Hearing of Voices

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Hearing of Voices

• Dr. Samuel Pfeifer

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Four Aspects of Inner Voices
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Hallucinations organic
Organic Delirium (e.g. alcohol withdrawal),
Disorientation (e.g. functional brain
disorder) Toxic Substances e.g. LSD
Severe Psychotic Depression Example The devil
is laughing at me I hear the police siren,
they are coming to bring me to jail, where I
belong. Context Severe Depression, often in old
age.
Typical When the causing substance or brain
condition subsides, the hearing of voices
disappears.
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Hallucinations Schizophrenia
1. Quality external, ego-dystonic, thoughts
becoming audible, loud, often with anxious
feelings
Criteria of DSM-IV
2. Content muffled sounds, murmuring, single
words, sentences, laughing, commentaries,
insults. Often unspectacular comments, orders .
. .
3. Additional phenomena thought insertion,
expansion, incoherence, bizarre delusions
clearly impaired ability to cope
4. Religious aspects often search for
explanations, rarely complex prophetic content
not congruent with the surrounding culture or
religious group
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Obsessional Ideation
1. Quality I know that my thoughts are
unrealistic, but if I do not give in, I am
developing unbearable stress and anxiety.
2. Content fear of contamination, inappropriate
behavior etc. sexual or religious content
controlling, washing, ordering etc.
3. Additional phenomena exaggeration of normal
concerns and rules varying severity causing
marked distress
4. Religious aspects intrusive thoughts of
blasphemy, religious symbols (666) obsessional
doubting Religious content in
obsessive-compulsive structure
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Multiple Personality (DID)
Origin Dissociation of partial personalities in
extreme trauma during childhood (Persons
victims, tormented children, guides, protecting
alters, persecutors, functioning facade etc.)
Inner Dialogue among the persons dealing with
past and present trauma discussions Can we
trust this person? - How do we cope with this
situation? etc. Crying or stiff upper lip?
Not multiple when a person feels torn between
two options when there are two streams of
consciousness at the same time frequent
emotional swings projective identification (I
feel like my mother)
Real DID Emphasis on the existential experience
of real persons, not mood swings or different
emotional states. Varying behaviors, amnesia for
substantial amounts of time. -- Further Criteria
of DSM-IV.
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The Brain
Frontal Lobe
Sensory Areas
Limbic System
Brain Stem
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POSSIBLE NEUROBIOLOGICAL CAUSES OF HEARING VOICES

• Neurotransmitter Imbalance (Psychotic Disorders)
• Toxic Influences
• Sensory Deprivation
• Stress
• Strain
• Trauma - Dissociation

STRESS AND VULNERABILITY