The Auditory hallucinations Are one of the main perceptual alterations that can be seen in humans.
As the name implies, they deal with a psychotic condition in which unreal sounds are perceived through the auditory sense.
Typically, this type of symptomatology is associated with schizophrenia , However, hallucinations may appear in other mental disorders and as a direct effect of other causes.
The first definition of hallucination appeared in 1832 from the hand of Jean Étienn Dominique Esquirol , A French physician who related perceptual distortions to brain functioning.
Esquirol conceptualized the hallucination in the following terms"in hallucinations everything happens in the brain".
This appreciation served for the first time to postulate perceptual distortions as a brain phenomenon foreign to the functioning of the senses.
"The activity of the brain is so intense that the visionary, the person who hallucinates, gives body and reality to the images that the memory Remember without the intervention of the senses,"commented the French professional very correctly.
Thus, for many years now, hallucinations are considered mental alterations that respond to an abnormal functioning of the Brain structures .
In this line, it is also necessary to emphasize the conceptualization of the hallucinations realized by the authors who investigated this phenomenon under what is known as intellectualist stance.
These authors interpreted hallucination as a phenomenon of belief, of judgment and, therefore, considered it as a disorder of an intellectual nature.
From this perspective, hallucinations cease to be a perceptive disorder and begin to acquire connotations of judgment and belief, so that it begins to be conceptualized as disorders of thought and to relate to delusions.
At present, it is considered that hallucinations constitute an alteration of both thinking and perception, which is why both factors are involved in conceptualizing these symptoms.
Criteria for auditory hallucinations
It is necessary to take into account that not all the perceptive alterations make a hallucination.
In fact, hallucinations constitute a type of perceptual alteration, however these may also adopt other forms of presentation and manifest different characteristics.
In order to adequately distinguish hallucinations from other symptoms, Slade and Bentall, two cognitive authors, proposed three main criteria.
1- Any experience similar to the perception that occurs in the absence of an appropriate stimulus
This first criterion allows to differentiate between illusion and hallucination, two concepts that can easily be confused.
In the illusion are involved both internal and external influences, a fact that produces a misinterpretation of a real stimulus.
However, in hallucination there are only internal causes, so there is no real stimulus that motivates the appearance of what is perceived.
For example, in an illusion you can confuse the noise of a fan with the voice of a person and think that someone is whispering something.
However, in a hallucination the person's voice does not appear after the misinterpretation of a real stimulus, but the element heard is produced solely by the brain activity.
2- It has all the strength and impact of the corresponding real perception
This second criterion allows to differentiate the hallucination of another very similar phenomenon, the pseudoalucination.
Thus, to affirm the presence of a hallucination, the person who suffers it must have the conviction that what is experienced has its origin outside the person and has a real character.
Pseudoalucination is a phenomenon similar to hallucination that appears motivated by dissociation but in which the person is more or less able to separate his pseudoalucination from reality.
3- It is not susceptible of being directed or controlled by who suffers it
The lack of control allows to distinguish the hallucination of other images or sounds experienced, and refers to the impossibility of altering or diminishing the experience by the simple desire or will of the person.
In this way, the hallucination makes a Psychotic alteration . The person who suffers from it absolutely believes in it and is not able to control or alter its appearance.
Verbal auditory hallucinations
Auditory hallucinations are the ones that occur more frequently, especially in psychotic subjects, which is why they have also received more scientific attention during the last years.
They can acquire two forms of presentation: verbal and nonverbal. In addition, an individual may suffer both types of hallucinations simultaneously.
Wernicke Denominated this type of hallucinations like phonemes, and indicated that they usually appear with a more threatening and imperative tone, especially in people who suffer schizophrenia .
In this way, the patient can perceive voices of persons known or unknown who comment on their own acts or dialogue with him directly.
The Severe depressive-type affective psychoses Can also provoke verbal auditory hallucinations. In these cases, the voices perceived by the patient usually have an imperative tone and remarked their feelings of guilt.
In contrast, those seen in manic episodes of bipolar disorder may have pleasant content or grandiosity, and correlate with the person's expansive mood.
It must be taken into account that the content of hallucinations can seriously affect the behavior of the person who suffers and affect them in an important way in their life.
In this way, the patient's life can revolve around the voices he hears frequently and these can cause him a high discomfort.
In some exceptional cases hallucinations can be reassuring and do not disturb the patient.
Nonverbal auditory hallucinations
These types of hallucinations have a wide spectrum of presentation and patients complain of hearing noises, unstructured sounds, whispers, bells, motors, etc.
They are often less serious than verbal hallucinations, and usually produce less structured, more vague perceptual distortions about the person's behavior and well-being.
However, these hallucinations can also be highly unpleasant for the person who suffers from it and may require treatment.
Finally, it should be noted that auditory hallucinations may vary in their presentation form.
Both verbal and nonverbal can be heard inside or outside the head, heard clearly or vaguely, be poor in detail or become a real speech.
In general it is maintained that those that are heard outside the head, are heard vaguely, are poor in details and adopt the nonverbal form are the ones that revert less seriousness on the patient.
Musical hallucination
It is a special type of very rare auditory hallucination of which much of its diagnostic function and its etiological factors are unknown.
Berrios noted in 1990 that its most frequent causes are deafness and brain injuries.
The hallucinatory experience of these symptoms can vary in some aspects like the form of beginning, the familiarity of the heard thing, the musical genre and the location of the perceived thing.
However, all forms of presentation are characterized by hearing"songs"or songs well delimited without the presence of the auditory stimulus.
Clinical dimensions
Hallucinations should be interpreted as multidimensional phenomena and not as a one-dimensional alteration.
In other words, not only must the presence or absence of hallucination be considered, but also the functional continuum that characterizes it.
Thus the analysis of hallucinations must be done from one extreme (normal behavior and absence of hallucinations) to the other extreme (clearly psychotic behavior and the presence of highly structured hallucinations).
The main dimensions to take into account are:
Degree of control over auditory hallucination
As we have seen, to speak of auditory hallucination this has to be totally uncontrollable for the patient.
Thus, in order to clarify the characteristics of the symptoms suffered, it is necessary to evaluate the degree of control that the individual presents about the elements he hears and the perceptive distortions that he presents.
Emotional response
Auditory hallucinations usually cause discomfort and anxiety to the person who has it.
However, this is not always the case, since in some cases they may even be pleasant and in other cases they can lead to a highly disturbing emotional conditioning.
This fact is fundamental when specifying the characteristics of the symptom, its severity and the impact it generates on the life of the individual.
Localization of hallucination
Auditory hallucinations can be located inside or outside the person's head.
In this way, a patient can interpret the stimuli that he hears occur within his brain or perceive them from the outside world.
Both types of locations can involve gravity and can affect the behavior of the person, however, those that are located in the interior usually cause greater discomfort in the individual.
Coping Strategies
It is important to consider what coping strategies the person presents with regard to hallucinations.
These can range from none in cases where the patient is not aware of suffering from hallucination, to very elaborate strategies in individuals who try to mitigate the appearance of these annoying symptoms.
Frequency and duration
In some cases, hallucinations occur sporadically and in very short intervals of time, while in other cases these may occur continuously and protracted.
Content of hallucination
The content of the hallucination is the main factor that will determine the discomfort originated and the affectation that will have on the behavior of the individual.
Whenever one of these symptoms is detected or diagnosed, it is especially relevant to clarify the content of perceptual distortion.
Causes
Auditory hallucinations are frequently associated with the presence of schizophrenia; however, this disease is not the only cause that can lead to its occurrence.
The main causes that can motivate the manifestation of auditory hallucinations are:
- Epilepsy of the temporal lobe : Crises Convulsive Produced in this region of the brain can cause hallucinations to appear relatively frequently.
- Hallucinogen consumption Substances such as cannabis, LSD , Methamphetamine and many others can lead to hallucinations.
- Dementia : In the more advanced stages of the disease can hallucinations in response to brain deterioration.
- Alcohol Abstinence L : The alcoholic who stops consuming his desired substance can manifest a series of symptoms, one of them the auditory hallucinations.
- Psychosis : Any type of psychotic disorder can manifest itself with auditory hallucinations.
- Depression : Severe and psychotic depressions can occur with hallucinations.
- Narcolepsy : It is a disease that causes excessive drowsiness and can provoke fleeting visions in the wake-sleep transition.
- Others : Although less frequently, physical diseases such as cancer, encephalitis, Hemiplegic migraine And cardiovascular accidents can also lead to the development of auditory hallucinations.
Treatment
The hallucinations make a serious alteration that can endanger both the well-being and the integrity of the person who suffers.
In fact, hallucinations not only create an annoying symptom for the person who suffers it, but when it affects their behavior, it can pose a significant danger to the individual.
The characteristics of these alterations demonstrate the high importance of applying adequate treatment when suffering from hallucinations.
The intervention to be performed should address the underlying mental illness and motivate the auditory hallucinations.
However, before this type of psychotic symptomatology, pharmacological treatment is usually Antipsychotic medications .
In addition, psychological treatments such as Cognitive behavioral therapy May be appropriate in some cases to increase coping skills and coping strategies.
References
- Berenguer V, Echanove MJ, González JC, Cañete C, Alvarez I, Leal C, Sanjuan J.
- Pharmacogenetic evaluation of antipsychotic response in patients with auditory hallucinations. Actas Esp Psiquiatr 2002.
- González JC, Sanjuan J, Aguilar EJ, Berenguer V, Leal C. Clinical dimensions of auditory hallucinations. Archives of Psychiatry 2003; 6 (3): 231-46
- Lawrie SM, Buechel C, Whalley HC, Frith CD, Friston KJ, Johnstone EC. Reduced frontotemporal functional connectivity in schizophrenia associated with auditory hallucinations. Biol Psychiatry 2002; 51 (12): 1008-11.
- Junginger J, Frame CL. Self-report of the frequency and phenomenology of verbal hallucinations. J Nerv Ment Dis 1985; 173: 149-55.
- Johns LC Hemsley D, Kuipers E. A comparison of auditory hallucinations in a psychiatric and non-psychiatric group. Br J Clin Psicol 2002; 41: 81-6.
- Holmes C, Smith H, Ganderton R, Arranz M, Collier D, Powell J, Lovestone S. Psychosis and aggression in Alzheimer's disease: the effect of dopamine receptor gene variation. Neurol Neurosurg Psychiatry 2001; 71 (6): 777-9.
- Slade P, Bentall R. Sensory deception: A scientific analysis of hallucination. London and Sydney: Croom Helm. 1988.