psychosis · doi:10.1080/17522439.2015.1070370 · Cited by 25 · see citing works
Ethnic Variation in Whether Dissociation Mediates the Relation Between Traumatic Life Events and Attenuated Positive Psychotic Symptoms
Anglin, D. M., Polanco-Roman, L. A., & Lui, F. (2014) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2014.953283 · Cited by 25 · see citing works
Madness, childhood adversity and narrative psychiatry: caring and the moral imagination
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Early risk and protective factors and young adult outcomes in a longitudinal sample of young people with a history of psychotic‐like experiences
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The Shaman and Schizophrenia, Revisited
Luhrmann, T. M., Dulin, J. C., & Dzokoto, V. A. A. (2023) · Culture Medicine and Psychiatry · doi:10.1007/s11013-023-09840-6 · Cited by 24 · see citing works
The use of phenomenology in mental health nursing research
Picton, C., Moxham, L. J., & Patterson, C. (2017) · Nurse Researcher · doi:10.7748/nr.2017.e1513 · Cited by 24 · see citing works
Young people's narratives of hearing voices: Systemic influences and conceptual challenges
Parry, S. L., Loren, E., & Varese, F. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2532 · Cited by 24 · see citing works
Auditory Verbal Hallucinations as Dialogical Experiences
Garcelán, S. P., Álvarez, M. P., García‐Montes, J. M., & Cangas, A. J. (2015) · Journal of Constructivist Psychology · doi:10.1080/10720537.2014.938847 · Cited by 24 · see citing works
Managing Dissociation in Imagery Rescripting for Voice Hearers With Trauma: Lessons From a Case Series
Paulik, G., Newman‐Taylor, K., Steel, C., & Arntz, A. R. (2020) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.06.009 · Cited by 23 · see citing works
The Phenomenon of “Hearing Voices”: Not Just Psychotic Hallucinations—A Psychological Literature Review and a Reflection on Clinical and Social Health
Iudici, A., Quarato, M., & Neri, J. (2018) · Community Mental Health Journal · doi:10.1007/s10597-018-0359-0 · Cited by 23 · see citing works
Dissociative Disorders: Between Neurosis and Psychosis
Devillé, C., Moeglin, C., & Sentissi, O. (2014) · Case Reports in Psychiatry · doi:10.1155/2014/425892 · Cited by 22 · see citing works
Interviewing anorexia: How do individuals given a diagnosis of anorexia nervosa experience Voice Dialogue with their eating disorder voice? A qualitative analysis
Chua, N., Serpell, L., Burnett‐Stuart, S., & Pugh, M. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2652 · Cited by 21 · see citing works
Voice-hearing and personification: Characterising social qualities of auditory verbal hallucinations in early psychosis.Preprint
Alderson‐Day, B., Woods, A., Moseley, P., Common, S., Deamer, F., Dodgson, G., & Fernyhough, C. (2020) · doi:10.31234/osf.io/rvfty · Cited by 21 · see citing works
Prevalence of auditory pseudohallucinations in adult survivors of physical and sexual trauma with chronic post-traumatic stress disorder (PTSD)
Clifford, G., Dalgleish, T., & Hitchcock, C. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.10.015 · Cited by 20 · see citing works
Brain functional integration: an epidemiologic study on stress-producing dissociative phenomena
Sperandeo, R., Monda, V., Messina, G., Carotenuto, M., Maldonato, M. N., Moretto, E., Leone, E., Luca, V. D., Monda, M., & Messina, A. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s146250 · Cited by 20 · see citing works
Psychiatric nurse's perceptions of their interactions with people who hear voices: A qualitative systematic review and thematic analysis
McCluskey, A., Watson, C. L., Nugent, L., O’Connor, T. P., Moore, Z. E. H., O’Brien, N., Molloy, L., & Patton, D. (2022) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12829 · Cited by 20 · see citing works
Auditory hallucinations and PTSD in ex-POWS
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An emotional regulation approach to psychosis recovery: The Living Through Psychosis group programme
Ryan, A., Crehan, E., Khondoker, M. R., Fell, M., Curtin, R., & Johns, L. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2021.101651 · Cited by 19 · see citing works
Straight to the Source: e-Communities for Nonsuicidal Self-Injury and the Emerging Case for Harm Reduction in the Treatment of Nonsuicidal Self-Injury
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Can We Use an Interventionist-Causal Paradigm to Untangle the Relationship between Trauma, PTSD and Psychosis?
Brand, R. M., Rossell, S. L., Bendall, S., & Thomas, N. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00306 · Cited by 18 · see citing works
Voices
Ross, C. A. (2020) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001206 · Cited by 17 · see citing works
Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat
Hall, H. (2022) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2022.2120154 · Cited by 17 · see citing works
Firebug! Dissociative Identity Disorder? Malingering? Or …? An Intensive Case Study of an Arsonist
Loewenstein, R. J. (2020) · Psychological Injury and Law · doi:10.1007/s12207-020-09377-8 · Cited by 16 · see citing works
Understanding ‘Ed’: A theoretical and empirical review of the internal eating disorder ‘voice’
Pugh, M. (2020) · Psychotherapy Section Review · doi:10.53841/bpspsr.2020.1.65.12 · Cited by 16 · see citing works
Empirical Testing of Criteria for Dissociative Schizophrenia
Laferrière-Simard, M.-C., Lecomte, T., & Ahoundova, L. (2013) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2013.834860 · Cited by 16 · see citing works
Exploring the relationship between auditory hallucinations, trauma and dissociation
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A Neuropsychological Approach to Auditory Verbal Hallucinations and Thought Insertion - Grounded in Normal Voice Perception
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Psychotic-like experiences in a conflict-affected population: a cross-sectional study in South Sudan
Ayazi, T., Swartz, L. M., Eide, A. H., Lien, L., & Hauff, E. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-016-1243-2 · Cited by 16 · see citing works
A brief CBT intervention for depersonalisation/derealisation in psychosis: Study protocol for a feasibility randomised controlled trial
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“Dissociation has long been considered a psychological defence mechanism to protect the individual against intolerable events such as trauma (see [14]).”
Background
The meaning of voices in understanding and treating psychosis: Moving towards intervention informed by collaborative formulation
Lonergan, A. (2017) · Europe’s Journal of Psychology · doi:10.5964/ejop.v13i2.1199 · Cited by 15 · see citing works
Staff experience of delivering clinical care on acute psychiatric wards for service users who hear voices: a qualitative study
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Delusional beliefs and their characteristics: A comparative study between dissociative identity disorder and schizophrenia spectrum disorders
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A narrative review of psychological theories of post‐traumatic stress disorder, voice hearing, and other psychotic symptoms
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Prevalence and distribution of high-risk human papillomavirus genotypes in cervical carcinoma, low-grade, and high-grade squamous intraepithelial lesions in Jordanian women.
Obeidat, B., Matalka, I. I., Al-Mohtaseb, A. H., Jaradat, S. A., Hayajneh, W. A., Khasawneh, R. H., Haddad, H. I., & Obeidat, F. N. (2013) · PubMed · Cited by 15 · see citing works
Insight among people with severe mental illness, co-occurring PTSD and elevated psychotic symptoms: Correlates and relationship to treatment participation
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Bradford and Airedale Early Intervention in Psychosis Service,
Longden, E., England, B., Madill, A., & Waterman, M. G. (2016)
Self-citation
Assessing Voice Hearing in Trauma Spectrum Disorders: A Comparison of Two Measures and a Review of the Literature
Shinn, A. K., Wolff, J. D., Hwang, M., Lebois, L. A. M., Robinson, M. A., Winternitz, S. R., Öngür, D., Ressler, K. J., & Kaufman, M. L. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.01011 · Cited by 31 · see citing works
82. Functional Connectivity of Voice Hearing: From Psychosis to the Trauma Spectrum
Shinn, A. K., Hwang, M., Wolff, J. D., Lebois, L. A. M., Winternitz, S., Ressler, K. J., Öngür, D., & Kaufman, M. L. (2019) · Biological Psychiatry · doi:10.1016/j.biopsych.2019.03.096
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Dissociation, victimisation, and their associations with voice hearing in young adults experiencing first-episode psychosis
Longden, E. (2014) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York)
Self-citation

Authors: Longden, E., Madill, A., & Waterman, M. G.
Affiliations: University of Leeds (GB)
ORCID: Longden, Eleanor
Madill, Anna
Waterman, Mitch G.
Venue: Psychological Bulletin
Publisher: American Psychological Association (APA)
Published: 2012
Volume: 138
Issue: 1
Pages: 28-76
ISSN: 0033-2909 (ISSN-L)
1939-1455
DOI: 10.1037/a0025995
OpenAlex: W1968959263
Cited by: 248
References: 499
Citations by year: 2026: 15 · 2025: 15 · 2024: 7 · 2023: 12 · 2022: 15 · 2021: 16 · 2020: 26 · 2019: 12 · 2018: 32 · 2017: 23 · 2016: 26 · 2015: 17 · 2014: 17 · 2013: 10 · 2012: 4
FWCI: 6.78
Type: journal article
Language: en
Open access: closed
Locations: Psychological Bulletin (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords: voice hearing, dissociation, trauma, child sexual abuse, schizophrenia, psychosis, dissociative disorders, voice frequency, attachment, self-other relations, diathesis
MeSH terms: Adolescent, Child, Child Abuse, Child, Preschool, Concept Formation, Dissociative Disorders, Hallucinations, Humans, Internal-External Control, Life Change Events, Psychiatry, Psychological Theory, Psychotherapy, Psychotic Disorders, Schizophrenic Psychology, Stress Disorders, Post-Traumatic, Voice, Prevalence

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Dissociation, trauma, and the role of lived experience: Toward a new conceptualization of voice hearing.

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