Hearing voices and other altered perceptual experiences across psychotic, mood, and anxiety disorders: from phenomenology and mechanisms to future directions.

Hearing voices is well studied in psychosis, but unusual perceptions in other senses and in other mental health conditions are often overlooked. This narrative review examined voices and altered perceptual experiences across psychotic, mood, and anxiety disorders. Key findings include: these experiences vary widely within individuals and across diagnoses, often involving multiple senses; existing research focuses mainly on trauma and brain processes as causes; current theories mostly address only voices; new treatments need to be broader; and there are major issues with how these experiences are defined and how they differ across cultures. The review calls for better assessment tools and more consistent research methods, and emphasizes including patients' own perspectives and cultural context.

Study at a glance

Abstract

While voice-hearing in psychosis has received much attention, perceptual experiences in other sensory modalities and psychiatric conditions have remained relatively overlooked. The present review aimed to address this gap by providing an overview of voices/altered perceptual experiences (APE) across psychotic, mood and anxiety disorders in terms of phenomenological characteristics, biopsychosocial mechanisms, etiological models and therapeutic interventions. Where possible, lived experience perspectives and transcultural considerations were embedded. A narrative literature review was conducted. Knowledge pertaining to voices in psychosis formed the foundation, broadened to include other sensory modalities and diagnostic conditions. Quality assessment demonstrated an excellent rating of 12/12. Notable findings related to: (i) phenomenological heterogeneity in voices/APE within individuals and across diagnostic conditions, with multisensory/multimodal experiences relatively widespread; (ii) existing mechanistic studies mainly focusing on the role of trauma and neurocognition in voices; (iii) prevailing explanatory models mostly focusing on voices; (iv) a need for emerging interventions to extrapolate to encompass broader therapeutic applications; and (v) wide-ranging specificity issues and transcultural considerations to be addressed. Future research should invest in appropriate assessment tools as well as ensuring methodological consistency in mechanistic studies. Incorporating lived experience perspectives and meaningfully embedding transcultural considerations in theoretical and empirical ways are also essential.