Hearing voices and psychiatric diagnosis

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A psychiatric diagnosis is usually given by a doctor or mental health specialist on the basis of what someone says about their thoughts, feelings and experiences, alongside observations about their behaviour. In the US, clinicians use the DSM-5 to make a psychiatric diagnosis, whereas in the UK they mainly use the ICD-10 system.

Around 75% of people with a diagnosis of schizophreniaquestion icon hear voices. Voices can also occur in people who have a diagnosis of psychosisquestion icon, bipolar disorderquestion icon, borderline personality disorderquestion icon, dissociative identity disorderquestion icon, PTSDquestion icon, anorexiaquestion icon or severe depression.

Many people think that voices that are loud, commanding, and come from an external location are more of a worry than those that are experienced as occurring ‘inside the head’. In the past, people thought that these kind of voices were typical of schizophrenia. However, research suggests that the volume, content or perceived location of a voice is not relevant to the type of diagnosis a person may receive. There is little evidence for the once widespread view that ‘internal voices’ – i.e. voices that occur ‘inside the head’ – are somehow more benign than those that appear to come from an external location.

Some people who hear voices find psychiatric diagnoses helpful, others find them stigmatising and harmful. What is important to understand is that hearing voices is not in itself a sign that someone has a mental health problem, regardless of whether the voices shout or whisper or are experienced as ‘internal’ or ‘external’. In some people’s experience, it’s not the voices themselves which are upsetting. Rather, it’s difficulties in coping with voices, and the stigmaquestion iconand negativity that surrounds the experience, which causes the most distress.

Psychiatric diagnosis icon

Did you know?

Researchers and clinicians differ over the question of whether psychiatric diagnoses pick out ‘real illnesses’.

Some think they are best understood as describing patterns of experience, thoughts and behaviour that may be distressing or disruptive. On this view, psychiatric diagnoses are useful classificatory tools – they can help health professionals communicate with each other or decide which forms of treatment might help – but they can’t tell us anything about the underlying causes of someone’s moods or experiences.

If you’re interested in these different views about diagnosis you can find out more about them here and here.

A closer look:

Voice-hearing in people who don’t need psychiatric care

Many people who hear voices live well with their experiences without ever needing mental health support. Watch this short animation to find out more about the latest research in this field.

Emmanuelle Peters and her colleagues at Kings’ College London have spent the last few years researching the way hearing voices occurs in the general population, and the way it occurs in people with mental health problems such as psychosis. In this short talk, she explains what her work has revealed so far.

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