Hearing Voices

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What is hearing voices?

Hearing voices is a common type of auditory hallucination. Hallucinations are sensations or perceptions that occur in a wakeful state and seem real, but are created by the brain. Overall, auditory hallucinations are the most common type of hallucination. These can include familiar sounds, unusual noises, even human voices. The voices in auditory hallucinations can be pleasant or threatening.

Hearing voices can be associated with some psychiatric disorders or medical conditions. Psychiatric conditions associated with hearing voices include bipolar disorder, psychotic depression, schizoid and schizotypal personality disorders, and schizophrenia. Medical conditions affecting the central nervous system, such as brain tumors, delirium, dementia, epilepsy and other seizure disorders, and stroke, can be associated with hearing voices. Voices may also be associated with high fevers.

Some people abuse certain substances because those items can cause hallucinations, including hearing voices. Auditory and other hallucinations can also be associated with other substances, such as alcohol, when used in large quantities or during withdrawal. They can also be a side effect of some medications and may occur with hearing loss, sleep deprivation, or severe fatigue.

The specific cause of hallucinations, including hearing voices, is not known.

Hearing voices can be a symptom of serious, and even life-threatening, conditions. Seek immediate medical care (call 911) if you cannot distinguish the voices from reality or if the voices are accompanied by bluish coloration of the lips or fingernails; chest pain or pressure; cold, clammy or dry, hot skin; confusion or loss of consciousness for even a moment; high fever (higher than 101 degrees Fahrenheit); persistent vomiting; rapid, slow or absent pulse; respiratory or breathing problems, such as rapid or slow breathing, shortness of breath, or no breathing; seizure; serious injury; severe abdominal pain; or threatening, irrational or suicidal behavior. Also seek immediate medical care if the voices you hear are telling you to harm yourself or others.

S eek prompt medical care if you are being treated for a condition associated with hearing voices and your symptoms are persistent, worsen, or otherwise cause you concern.

What other symptoms might occur with hearing voices?

Hearing voices may accompany other symptoms that vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the brain may also involve other body systems.

Psychological and cognitive symptoms that may occur along with hearing voices

Hearing voices may accompany other psychological or cognitive symptoms including:

  • Anxiety, irritability or agitation

  • Changes in mood, personality or behavior

  • Confusion, forgetfulness or disconnectedness

  • Delusions

  • Difficulty with memory, thinking, talking, comprehension, writing or reading

  • Heightened arousal or awareness

  • Mood depression or elevation

  • Poor judgment

  • Withdrawal or depression

Other symptoms that may occur along with hearing voices

Hearing voices may accompany symptoms related to other body systems including:

Serious symptoms that might indicate a life-threatening condition

In some cases, hearing voices may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Being a danger to yourself or others, including threatening, irrational or suicidal behavior

  • Bluish coloration of the lips or fingernails

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Chest pain, chest tightness, chest pressure, palpitations

  • Rapid heart rate (tachycardia), slow heart rate (bradycardia), or abnormal heart rhythms (arrhythmias)

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, slow breathing, not breathing, choking

  • Seizure

  • Severe and persistent vomiting

  • Severe pain

  • Trauma, such as bone deformity, burns, eye injuries, and other injuries

What causes hearing voices?

The specific cause of hallucinations, including hearing voices, is not known, but they can be associated with some psychiatric disorders or medical conditions. Substance abuse and withdrawal, medication side effects, sensory loss, sleep deprivation, and severe fatigue can also be associated with hearing voices.

Psychiatric causes of hearing voices

Hearing voices may be caused by psychiatric conditions including:

  • Bipolar disorder

  • Psychotic depression (depression with disordered thought processes)

  • Schizoid personality disorder (disorder characterized by detachment and isolation)

  • Schizophrenia

  • Schizotypal personality disorder (disorder characterized by a need for isolation, odd beliefs, and disordered thinking)

Other causes of hearing voices

Hearing voices can have other causes including:

  • Brain tumors

  • Delirium

  • Dementia

  • Hearing loss

  • Medication side effects

  • Seizure disorders

  • Severe fatigue

  • Sleep deprivation

  • Substance abuse

Serious or life-threatening causes of hearing voices

In some cases, hearing voices may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Acute delirium (sudden onset of mental status changes due to illness or toxicity)

  • Seizure

  • Severe infection

  • Stroke

Questions for diagnosing the cause of hearing voices

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your hearing voices including:

  • When did you first hear voices?

  • What do the voices say?

  • Did any events or stresses occur before you started hearing voices?

  • Do you have any other symptoms?

  • Do you have any psychiatric or medical problems?

  • What medications are you taking?

  • Do you drink any alcohol?

  • Are you using any illicit drugs?

What are the potential complications of hearing voices?

Because hearing voices can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

  • Brain damage

  • Coma

  • Difficulties at work, in school, in social environments, and with relationships

  • Drug and alcohol use and abuse

  • Drug overdose or alcohol poisoning

  • Increased risk of injury

  • Legal or financial troubles

  • Self-harm

  • Suicide or violence

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Dec 19
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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