Voice hearing in young people with posttraumatic stress disorder (PTSD) following multiple trauma exposure

Background: PTSD is comorbid with a number of other mental health difficulties and the link between voice hearing and PTSD has been explored in adult samples.Objective: To compare the trauma history, symptomatology, and cognitive phenotypes of children and adolescents with a PTSD diagnosis following exposure to multiple traumatic events presenting with voice hearing with those who do not report hearing voices.Methods: Participants (n = 120) were aged 8-17 years and had PTSD following exposure to multiple traumas. Three primary analyses were conducted, comparing PTSD symptom severity, prevalence of sexual trauma, and level of negative post-traumatic cognitions between the voice hearing and non-voice hearing groups. Participants were allocated to the voice hearing group if they reported hearing voices in the past two weeks. A range of mental health and cognitive-behavioural factors were considered in exploratory secondary analyses. All analyses were pre-registered.Results: The voice hearing group (n = 50, 41.7%) scored higher than the non-voice hearing group (n = 70, 58.3%) for negative post-traumatic cognitions, but not PTSD symptom severity or prevalence of sexual trauma. In secondary analyses, the voice hearing group had more sensory-based and fragmented memories and higher scores for panic symptoms than the non-voice hearing group. When participants whose voices were not distinguishable from intrusions or flashbacks were removed from the voice hearing group in a sensitivity analysis, the voice hearing group (n = 29, 24.2%) scored higher on negative post-traumatic cognitions and trauma memory quality, with similar effect sizes to the original analysis.Conclusions: Voice hearing is common among youth exposed to multiple traumas with PTSD and is related to cognitive mechanisms proposed to underpin PTSD (appraisals, memory quality) and more panic symptoms. Further research should seek to investigate the underlying mechanisms and directionality for these relationships.