Auditory verbal hallucinations: The ins and outs of subtypes

Voice-hearing in psychosis is a heterogeneous and often distressing experience. Phenomenological studies have proposed the existence of several subtypes of auditory verbal hallucinations (AVHs) that may guide intervention, such as inner-speech based voices (ISVs), hypervigilance voices (HVs) and memory-based voices, but empirical data is scarce. We developed a detailed coding scheme with the aim of examining whether distinct subtypes of AVHs could be reliably identified and characterised in an early psychosis sample.

Using data collected from 40 voice-hearers accessing Early Intervention in Psychosis (EIP) services, we developed a comprehensive coding scheme to systematically identify and describe AVH subtypes. We additionally explored the relationship between each subtype and other clinically relevant variables.

Two distinct subtypes of AVHs were identified: ISV and HV. This first was characterised by internal, peripersonal, or proximal perceived voice location and inward-directed attention. The latter was characterised by external remote location, outward-directed attention and a compulsion to scan the environment for threats. Additionally, ISVs were significantly associated with suicidality, while HVs were associated with paranoia. While some AVHs were linked to real-life past experiences, we did not find an independent subtype for memory-based voices.

The detailed coding process developed to map AVH subtypes advances our theoretical understanding relevant to the development of clinical interventions and provides a systematic research basis for future explorations in larger studies. More research is needed to understand the role of memory in inner speech and hypervigilant voices.