title: Experiences of hearing voices: analysis of a novel phenomenological survey.
abstract: BACKGROUND
  Auditory hallucinations--or voices--are a common feature of many psychiatric disorders and are also experienced by individuals with no psychiatric history. Understanding of the variation in subjective experiences of hallucination is central to psychiatry, yet systematic empirical research on the phenomenology of auditory hallucinations remains scarce. We aimed to record a detailed and diverse collection of experiences, in the words of the people who hear voices themselves.
  
  
  METHODS
  We made a 13 item questionnaire available online for 3 months. To elicit phenomenologically rich data, we designed a combination of open-ended and closed-ended questions, which drew on service-user perspectives and approaches from phenomenological psychiatry, psychology, and medical humanities. We invited people aged 16-84 years with experience of voice-hearing to take part via an advertisement circulated through clinical networks, hearing voices groups, and other mental health forums. We combined qualitative and quantitative methods, and used inductive thematic analysis to code the data and χ(2) tests to test additional associations of selected codes.
  
  
  RESULTS
  Between Sept 9 and Nov 29, 2013, 153 participants completed the study. Most participants described hearing multiple voices (124 [81%] of 153 individuals) with characterful qualities (106 [69%] individuals). Less than half of the participants reported hearing literally auditory voices--70 (46%) individuals reported either thought-like or mixed experiences. 101 (66%) participants reported bodily sensations while they heard voices, and these sensations were significantly associated with experiences of abusive or violent voices (p=0·024). Although fear, anxiety, depression, and stress were often associated with voices, 48 (31%) participants reported positive emotions and 49 (32%) reported neutral emotions. Our statistical analysis showed that mixed voices were more likely to have changed over time (p=0·030), be internally located (p=0·010), and be conversational in nature (p=0·010).
  
  
  CONCLUSIONS
  This study is, to our knowledge, the largest mixed-methods investigation of auditory hallucination phenomenology so far. Our survey was completed by a diverse sample of people who hear voices with various diagnoses and clinical histories. Our findings both overlap with past large-sample investigations of auditory hallucination and suggest potentially important new findings about the association between acoustic perception and thought, somatic and multisensorial features of auditory hallucinations, and the link between auditory hallucinations and characterological entities.
  
  
  BACKGROUND
  Wellcome Trust.
authors.affiliation: Centre for Medical Humanities and School of Medicine, Pharmacy and Health, Durham University, Durham, UK. Electronic address: angela.woods@durham.ac.uk.
authors.forename: Angela
authors.initials: A
authors.lastname: Woods
authors.affiliation: Department of Anthropology, Stanford University, Stanford, CA, USA; Lived Experience Research Network, Baltimore, MD, USA.
authors.forename: Nev
authors.initials: N
authors.lastname: Jones
authors.affiliation: Department of Psychology, Durham University, Durham, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Alderson-Day
authors.affiliation: Centre for Medical Humanities and Department of Geography, Durham University, Durham, UK.
authors.forename: Felicity
authors.initials: F
authors.lastname: Callard
authors.affiliation: Department of Psychology, Durham University, Durham, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Fernyhough
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D003863:Depression; D005239:Fear; D005260:Female; D006212:Hallucinations / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological; D014831:Voice