Auditory Pseudohallucinations in United Kingdom War Veterans and Civilians With Posttraumatic Stress Disorder

Objective: Hearing voices is a little-known feature of posttraumatic stress disorder (PTSD), mainly reported in US war veterans; it may be better conceived of as a dissociative than as a psychotic phenomenon. We investigated this feature in a pair of studies: Study 1 tested whether hearing voices was also reported by United Kingdom war veterans and whether it was associated with other dissociative reactions. Study 2 tested whether reports of hearing voices would generalize to a civilian sample, evaluated whether it was specific to PTSD or could be explained by trauma exposure alone, and investigated
its phenomenological characteristics in more detail.

Method: Study 1, which was conducted from 2005 to 2008 at numerous sites in the United Kingdom, contrasted male war veterans with current PTSD, past PTSD, and no PTSD on measures of dissociation and hearing voices. Study 2, which was conducted from 2004 to 2008 in London, United Kingdom, compared hearing voices in civilian patients with PTSD, healthy controls exposed to trauma, and depressed patients.

Results: Study 1 showed that more veterans with current or past PTSD than no PTSD described hearing voices, which was related to other dissociative reactions. Study 2 confirmed that hearing voices was also present in a civilian sample, that it was specific to PTSD, and that it had the characteristics of a pseudohallucination.

Conclusions: The results emphasize the dissociative nature of PTSD, identify a little-known symptom that causes considerable distress, and suggest new directions for the assessment and treatment of PTSD in military
and civilian populations.

J Clin Psychiatry

Submitted: June 20, 2009; accepted October 19, 2009.

Online ahead of print: March 9, 2010.

Corresponding author: Chris R. Brewin, PhD, Clinical, Educational and Health Psychology, University College London, Gower St, London WC1E 6BT, United Kingdom (c.brewin@ucl.ac.uk).