Auditory Hallucinations: Why Do They Occur?

Plenty has been written about the origin of auditory hallucinations. Therefore, today we want to explain some hypotheses about it.
Auditory Hallucinations: Why Do They Occur?
Gorka Jiménez Pajares

Written and verified by el psicólogo Gorka Jiménez Pajares.

Last update: 17 March, 2023

Auditory hallucinations consist of the perception of sound elements, sometimes devoid of meaning (such as small beeps or tinnitus), while on other occasions, they are conversations, whose impact on the person is very intense. However, such sounds are far from real. They’re the result of the person’s mind.

Therefore, auditory hallucinations have the all the impact that a real sound or voice would have. For example, Patrick is a 21-year-old man who comes to the office and clearly identifies two voices. The first of them is named Clara, who says to him, “you’re a bad boy, very bad” while the other voice, Rosa, only speaks to Clara. She has never been in contact with Patrick, who listens with obvious discomfort to voices like “I completely agree with you, Clara. He’s the destroyer of the world.”

“Some people without a mental disorder have transient hallucinatory experiences.”

-American Psychiatric Association-

What types of hallucinations are there?

There are as many types of hallucinatory phenomena as sensory modalities in human beings (Belloch, 2020). In turn, these can be simple phenomena, such as “hearing the starlings chirping”; or complex, as is the case of Patrick that we’ve provided as an example. Likewise, hallucinations can be as follows (Belloch, 2021):

  • Visual, like seeing small animals that crawl around the bed with the mission of gnawing the threads of the sheets.
  • Somatic, such as the feeling of small insects (that aren’t real) making tunnels under the skin.
  • Olfactory, like smelling something rotten in the middle of a tulip garden.
  • Tactile, such as feeling that various entities or “spirits” brush against the patient’s skin.
  • Gustatory, such as perceiving the taste of cotton candy as extremely bitter.
  • Kinesthetic, that is, related to the perception of how one’s own body moves. For example, feeling that the fingers of the right hand are moving intensely when, in reality, they’re still.
  • Musicals. For example, hearing the national anthem when it’s completely silent.

The range of modalities is extremely large. Furthermore, we now know that “the more complex” the hallucinatory phenomenon, the more likely it is to have a  psychiatric cause rather than an organic one.

For example, “perceiving cricket sounds in the back of the mind” most often has an organic cause. In contrast, “listening to the voice of God” is more closely related to psychiatric disorders such as schizophrenia.

“Schizophrenia cannot be understood without understanding despair.”

-Ronald David Laing-

Why do auditory hallucinations arise?

There are numerous investigations that have tried to find the cause of auditory hallucinations. Consequently, the hypotheses that are currently being considered are numerous and suggest that the hallucinatory phenomenon could be the consequence of both a biological and a psychological predisposition to hallucinate. Let’s take a look at the different theories that explain the etiology of auditory hallucinations.

Heb’s study

A man sitting alone in a prison cell.
Some studies suggest that the fundamental context for the generation of an auditory hallucination is total isolation.

According to Hebb, everyone has the potential to hallucinate. Only one condition is necessary: That the person is sensory deprived. That is, they’re completely isolated.

For this study, he subjected various people to different types of auditory stimulation. Among the results of his study, he found that when the auditory stimulus was monotonous, the patients felt intensely irritated and apathetic.

Sometimes they would even develop symptoms of a panic attack. Parallel to the above, the patients reported anomalies in their perception, that is, hallucinations.

“Hallucinations could consist of a “normal” response to the absence or drastic decrease in environmental stimulation.”

-Amparo Belloch-

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Zuckerman’s “auditory visual sensations”

Zuckerman (Belloch, 2021) made a differentiation between the different types of auditory hallucination. Therefore, he suggested the following:

  • Type A hallucinations are those that are simple, such as soft tones or fragments of sounds.
  • Type B hallucinations are complex and have special meaning for the person.

In his experiments, Zuckerman noticed that as patients became more sensory “deprived” (ie, unstimulated or isolated), a curious progression occurred.

Therefore, as the participants became more isolated from sources of sensory stimulation, the hallucinations, initially type A, progressively became type B hallucinations.

“Up to 15% of participants reported complex or type B auditory hallucinations.”

-Amparo Belloch-

Slade and Bentall’s study

These authors suggest two important variables when it comes to hallucinating: Expectations and suggestion. That is, if the environmental stimulation (for example, the sounds of cars driving) is scarce or null (that is, the patient is isolated), the risk of hallucinating would increase when the person is predisposed to it, that is, when it’s suggested.

In this regard, it was found that, if the patients performed verbal tasks (such as singing or verbalizing their thoughts aloud), the probability that auditory hallucinations would appear decreased. They authors mention that “the spoken word” could be an external temporary marker that inhibits the presence of the hallucinatory phenomenon.

“In the Slade and Bentall experiment, it was found that the less complex the situation, the more clear and long-lasting the hallucinations, and vice versa.”

-Amparo Belloch-

Influential variables in the origin of auditory hallucinations

Among the general population, up to 27% of people have hallucinated at some point in their lives (Belloch, 2021). Therefore, it’s worth asking what other variables influence auditory hallucinations. We’ll explain them to you below:

  • As we’ve seen, scant and low-structured environmental stimulation (for example, isolation) increases the probability of experiencing auditory hallucinations.
  • The person’s ability to create fantasies or imagine fantastic events, along with the ability to become abstracted or “lost” in their imagination, are two risk factors in this context.
  • There’s a trait in the personalities of some subjects that increases the probability of experiencing these hallucinatory phenomena. We’re referring to schizotypy.
  • Certain substances (for example mescaline, LSD, or cannabis) have the potential to cause auditory hallucinations. In this regard, studies show that the effects of LSD vary depending on the personality and expectations of the person who consumes it. This substance could potentially “hypersensitize” sensory systems.
  • Trauma is another factor that has been frequently associated with hallucinations in different investigations. There’s a strong association between having suffered sexual abuse as a child and the presence of auditory hallucinations in adulthood.

In fact, studies have found that being raped before the age of 16 increases the risk of suffering from auditory hallucinations in the year after the assault by 600%

There is a “dose-effect” relationship between trauma and psychotic symptoms. That is, the more frequent the traumas have been, the greater the probability of suffering from auditory hallucinations (Belloch, 2021).

“The traumas most associated with hallucinations are sexual abuse and harassment.”

-Amparo Belloch-

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Those who hear voices

It’s increasingly common to find experts in psychiatry and psychopathology questioning the diagnosis of psychosis. In this regard, they claim that psychotic experiences are typically human and eminently psychological phenomena.

In the context we’re talking about, there’s a hypothesis, called hearing voices whose objective is to validate our experiences (Belloch, 2021).

Therefore, “hearing voices” is less stigmatizing (Belloch, 2021). By validating this hallucinatory experience and labeling it as “normal”, there’s an improvement in the person’s mental health.

For this, “mutual support groups” have been created, which those who hear voices can attend in order to share their experience and the strategies they implement to deal with this situation.

“Voice hearers without a psychiatric diagnosis experience low discomfort and a greater ability to manage and control their voices.”

-Amparo Belloch-

Morrison’s theory: A novel explanation of auditory hallucinations

Auditory hallucinations have various explanations.
The neurobiological substrate of auditory hallucinations is still not well understood, so there’s a great deal of active research in this regard.

There are many variables, hypotheses, and theories that try to explain the origin of auditory hallucinations. To conclude this article, we want to contribute something new regarding the state of this issue.

According to Morrison, there could be a correspondence between what happens in the context of OCD and auditory hallucinations. For the author, the intrusive thoughts (or obsessions) present in OCD could be understood as “auditory hallucinations.”

He justifies this idea by stating that hallucinations, like intrusive thoughts, are far from intentional. Furthermore, he suggests that:

  • Both PIs and auditory hallucinations have significant emotional significance.
  • Its contents are often unpleasant and unwanted.
  • They have to do with rare events and phenomena, and the person is unable to exercise any control over them.

In fact, it has been observed that patients who are vulnerable to suffering from auditory hallucinations report a greater number of intrusive thoughts. To reduce the degree of the intrusion of thought, the person could attribute it to an external stimuli. In other words, they could turn their intrusive thought into a voice (heard externally).

Auditory hallucinations are multifactorial

In short, the importance of these sensory alterations is so great that new research is still being done in this regard, especially regarding their real origin. It’s a multifactorial issue that can decrease the quality of life of those affected, therefore requiring an early multidisciplinary approach.

  • Belloch, S. A. (2023). Manual De Psicopatologia, Vol I.
  • American Psychiatric Association. (2014). DSM-5. Guía de consulta de los criterios diagnósticos del DSM-5: DSM-5®. Spanish Edition of the Desk Reference to the Diagnostic Criteria From DSM-5® (1.a ed.). Editorial Médica Panamericana.
  • Perona-Garcelán, S. (2006). Estado actual de la investigación psicológica en las alucinaciones auditivas. Apuntes de Psicología, 83-110.
  • Langer, Á. I., & Cangas, A. J. (2007). Fundamentos y controversias en la diferenciación entre alucinaciones en población clínica y normal. Terapia psicológica, 25(2), 173-182.

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