The role of traumatic life events in the onset and content of auditory hallucinations : a qualitative case study approach
Studies indicate a high prevalence of traumatic life experiences in the life histories of people with severe mental illnesses such as psychosis. High rates of posttraumatic stress disorder (PTSD) have also been found within these groups. Conversely, psychotic symptoms such as auditory hallucinations have been identified in cases of chronic PTSD suggesting a significant overlap between psychotic spectrum disorders and trauma disorders. To date however, few studies exist investigating the specific link between the onset and content of auditory hallucinations and traumatic life events. A dominant cognitive model within the clinical literature suggests that voices are intrusive thoughts that are misattributed to an external source because they are ego-dystonic. The content of intrusive voices may originate from traumatic life experiences that result in the formation of dysfunctional core beliefs. Examination of the compatibility of this account with cognitive models of PTSD, suggests the conceptualisation of a second account of voices where voices occur as flashbacks resulting from unresolved trauma. The current study aimed to investigate the link between trauma and voices by developing a method to collect in-depth qualitative data from a clinical sample of voice hearers diagnosed with psychotic spectrum disorders. A combined narrative and IPA approach was employed to guide data collection and analysis of five subjective accounts of voice and trauma experiences. Case vignettes were constructed based on clinical history, trauma history and voice content of participants and the data investigated for evidence of the two models of voices across accounts. Findings support both conceptual models, identifying a clear link between the onset and thematic content of voices and trauma. They also highlight the importance of taking a dual approach to treatment of psychotic symptoms and PTSD. The study also emphasises the need to collect data within a iii. therapeutic relationship in order to address the ethical and professional issues inherent in this area of research.