Auditory hallucinations are sensory experiences where one hears voices or noises for which there is no external source, like hearing a knock at the door when no one is there. Several conditions can cause auditory hallucinations, including mental health disorders, substance use, and medical conditions. Treatment depends on the underlying cause and frequently includes medication and therapy.
What Are Auditory Hallucinations?
An auditory hallucination is when you hear sounds or voices that are not actually present. Although it may seem like the sound comes from one’s surroundings, it is actually generated by the brain itself. Hallucinations should not be confused with illusions or misperceptions of actual stimuli. Auditory hallucinations are the most common type in people with and without mental health disorders.1,2,3,4
Can Auditory Hallucinations Be Normal?
Despite hallucinations being a hallmark psychotic symptom, it is actually common for people to experience such faulty perceptions in certain non-clinical circumstances, such as when falling asleep (i.e., hypnagogic hallucinations) or waking up (hypnopompic hallucinations), or during extreme physiological or psychological stress (i.e. bereavement, sleep deprivation, sensory deprivation). One study found that 80% of bereaving individuals report hallucinations within a month of their loved one’s death.11 In some cultures or spiritual circles, ‘voice-hearers’ are revered and even trained to hone this ability.
Hallucinatory experiences are generally not a cause for concern, especially if they are infrequent and not disruptive of daily living. Research suggests that as many as 65% of non-clinical individuals may experience at least one auditory hallucination in their lifetime.12 Individuals who are hypervigilant, such as a new mother thinking she heard her baby cry (when it may not have), are prime candidates for experiencing a benign hallucination.13 However, it is important to note that in some cases, auditory hallucinations can be a symptom of a psychiatric or neurological condition and should be evaluated by a healthcare professional.
Auditory Hallucination Types
Auditory hallucinations can occur in a few main ways: Verbal vocalizations (voices speaking comprehensible words), non-verbal vocalizations (laughing, humming, whistling, whispering), and non-vocal sounds and music. Auditory hallucinations can also occur together with other types of hallucinations, like visual or tactile, known as multimodal hallucinations.
The form and content of auditory hallucinations can vary widely among individuals with different cultural, social, and personal influences, as well as the condition that causes them. For example, verbal hallucinations are most common in schizophrenia, while music-related hallucinations are more common in conditions like tinnitus.15
The three main types of auditory hallucinations include:
Auditory Verbal Hallucinations
Auditory verbal hallucinations are faulty perceptions of one or more voices speaking. Such voices may be pleasant and conversational or command-like and frightening, potentially influencing people to behave in an unusual or disruptive way. One study found that 26% of 160 patients with psychosis found their auditory hallucinations to actually be pleasurable.15
Voices may range from a single voice to multiple voices, and such voices may be directed to the individual hallucinating or conversing with each other. Some experience the voices as announcing to others one’s private inner thoughts.
Auditory Non-Verbal Vocalizations
Auditory hallucinations can be vocal but not in the form of clear words, such as whispers, screams, “pssts,” whistling, and humming. They can also take the form of unintelligible or garbled speech-like vocalizations. Some research studies group non-verbal vocalizations together with verbal hallucinations (“voices”), while others categorize them with sounds and noises.
Auditory Non-Vocal Sounds and Noises
Auditory hallucinations can be experienced as sounds like footsteps, music, buzzing, ringing, knocking, tapping, animal sounds, gunshots, explosions, running water, street noise, or machinery. As with vocalizations, sound and noise hallucinations can have multimodal qualities, occurring together with visual hallucinations and accompanying other psychotic symptoms like delusions.
What Causes Auditory Hallucinations?
Auditory hallucinations can result from the use of drugs (recreational or prescription), exposure to toxins, mental illness (e.g., schizophrenia), neurologic diseases (e.g., multiple sclerosis), and nutritional deficiencies. Treatment for auditory hallucinations will depend on the cause.
Possible causes of an auditory hallucination include:
Hallucinations are one of several psychotic, positive symptoms that can accompany schizophrenia, a mental health disorder that occurs in under 1% of the population. Approximately 70% of people with schizophrenia experience hallucinations, with auditory hallucinations being the most common. Depending on the severity and adherence to treatment, they can come and go in an episodic manner or be more persistent.
Schizophrenia is one of several schizophrenia spectrum disorders that may give rise to auditory hallucinations. Also included in this DSM-5 category are schizophreniform disorder, schizoaffective disorder, brief psychotic disorder, and schizotypal personality disorder.
Other Mental Illnesses
Auditory hallucinations are not exclusive to schizophrenia spectrum disorders. From a formal diagnostic perspective in the DSM-5, “psychotic features” may be present in both the bipolar spectrum and depressive spectrum of disorders. Hallucinations may also be observed in those with anxiety disorders — such as post-traumatic stress disorder, panic disorder, and obsessive-compulsive disorder — as well as somatic disorders — like illness anxiety disorder (i.e., “hypochondriac syndrome”), conversion disorder, and somatic symptom disorder. The neurobiological underpinnings may vary depending on the condition but usually involve dysregulation of neurotransmitter levels in the brain.
Mental health conditions that may cause auditory hallucinations include:
- Major depressive disorder (MDD) with psychotic features: Psychotic features accompany an estimated 18.5% of cases diagnosed with MDD, a disorder prevalent in 2% in the general population. Most hallucinations that can arise in MDD are auditory (96.7%), and have been most closely associated with feelings of guilt and worthlessness.16
- Bipolar disorder: Hallucinations, in general, are less common in bipolar disorder (41.4%) compared to schizophrenia spectrum disorders (73.3-78.9%), with auditory hallucinations occurring in about 27.4% of bipolar disorder cases. It is not well understood why hallucinations arise in this mood disorder, but it is likely due to various factors, including genetics, neurobiology, and environment (e.g., stress).17
- Postpartum psychosis: Only occurring in .1% to .2% of the general population, symptoms of postpartum psychosis (such as auditory hallucinations) are relatively rare yet particularly imperative to treat for the safety of the infant (4% risk of infanticide) and mother (5% risk of suicide). It is unclear why hallucinations may be triggered by childbirth, but a combination of genetic, hormonal, situational, and environmental factors (e.g., stress, and sleep deprivation) are suspected.18
- Post-traumatic stress disorder (PTSD): Trauma can significantly increase the risk for developing auditory hallucinations. In fact, it is estimated that up to 50% of individuals with PTSD experience auditory hallucinations. The risk for hallucinations is higher with greater PTSD symptom severity, and the content (e.g., voices, sounds) is often related to the traumatic event(s). Suicidal ideation is of particular concern in these severe cases, as auditory hallucinations tend to be negative and distressing.19,20,21,22
- Delusional disorder: Although hallucinations are not the prominent symptom in this psychotic disorder, auditory hallucinations may arise in relation to the theme of the delusion (e.g., hearing the footsteps of an FBI agent approaching).
- Brief Psychotic Disorder: As the name suggests, this psychotic state lasts at least one day but less than one month, and despite the interruption of life by psychotic symptoms (such as auditory hallucinations), the individual returns to their baseline state. It is not well understood why brief psychotic disorder occurs; although a stressor may trigger symptom onset, it can also arise without any apparent stressors.
- Obsessive-compulsive disorder (OCD): Although not a common symptom of OCD, auditory hallucinations have been reported in the form of voices, sounds and music. In fact, OCD can co-occur with schizophrenia an estimated 25% of the time. Both hallucinations and obsessive/compulsive phenomena share underlying neurobiological dysfunction in the brain’s pre-frontal and mid-brain dopamine circuitry, yet it is unclear the degree to which these disorders are distinct.23,24
- Personality Disorders: Borderline personality disorder and dissociative identity disorder (previously known as multiple personality disorder) are accompanied by auditory hallucinations in an estimated 40% of cases. Although the connection between personality disorders and hallucinations is not well understood, it has been suggested that trauma may be involved in some cases.25
Certain recreational drugs can cause auditory hallucinations by affecting neurotransmitter levels in the brain, and altering sensory processes and perception. While several drugs can cause hallucinations (e.g., LSD, PCP, mescaline), cocaine and methamphetamine most notably are associated with true hallucinations (as opposed to perceptual distortions and mood changes that are typical of psychedelic use).26 Hallucinations can occur during acute intoxication, withdrawal, and even beyond withdrawal (as with substance-induced psychosis).
Alcohol Misuse and Withdrawal
Alcohol is a central nervous system depressant affecting brain function, altering sensation and perception. When misused, as in the case of binge drinking or alcoholism, it can lead to psychotic symptoms, including auditory hallucinations. When resulting from excessive alcohol use over an extended period of time, it is called alcohol-related psychosis (a.k.a. alcohol-induced psychotic disorder, alcohol hallucinosis), but withdrawal from alcohol and delirium tremens can also give rise to hallucinations.27
Certain prescribed and over-the-counter medications can cause the side effect of auditory hallucinations, such as medications used to treat Parkinson’s disease, medications for depression, ADHD medications, hypertension medication, corticosteroids, and antiepileptic medications.28,29
The brain needs sleep to restore and maintain daily functioning. Sleep deprivation caused by insomnia, sleep apnea, situational life factors, or other sleep disorders can interfere with the brain’s ability to sense and perceive stimuli, either by detecting things that aren’t really there or not detecting things that are present.30
There are also several sleep disorders in which the lines between waking and sleep (dreaming) mentation are blurred, leading to hypnagogic (in the process of falling asleep) hallucinations or hypnopompic (in the process of waking up) hallucinations. Examples include narcolepsy and sleep paralysis, where the individual’s brain produces dream-like activity while the person is seemingly awake.
Auditory hallucinations can occur in diseases (e.g., Alzheimer’s disease, dementia, Parkinson’s disease, Huntington’s disease) where deterioration of the brain tissue and/or change in neurotransmitter levels leads to faulty communication between brain regions and thus impairments in cognition, sensation, and perception. In the case of Parkinson’s disease, hallucinations can be caused both by a depletion of dopamine that characterizes the disease, as well as excessively high dopamine levels that can result from medication used to treat the illness.31
Conditions that interfere with the auditory sensory pathways can produce auditory hallucinations, as can vitamin deficiencies, endocrine disorders, autoimmune disorders, epilepsy, brain tumors, traumatic brain injury, and chromosomal disorders.32,33,34,35,36,37,38,39,40
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Diagnosing Auditory Hallucinations
If you or someone you care about is experiencing auditory hallucinations, it is important to seek professional help to determine the cause and whether the symptoms are indicative of a more serious medical or mental health condition. A primary care physician, psychiatrist, hospital, or clinic could initiate the evaluation and, if needed, direct you to a specialist depending on the suspected cause.
The diagnostic process for auditory hallucinations may include:
- Psychiatric evaluation: An evaluation usually consists of speaking with a psychiatrist or psychologist about what the individual is experiencing and engaging in neuropsychological testing (which is a series of brief activities and puzzles that are used diagnostically to assess brain function in a non-invasive way).
- Blood tests: Diagnostic blood tests can help assess the presence of psychosis-inducing substances, hormone levels, infection, medical conditions, and malnutrition.
- Urine & Other Relevant Screens: Toxicology screens can help determine if drugs or other medical conditions may be underlying the hallucinations.
- Imaging scans: Neuroimaging (e.g., MRI, PET, CT) scans can help detect abnormal brain tumors or cysts that may put pressure on surrounding brain tissue and cause psychotic symptoms.
Auditory Hallucination Treatment
Auditory hallucinations can be distressing and indicative of various underlying conditions like substance use disorders, mental health disorders, and neurological conditions, as well as side effects of medication. A combination of treatment methods, including medication, psychotherapy, and detoxification/rehabilitation (if substance-related), is usually the most effective approach to managing auditory hallucinations. Since hallucinations of all types tend to increase with heightened anxiety, any treatment — pharmacological, psychological, or behavioral — that reduces anxiety also tends to reduce the frequency of hallucinations. It is important to seek treatment as soon as possible to avoid any further negative impact on daily functioning and quality of life.
Medication can be helpful in treating auditory hallucinations by targeting the underlying condition that is causing them. For example, if hallucinations are a symptom of a psychiatric disorder like schizophrenia, antipsychotic medication can be prescribed to reduce the intensity and frequency of the hallucinations. If they are due to a neurological condition like Parkinson’s disease, different medications or adjustments to medication may be warranted. While if substance use is the cause of the hallucinations, medications to facilitate detoxification and stabilization may be given. Anti-anxiety and antidepressant medications may be used to reduce related symptoms like anxiety that can exacerbate psychotic symptoms.
Psychotherapy can help treat auditory hallucinations by providing a safe and supportive environment for individuals to explore their experiences and develop coping strategies. Auditory hallucinations can be distressing and associated with underlying psychological conditions such as anxiety or trauma. Through psychotherapy, individuals can learn techniques such as mindfulness, relaxation, and cognitive restructuring to help manage their symptoms, as well as explore underlying psychological factors such as unresolved emotions or past traumas. There are several paths to finding the right therapist, such as asking your local physician, family or friends for a recommendation or searching online for in-person or virtual options.
Therapy options for auditory hallucinations include:
- Cognitive behavioral therapy for psychosis (CBTp): The goal of CBT for psychosis to reduce distress from difficult symptoms like hallucinations, delusions, and negative symptoms by working with the patient to challenge these thought disturbances, form new thought patterns, and establish effective coping strategies. This is a highly structured, time-limited, goal-based treatment that has been shown to reduce distress from psychotic symptoms in patients when use in conjunction with medication.
- Acceptance and commitment therapy (ACT): ACT can help treat hallucinations (in addition to other disorders such as depression, substance misuse, and anxiety disorders) by helping individuals observe and accept their experiences without judgment. As a relatively newer therapy, the goal is to develop psychological flexibility that can help with living a meaningful life despite the presence of distressing symptoms.
- Group therapy: By providing a supportive and validating environment where individuals can share their experiences and learn coping strategies from others with similar struggles, group therapy can be effective for those experiencing hallucinations, especially when combined with individual therapy and medication.
- Psychodynamic therapy: Psychodynamic therapy can sometimes be helpful with patients who have good insight to recognize how their psychotic symptoms may be related to past traumas, unconscious conflicts, and other psychological issues that haven’t been fully examined or acknowledged, and how they might be maintained in the present by certain relationships and activities.
- Family therapy: Family therapy can be a powerful and effective adjunct to individual therapy and medication as it helps family members create an environment of support and positivity that reduces anxiety, anger, and confusion that can arise with psychotic symptoms like hallucinations.
- Social Skills Training (SST): If hallucinations are part of a mental health syndrome involving cognitive and emotional dysfunction, such as schizophrenia, SST can be particularly useful, especially in conjunction with psychotherapy and medication, to help the individual develop coping mechanisms and skills that are deficient. This training may involve individual and/or group work.41
Transcranial magnetic stimulation (TMS)
Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate specific brain areas or pathways. In the case of auditory hallucinations, TMS works by targeting areas of the brain that process sound and speech and potentially other areas that can dysfunctionally give rise to hallucinations. Although research has been mixed, especially in establishing optimal parameters (target area, frequency, etc.), it may be a worthwhile consideration for those with resistant auditory hallucinations.42
How to Cope With Auditory Hallucinations
If auditory hallucinations are interfering with your daily functioning, it is important to see a mental health professional and establish a treatment plan. In addition to medical treatment (e.g., medication, therapy), several strategies may be helpful to cope with auditory hallucinations and allow you to lead a balanced and stable life despite intrusive symptoms.
Here are some ways to cope with auditory hallucinations:
- Join a support group: Engaging with others plays an important role in the long-term treatment and management of conditions that give rise to hallucinations, especially in a group therapy setting. Realizing that you are not alone can be invaluable to feeling supported. Isolation can exacerbate psychotic symptoms, and regular meetings with a group also serve to stay connected with others in a safe space.
- Get enough sleep: Sleep’s impact on mental health is undeniable. Not only can too little sleep (i.e., sleep deprivation) produce hallucinatory experiences in non-clinical individuals, but poor sleep (quality and/or quantity) can in fact worsen psychotic symptoms such as hallucinations in clinical populations (e.g., schizophrenia, substance misuse, neurodegenerative conditions). Making sure you get sufficient sleep on a routine basis is important to improving psychotic symptoms like hallucinations.43,44
- Avoid alcohol and drug use: Alcohol and drug use can give rise to hallucinations directly (depending on the substance, amount, and frequency) and indirectly by exacerbating symptoms of existing mental health (e.g., schizophrenia) or medical (e.g., Parkinson’s disease) condition. Alcohol and drugs also affect sleep quality which can also impact one’s tendency to experience psychotic symptoms.
- Practice meditation: Auditory hallucinations can be very disruptive to daily functioning, either distracting one from focusing on daily tasks (work or otherwise) or interfering with sleep and thus causing fatigue during the day. Meditation techniques can be helpful in coping with these uncomfortable sensations as well as in reducing stress which in some cases can trigger or exacerbate hallucinations.
- Explore new hobbies: Engaging in a new interest or revisiting an old interest (e.g., journaling, painting/sketching, pickleball, playing an instrument, taking a cooking class, knitting, gardening, golf) can be helpful in distracting one from hallucinations. The act of engaging in an activity can provide a sense of control and accomplishment, reduce anxiety, and promote relaxation.
- Embrace self-compassion: Self-compassion involves treating oneself with kindness, understanding, and acceptance, and in the case of hallucinations, this may involve reducing negative self-talk, giving yourself a pass for not being productive with work, and treating yourself with the same kindness and understanding that you would offer a friend who is struggling.
- Surround yourself with positive people: When dealing with challenging symptoms like auditory hallucinations, it is important to surround yourself with positive and compassionate people who can help remind you to embrace self-compassion, distract you from your symptoms by engaging in activities with you, and be someone you can talk to when you are experiencing symptoms or feeling stressed.
- Family support: Having family members join for therapy appointments can make a big difference in the treatment outcome for individuals with a mental health disorder, especially one involving psychotic symptoms. Psychotic symptoms like hallucinations may leave gaps in what the individual shares with the clinician and family members can provide additional information that may be key in determining treatment and support. Moreover, coping strategies work best when relatives are involved, educated about the condition, and equipped with coping strategies themselves.45
- Breathing Exercises: Since hallucinations of all types tend to increase with heightened anxiety, any intervention that reduces anxiety also tends to reduce the frequency of hallucinations. Such interventions need not be pharmacological or even psychotherapeutic but rather could include relaxation techniques, like various breathing exercises, including diaphragmatic breathing.
- Stress management: Avoiding stressful situations is not always possible, and learning techniques to manage stress is important, such as recognizing stress before it becomes unmanageable, using relaxation and mindfulness techniques, and reframing one’s thoughts. Several mental health apps offer stress management techniques, as do a number of stress management books.
- Attention to nutrition, diet, and exercise: Poor nutrition can be a stress factor rendering an individual who is already at risk for psychosis and/or drug misuse even more vulnerable. There is some evidence supporting the notion that foods with anti-inflammatory properties (such as omega-3 fatty acids, vitamins C and D) can be helpful in reducing psychotic symptoms in some cases. Regular exercise is also important for mental health and can reduce anxiety which can exacerbate hallucinations.45
- Smart device apps: While nothing replaces face-to-face, in-person support, various CBT apps are available to help maintain routines, activity, emotional awareness, and a sense of overall well-being. Smart devices are also a great way to check in with friends and family if seeing them in person is not an option.
If you or someone you care about is experiencing auditory hallucinations, it is important to seek help. Hallucinations can be distressing and disrupting to daily living, but you do not have to suffer alone as there are professionals who can provide you with support and treatment. The first step to relief is reaching out to a trusted healthcare provider, family member, or friend who can start you on the path. If you have trouble finding professional help near you, consider checking out these online therapy resources.
For Further Reading
- The Essential Schizophrenia Companion – by Robert Francis
- National Institute of Mental Health
- Are There Different Types of Schizophrenia?
- How to Get Help for a Friend or Loved One
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- NIDA Treatment Resources
- Double Trouble in Recovery (dual diagnosis)
- SMART Recovery (non-faith-based addiction recovery)
- Alcoholics Anonymous
- Is there a link between marijuana use and psychiatric disorders? | National Institute on Drug Abuse (NIDA)
- Marijuana and Public Health