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Cited by 48Posttraumatic Stress Disorder ResearchHallucinations in medical conditionsPsychoanalysis and Psychopathology Research

Hallucinations in posttraumatic stress disorder: insights from predictive coding

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Lyndon, Stanley, Corlett, Philip R.·2020·Journal of Abnormal Psychology
DOI 10.1037/abn0000531PMC PMC10658640
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Abstract

criteria for posttraumatic stress disorder (PTSD), they are increasingly documented in PTSD. They are noted in the absence of clear delusions, formal thought disorganization, disorganized speech, or behavior, ruling out a comorbid psychotic disorder like schizophrenia as a better explanation for these hallucinations. Hallucinations in both PTSD and schizophrenia share phenomenological features. We propose that hallucinations in PTSD, like those in schizophrenia, might be explained in terms of aberrant predictive coding, specifically the misapplication of strong prior beliefs that vitiate perceptual inference. This approach highlights the broader relationship between trauma and psychosis. Under predictive coding, the nervous system organizes past sensory data into an internal model of the world. Under stress, the brain prioritizes speed over accurate encoding. However, memories for traumatic experiences are typically strongly consolidated, to avoid similar experiences in future. In PTSD, this could lead to a world model comprised of inaccurate but overly precise prior beliefs, that can be triggered by stimuli tangentially related to the index trauma, resulting in hallucinations. Crucially, this evidence accumulation depends upon the relative precision of prior beliefs and sensory evidence (supplied in the form of prediction errors). Our basic argument is that stressful situations induce belief updating, in terms of precise prior beliefs, that are difficult to undo. These unduly precise, trauma-related beliefs then constitute perceptual hypotheses, memories, or narratives that bias subsequent experience. This prior bias may be so severe that sensory evidence is effectively ignored; that is, treated as very imprecise, in relation to prior beliefs. Such an account may lead to cognitive therapies for hallucinations aimed at strong prior beliefs, and the exciting prospect of combining such therapies with drugs that modulate neuroplasticity and enhance the adaptive consolidation of more appropriate priors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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  • In both PTSD and schizophrenia, stress was identified as a common trigger leading the brain to prioritize speed of encoding over accuracy, increasing the chance of formulating precise but inaccurate prior beliefs.

    “In both disorders, stress was identified as a common trigger leading the brain to prioritize speed of encoding over accuracy, increasing the chance of formulating precise but inaccurate prior beliefs (de Filippis et al., 2024; Lyndon and Corlett, 2020).”

    From Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review. (2025) · cites this paper as Lyndon and Corlett, 2020

    The Abstract (page not available) says that under stress the brain prioritizes speed over accurate encoding and proposes that, in PTSD, this could produce inaccurate but overly precise prior beliefs. It compares hallucinations in PTSD and schizophrenia, but does not establish this stress-to-priors pathway in both disorders; the citing sentence also presents a proposed mechanism more definitively than the source does. (LLM, conf=0.87)

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Research works printed but not linked: 6

  1. Aitchison L, & Lengyel M. (2017b). With or without you: predictive coding and Bayesian inference in the brain. Curr Opin Neurobiol, 46, 219– 227. doi: 10.1016/j.conb.2017.08.010 28942084 PMC5836998 · DOI · Paper page
  2. Brewin CR, & Patel T. (2010b). Auditory pseudohallucinations in United Kingdom war veterans and civilians with posttraumatic stress disorder. J Clin Psychiatry, 71(4), 419– 425. doi: 10.4088/JCP.09m05469blu 20361915 · DOI
  3. Brown R, & Kulik J. (1977). Flashbulb memories. Cognition, 5(1), 73– 99. doi: 10.1016/00100277(77)90018-x · DOI
  4. Chassy P, Calmès MD, & Prade H. (2012b). Making sense as a process emerging from perception-memory interaction: A model. International Journal of Intelligent Systems, 27(8), 757– 775. doi: 10.1002/int.21545 · DOI
  5. Colombo M, & Wright C. (2018). First principles in the life sciences: the free-energy principle, organicism, and mechanism. Synthese, 1– 26. Retrieved from https://link.springer.com/article/10.1007/s11229-018-01932-w30872868 · DOI
  6. Mowrer O. (1947). On the dual nature of learning—a re-interpretation of” conditioning” and” problem-solving.”. Harvard educational review.

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Authors
Lyndon, S., & Corlett, P. R.
Affiliations
Yale University (US)
Corresponding author
Corlett, Philip R.
ORCID
Venue
Journal of Abnormal Psychology
Publisher
American Psychological Association (APA)
Published
2020-08
Volume
129
Issue
6
Pages
534-543
ISSN
  • 0021-843X (ISSN-L)
  • 1939-1846
DOI
10.1037/abn0000531
PMC
PMC10658640
OpenAlex
W3028387032
Cited by
48
References
92
Citations by year
2026: 10 · 2025: 10 · 2024: 10 · 2023: 8 · 2022: 6 · 2021: 1 · 2020: 3
FWCI
1.80
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Abnormal Psychology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R21MH116258, R01MH112887)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
hallucinations, post-traumatic stress disorder, predictive coding, prior beliefs, perceptual inference, schizophrenia, belief updating, prediction error, memory consolidation, neuroplasticity
MeSH terms
Hallucinations, Humans, Stress Disorders, Post-Traumatic, Diagnostic and Statistical Manual of Mental Disorders

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