Phenomenal aspects of auditory verbal hallucinations in post-traumatic reactions

This study is a preliminary theoretical discussion of possible specificities of AVHs (Auditory Verbal Hallucinations) in PTSD patients, based on the analysis of classic psychopathological literature enriched by personal clinical experience. AVHs have been extensively studied in empirical research, in different clinical and non-clinical samples. Most of these studies do not show significant differences, implicitly suggesting that AVHs are a unique "object" which is present in a wide array of clinical and non-clinical conditions. We claim that this is due to the instruments used to measure the phenomenon, and that a more qualitative study is needed to unveil possible differences. Accordingly, in this paper we focus on AVHs in persons with psychotraumatic reactions and, to highlight distinctions among apparently similar phenomena, we suggest considering AVHs not as fixed, isolated object, but as the articulation of a dynamic, figure-background relationship. In patients with PTSD we found at least four different kinds of AVHs: a) AVHs in typical post-traumatic flashbacks. In most cases of PTSD, AVHs appear within dissociative states of consciousness, such as flashbacks that represent one of the consequences of how the traumatic experience affects and modifies the subject's experience. b) AVHs in post-traumatic flashbacks with "double-reality". AVHs, as well as other symptoms with a reliving character, can also be inscribed in brief experiences of dissociation such as depersonalization and derealization. c) AVHs in post-traumatic depression. AVHs are the external projection of the depressive guilt experienced by the patient. In these cases, AVHs are mood congruent, understandably derivable from guilt ideas, and represent the external personification of what the patient thinks. d) "Schizophrenic-like" AVHs. AVHs occur in unaltered state of consciousness and they do not represent well-detailed personalities from the patient's past. Rather, they are vague, impersonal and allusive, as it is often the case with schizophrenic voices.