Voices and visions in the general population: Exploring the influence of appraisals on distress

Background A significant minority in the general population who do not meet the criteria for psychosis report experiencing voices or visions (this paper will use the term hallucinations to describe such experiences). Little... [ view full abstract ]

Background

A significant minority in the general population who do not meet the criteria for psychosis report experiencing voices or visions (this paper will use the term hallucinations to describe such experiences). Little is known about what differentiates hallucinations experienced by people with psychosis and those experienced by individuals who do not meet the criteria for a psychotic disorder. This study compared the characteristics of hallucinations, and their appraisals, in individuals with a psychotic disorder, a non-psychotic mental disorder and no disorder.

Method

Participants (n=253) aged between 30-33 years who had reported hallucinations were recruited from a community birth cohort and assessed for life-time diagnoses of mental disorders using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Participants’ reports of hallucinations were rated using the Appraisals of Anomalous Experiences Interview (AANEX) measuring the characteristics of hallucinations and their appraisals. They were allocated to groups based on their lifetime diagnoses from the SCID-I:  17% (43) had no mental disorder, 6.3% (16) had a psychotic disorder, and 76.7% (194) met criteria for a non-psychotic mental disorder.

Results

Compared to those with no disorder, participants with a psychotic disorder were nearly 12 times more likely to appraise their hallucinations as distressing and dangerous,  9 times more likely to experience recurrent hallucinations (five or more times), and 10 times more likely to report hallucinations of longer duration. Those with a non-psychotic disorder were twice as likely to have recurrent hallucinations than those with no disorder. 

Conclusions

This study presents novel findings regarding the predominantly negative appraisals of hallucinations in both clinical and non-clinical groups. The severity of negative appraisals, recurrence and longer duration of hallucinations differentiated clinical from non-clinical populations. These findings provide support for therapies which address the appraisals of hallucinations in order to reduce the distress associated with these experiences.