Table 1A.

Studies of voice hearing in Posttraumatic Stress Disorder (PTSD).

	Study	Size of Dx Sample	Female	Sample	Trauma history	Study Setting	Diagnostic Assessment	Voice Hearing Measure	Operational Definition/ Description of Voice Hearing	Voice Hearing Rate
1	Mueser and Butler (39)	N = 36	0%	Combat veterans with PTSD (mean age 38.8 years) who showed no psychotic symptoms other than AH (in n = 5)	Combat, adulthood	Inpatient unit at a VA Medical Center in California, USA	DSM-III criteria and MMPI (61)	“Clinical interviews”	Not specified (but abstract and intro briefly relate AH to “intrusive auditory perceptions,” possibly analogous to intrusive images)	13.9% AH
2	Wilcox et al (40)	N = 59	0%	Combat veterans with PTSD, consecutively treated at clinic in a 3-month period (mean age of sample not specified)	Combat, adulthood	VA outpatient clinic in Texas, USA	DSM-III criteria	Not specified	Not specified (but abstract mentions “intrusive auditory perceptions”)	28.9% life prevalence of AH
3	Butler et al (41)	N = 20	0%	38 Vietnam-era veterans, not treatment-seeking, with verifiable combat experience in the armed forces (n = 20 with PTSD, mean age 40.2 years, and n = 18 without PTSD, mean age 40.9 years). Exclusion criteria included suspected schizophrenia, psychosis, or major affective disorder.	Combat, adulthood	Veterans’ center in California, USA	DSM-III-R criteria and M-PTSD	SAPS hallucinations subscale	SAPS hallucinations subscale assesses for AH (“Have you heard voices or other sounds when no one is around?”), voices commenting (“Have you ever heard voices commenting on what you are thinking or doing?”), voices conversing (“Have you heard two or more voices talking with each other?”), somatic or tactile hallucinations, olfactory hallucinations, visual hallucinations, and a global rating of hallucination severity. Study authors summed individual subscale items (not including global ratings).	25.0% with mild-moderate hallucinations (prevalence of individual hallucination items, including AH or first rank VH, not specified)
4	David et al (42)	N = 53	0%	Veterans with chronic combat-related PTSD (mean age 46.9y) consecutively admitted	Combat, adulthood	Inpatient PTSD rehab unit in Florida, USA	SCID for DSM-III-R and M-PTSD	SCID for DSM-III-R	SCID DSM-III-R B35: “Did you ever hear things that other people couldn't hear, such as noises, or the voices of people whispering or talking? (Were you awake at the time?)” Per study authors, hallucinations were rated as psychotic if not accompanied by the perception of being back in the traumatic situation/flashbacks and if there was at least momentary disturbance in reality testing.	37.7% AH
5	Hamner et al (43)	N = 45	0%	Vietnam combat veterans with PTSD but without a primary psychotic disorder seeking treatment in a PTSD clinic (n = 22 with psychotic features, mean age 52.5 years, and n = 23 without psychotic features, mean age 51.1 years). Patients were considered to have psychotic features if they scored ≥4 (moderate or higher severity) on one of the four critical positive items on the PANSS (delusions, conceptual disorganization, hallucinatory behavior, suspiciousness/persecution).	Combat, adulthood	Outpatient PTSD clinic in South Carolina, USA	CAPS and SCID for DSM-III-R	SCID for DSM-III-R psychosis screening module and PANSS	SCID DSM-III-R B35 (see above). Per study authors, symptoms occurring only during a flashback or dissociative episode were not counted as psychotic features.	46.7% AH
6	Scott et al (44)	N = 20	95%	66 adolescents (13–18 years) consecutively admitted over 6-month study period (20 with PTSD, 18 with psychotic disorder, 28 with other disorders)	Limited details (sexual abuse in at least five patients with AH)	Adolescent inpatient unit in Brisbane, Australia	K-SADS	K-SADS items related to the form and content of hallucinations	“Has there ever been a time when you heard voices that other people could not hear?”(62)	85.0% AH (35.0% with first rank VH)
7a	Brewin and Patel (45), Study 1	N = 114	5%	Military veterans (mean age 36.3 years) receiving pensions for PTSD (93 with current PTSD, 21 with past PTSD)	Combat, adulthood	UK Service Personnel and Veterans Agency; and an ex-servicemen's mental welfare charity	SCID for DSM-IV	DES, a 28-item self-report instrument to screen for dissociative disorders	DES Q27: “Some people find that they sometimes hear voices inside their head that tell them to do things or comment on things that they are doing. Select a number that shows what percentage of the time this happens to you.”(63) Authors acknowledge it is not possible to know whether DES Q27 reflects true AH, pseudohallucinations, or some other experience.	59.6% VH
7b	Brewin and Patel (45), Study 2	N = 30	53%	30 patients (mean age 40.7 years) with PTSD arising primarily from adulthood trauma (50% also reported history of childhood trauma) were compared with trauma controls (n = 13) and depressed patients (n = 39).	Adulthood, 50% also reported childhood trauma in addition to adult trauma. Limited details on type of trauma.	Specialized PTSD clinic in London, UK	DSM-IV criteria for PTSD, confirmed by PSS	Semi-structured interview developed by the authors	Individuals were first asked about the presence of repetitive thoughts in the past week (“a stream of thoughts that repeats a very similar message over and over again inside your head”), and if so whether the individual experienced this as a voice vs. a stream of thoughts	67.0% repetitive thoughts in the form of VH. “All patients who heard voices regarded them as manifestations of their own thoughts (i.e., as pseudohallucinations)”
8	Anketell et al (46)	N = 40	7.5%	Patients with chronic PTSD (mean age 45.2 years) who underwent treatment in outpatient center	Various: serious accident/fire/explosion (82.5%), natural disaster (5%), nonsexual assault (77.5%), sexual assault (15%), sexual contact in childhood (17.5%), combat (72.5%), torture (42.5%), imprisonment (50%), life-threatening illness (20%), other traumatic events (57.5%). No distinction made between childhood versus adult trauma except for childhood sexual contact.	Psychiatric hospital outpatients and outpatient clinic in Belfast, Ireland	PDS (a 49-item self-report measure of DSM-IV PTSD)	PANSS	PANSS P3: “verbal report or behavior indicating perceptions which are not generated by external stimuli. These may occur in the auditory visual, olfactory, or somatic realms.”(64) For AH, patients were asked, “Sometimes people tell me they can hear noises or voices inside their head that others can't hear, what about you?”	50.0% current VH
9	Nygaard et al (47)	N = 181	42.5%	Trauma-affected refugees (mean age 44.9 years) with PTSD with (n = 74 PTSD-SP) and without (n = 107 PTSD) secondary psychotic features	Torture (63.5% PTSD-SP, 36.4% PTSD), imprisonment (59.5% PTSD-SP, 35.5% PTSD), lived in a war zone (85.1% PTSD-SP, 82.2% PTSD), lived in a refugee camp (25.6% PTSD-SP, 24.3% PTSD), soldier in war (31.1% PTSD-SP, 21.5% PTSD)	Specialized psychiatric unit and treatment center in the Capital Region, Denmark	ICD-10 criteria	Psychiatric records	Definition of AH not explicitly specified, but patients with PTSD with secondary psychotic features (PTSD-SP) defined: 1) psychotic symptoms had to be experienced while awake. 2) Experiences described in relation to sleep (hypnogogic/hypnopompic) not included. 3) Patients with intact reality testing included. (4) Patients with flashbacks connected to psychotic or psychotic-like symptoms were included in the study.	27.1% AH
10	Crompton et al (7)	N = 61	0%	Israeli male veterans from the 1973 Yom Kippur War. Ex-prisoners of war (POW) (mean age 53 years) with PTSD (n = 61) were compared with ex-POW's without PTSD (n = 36) and veteran controls (no POW status) without PTSD (n = 96)	Trauma related to being POW, e.g., solitary confinement, torture (sexual and physical abuse; deprivation of food, water, and medical treatment), verbal and psychological abuse. Captivity ranged from 1.5 to 8 months.	Veterans in Israel contacted by telephone and asked to take part in a longitudinal study (65)	PTSD-I	SCL-90-R	SCL-90-R Q16: “In the past week, how much were you bothered by hearing words that others could not hear?”(66)	9.8% AH at time 1 (18 years post-war); 36.2% AH at time 2 (30 years post-war)
11	Clifford et al (48)	N = 40	Not specified	Adult survivors of physical and sexual trauma with chronic PTSD (n = 40, mean age 34.4 years) were compared with healthy control participants (n = 39, mean age 29.0 years) with no history of psychiatric disorders	Physical and sexual abuse. 47.5% reported trauma in both childhood and adulthood; 52% experienced trauma only in adulthood.	Sexual assault referral center in Paddington, London, UK (n = 15) or from a database of approximately 2,000 community volunteers recruited via local newspaper advertisements, maintained by the Medical Research Council Cognition and Brain Science research group at the University of Cambridge, UK (n = 25).	SCID for DSM-IV	“Auditory pseudo-hallucinations interview” used in Study 2 by Brewin and Patel (45)(45), and DES-II	Individuals were first asked about the presence of repetitive thoughts, and if so whether the individual experienced this as a voice vs. a stream of thoughts DES-II Q27: “Some people sometimes find that they hear voices inside their head that tell them to do things or comment on things that they are doing. Circle the number to show what percentage of the time this happens to you.”(67)	5.0% “auditory pseudo-hallucinations” (32.5% VH >10% of the time on DES-II Q27, self-report) (45.0% VH >10% of the time on DES-II Q27, semi-structured interview)