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Auditory verbal hallucinations and the differential diagnosis of schizophrenia and dissociative disorders: Historical, empirical and clinical perspectives - 10/04/17

Doi : 10.1016/j.ejtd.2017.01.003 
Andrew Moskowitz a, , Dolores Mosquera b, Eleanor Longden c
a Touro College Berlin, Am Rupenhorn 5, 14055 Berlin, Germany 
b Institute for the Research and Treatment of Trauma and Personality Disorders, Avenida de Oza 5, 15006 La Coruña, Spain 
c Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Harrop House, Bury New Road, Prestwich, M25 3BL Manchester, United Kingdom 

Corresponding author.

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Abstract

Introduction

Despite the long association between auditory verbal hallucinations (AVH) or voice hearing and schizophrenia, recent research has demonstrated AVH's presence in other disorders and in persons without a diagnosis, particularly amongst those with a history of traumatization. But are there differences in the type of voices between these populations?

Objective

To consider the status of the relationship between AVH and schizophrenia, in comparison to certain posttraumatic disorders, and the implications of this relationship both conceptually and clinically.

Method

The relationship between AVH and schizophrenia was reviewed from an historical and empirical perspective, in comparison to the posttraumatic or dissociative disorders, borderline personality disorder (BPD), posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). The relationship between AVH in general and dissociation was also considered. A psychotherapeutic approach to working with voices from a dissociation perspective was presented, along with a clinical case.

Results

AVH in schizophrenia appear to be very similar to AVH in other disorders, with some apparent differences disappearing when the person's attitude toward their voices changes. However, compared to BPD, PTSD, or DID, AVH in schizophrenia tend to be first experienced much later in life (adulthood as opposed to adolescence or even childhood), rarely include ‘child’ voices, and exert significantly less control over the person's behavior.

Conclusion

AVH are common in schizophrenia and posttraumatic disorders, and are not significantly differently manifested in these disorders. We contend that all voices are dissociative in nature, and can be most successfully treated through respectful engagement, which seeks to recognize the underlying purpose/concern of the voices, and transform the person's relationship with their voices. The dissociative etiology of AVH in schizophrenia, however, may be somewhat different from that in other disorders – a ‘bursting through’ of dissociative parts associated with severe depersonalization, as opposed to a more gradual development through absorption and intense focus on internal states. In concert with Bleuler's original proposal of schizophrenia as ‘split mind’, it is proposed that schizophrenia might represent a ‘low level’ dissociative disorder. Research to further explore this proposal is suggested.

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Keywords : Schizophrenia, Hallucinations, Dissociation, Differential diagnosis, Absorption


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Vol 1 - N° 1

P. 37-46 - janvier 2017 Retour au numéro
Article précédent Article précédent
  • The treatment of traumatic memories in patients with complex dissociative disorders
  • O. van der Hart, K. Steele, E. Nijenhuis
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  • Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder
  • Ellert R.S. Nijenhuis

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