Internal versus external auditory hallucinations in schizophrenia: symptom and course correlates

Area of Science:

• Psychiatry
• Clinical Psychology
• Neuroscience

Background:

• Auditory hallucinations in schizophrenia exhibit diverse phenomenology.
• The distinction between "internal" and "external" hallucinations and their clinical significance remains debated.
• Previous research on internal versus external hallucinations in schizophrenia has yielded equivocal empirical support.

Purpose of the Study:

• To investigate the associations of "internal" versus "external" auditory hallucinations with hallucination characteristics, symptom severity, and illness course in schizophrenia patients.
• To explore whether internal hallucinations represent a distinct subtype of auditory hallucinations in schizophrenia.
• To clarify the clinical correlates of internal versus external auditory hallucinations in schizophrenia.

Main Methods:

• A cross-sectional study of 97 stable outpatients diagnosed with schizophrenia or schizoaffective disorder.
• Participants experienced auditory hallucinations.
• Data collected on hallucination characteristics, other symptom severity, and illness course variables.

Main Results:

• Patients with internal hallucinations reported greater emotional negativity, distress, and duration.
• Internal hallucinations were perceived as less controllable and less likely to remit.
• Patients with internal hallucinations experienced more commenting/conversing/commanding voices but also greater insight into voice origin and had a later age of illness onset.

Conclusions:

• Phenomenological differences in auditory hallucinations are associated with distinct clinical characteristics in schizophrenia.
• Internal versus external hallucinations may delineate clinically relevant subgroups of patients.
• Understanding these differences can inform more homogeneous subgroup identification for research into underlying disease processes.