Skip to main content Accessibility help

Five year follow-up of non-psychotic adults with frequent auditory verbal hallucinations: are they still healthy?

  • K. Daalman (a1) (a2), K. M. J. Diederen (a1) (a3), L. Hoekema (a1), R. van Lutterveld (a1) (a4) and I. E. C. Sommer (a1)...



Previously, we described 103 adults (mean age 41 years) who experienced frequent, auditory verbal hallucinations (AVH), in the absence of a need for mental healthcare. Importantly, these adults were largely past the peak incidence age for psychosis (15–35 years). It is unclear if these older individuals with AVH are still at increased risk for psychosis or other psychopathology. To address this question, we conducted a 5-year follow-up of previously included individuals (103 with AVH, 60 controls).


Eighty-one adults with AVH (78.6%) and forty-nine controls (81.7%) could be contacted and were willing to participate. Participants were screened for psychosis and a need for mental healthcare at follow-up using the Comprehensive Assessment of Symptoms and History interview (CASH). Need for mental healthcare was defined as a clinical diagnosis as identified using the CASH and/or treatment by a mental healthcare specialist. Phenomenology of AVH was assessed with the PSYRATS Auditory Hallucinations Rating Scale.


Five individuals with AVH (6.2%) had developed psychosis and 32 (39.5%) had developed a need for mental healthcare. Voice-related distress at baseline significantly predicted need for mental healthcare. AVH persisted in most individuals (86.4%), without significant changes in phenomenology. None of the controls had developed psychotic symptoms, and need for mental healthcare (n = 6, 12.2%) was significantly lower in this group.


These findings suggest that frequent AVH in non-psychotic adults past the peak incidence age for psychosis constitute a rather static symptom and that individuals with AVH may be best viewed as situated on a need for care continuum.


Corresponding author

*Address for correspondence: Dr K. M. J. Diederen, Department of Physiology, Development, and Neuroscience, University of Cambridge, Downing Street, Cambridge CB2 3DY, UK. (Email:


Hide All
Allardyce, J, Gaebel, W, Zielasek, J, van Os, J (2007). Deconstructing Psychosis conference February 2006: the validity of schizophrenia and alternative approaches to the classification of psychosis. Schizophrenia Bulletin 33, 863867.
Andersen, SL, Tomada, A, Vincow, ES, Valente, E, Polcari, A, Teicher, MH (2014). Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development. Journal of Neuropsychiatry and Clinical Neurosciences 20, 292301.
Andreasen, NC, Flaum, M, Arndt, S (1992). The comprehensive assessment of symptoms and history (CASH). An instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615623.
Bartels-Velthuis, AA, van de Willige, G, Jenner, JA, van Os, J, Wiersma, D (2011). Course of auditory vocal hallucinations in childhood: 5-year follow-up study. British Journal of Psychiatry 199, 296302.
Beavan, V, Read, J, Cartwright, C (2011). The prevalence of voice-hearers in the general population: a literature review. Journal of Mental Health 20, 281292.
Bernstein, DP, Stein, JA, Newcomb, MD, Walker, E, Pogge, D, Ahluvalia, T, Stokes, J, Handelsman, L, Medrano, M, Desmond, D, Zule, W (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse and Neglect 27, 169190.
Browne, A, Finkelhor, D (1986). Impact of child sexual abuse: a review of the research. Psychological Bulletin 99, 66.
Carter, DM, Mackinnon, A, Howard, S, Zeegers, T, Copolov, DL (1995). The development and reliability of the Mental Health Research Institute Unusual Perceptions Schedule (MUPS): an instrument to record auditory hallucinatory experience. Schizophrenia Research 16, 157165.
Copolov, D, Trauer, T, Mackinnon, A (2004). On the non-significance of internal versus external auditory hallucinations. Schizophrenia Research 69, 16.
Crippa, JAS, de Lima Osório, F, Del-Ben, CM, Da Silva Freitas, MC, Loureiro, SR (2008). Comparability between telephone and face-to-face structured clinical interview for DSM–IV in assessing social anxiety disorder. Perspectives in Psychiatric Care 44, 241247.
Daalman, K, Boks, M, Diederen, K, de Weijer, AD, Blom, JD, Kahn, RS, Sommer, I (2011). The same or different? A phenomenological comparison of auditory verbal hallucinations in healthy and psychotic individuals. Journal of Clinical Psychiatry 72, 320325.
Daalman, K, Diederen, KM (2013). A final common pathway to hearing voices: examining differences and similarities in clinical and non-clinical individuals. Psychosis-Psychological Social and Integrative Approaches 5, 236246.
Daalman, K, Diederen, KMJ, Derks, EM, van Lutterveld, R, Kahn, RS, Sommer, IEC (2012). Childhood trauma and auditory verbal hallucinations. Psychological Medicine 42, 24752484.
de Weijer, AD, Neggers, SF, Diederen, K, Mandl, RC, Kahn, RS, Pol, H, Hilleke, E, Sommer, IE (2013). Aberrations in the arcuate fasciculus are associated with auditory verbal hallucinations in psychotic and in non-psychotic individuals. Human Brain Mapping 34, 626634.
Diederen, KM, De Weijer, AD, Daalman, K, Blom, JD, Neggers, SF, Kahn, RS, Sommer, IE (2010). Decreased language lateralization is characteristic of psychosis, not auditory hallucinations. Brain 133, 37343744.
Diederen, KM, Neggers, SF, de Weijer, AD, van Lutterveld, R, Daalman, K, Eickhoff, SB, Clos, M, Kahn, RS, Sommer, IE (2013). Aberrant resting-state connectivity in non-psychotic individuals with auditory hallucinations. Psychological Medicine 43, 16851696.
Diederen, KMJ, Van Lutterveld, R, Sommer, IE (2012). Neuroimaging of voice hearing in non-psychotic individuals: a mini review. Frontiers in Human Neuroscience. Published online: 9 May 2012. doi:10.3389/fnhum.2012.00111.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995 a). The structured clinical interview for DSM-III-R personality disorders (SCID-II). Part I: description. Journal of Personality Disorders 9, 8391.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW, Davies, M, Borus, J, Howes, MJ, Kane, J, Pope, HG, Rounsaville, B (1995 b). The structured clinical interview for DSM-III-R personality disorders (SCID-II). Part II: multi-site test-retest reliability study. Journal of Personality Disorders 9, 92104.
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, Barale, F, Caverzasi, E, McGuire, P (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220229.
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rössler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ, Valmaggia, L, Cannon, T, Velthorst, E, De Haan, L, Cornblatt, B, Bonoldi, I, Birchwood, M, McGlashan, T, Carpenter, W, McGorry, P, Klosterkötter, J, McGuire, P, Yung, A (2013). The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70, 107120.
Fusar-Poli, P, Yung, AR (2012). Should attenuated psychosis syndrome be included in DSM-5? Lancet 379, 591592.
Gaudiano, BA, Zimmerman, M (2013). Prevalence of attenuated psychotic symptoms and their relationship with DSM-IV diagnoses in a general psychiatric outpatient clinic. Journal of Clinical Psychiatry 74, 149155.
Haddock, G, McCarron, J, Tarrier, N, Faragher, EB (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine 29, 879889.
Hajebi, A, Motevalian, A, Amin-Esmaeili, M, Hefazi, M, Radgoodarzi, R, Rahimi-Movaghar, A, Sharifi, V (2012). Telephone versus face-to-face administration of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for diagnosis of psychotic disorders. Comprehensive Psychiatry 53, 579583.
Hanssen, M, Bak, M, Bijl, R, Vollebergh, W, van Os, J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181191.
Jones, SH, Thornicroft, G, Coffey, M, Dunn, G (1995). A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry 166, 654659.
Kessler, RC, Amminger, GP, Aguilar-Gaxiola, S, Alonso, J, Lee, S, Ustun, TB (2007). Age of onset of mental disorders: a review of recent literature. Current Opinion in Psychiatry 20, 359364.
Kirkbride, JB, Errazuriz, A, Croudace, TJ, Morgan, C, Jackson, D, Boydell, J, Murray, RM, Jones, PB (2012). Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PLoS ONE 7, e31660.
Larkin, W, Read, J (2008). Childhood trauma and psychosis: evidence, pathways, and implications. Journal of Postgraduate Medicine 54, 287.
Malinosky-Rummell, R, Hansen, DJ (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin 114, 68.
McCarthy-Jones, S (2011). Voices from the storm: a critical review of quantitative studies of auditory verbal hallucinations and childhood sexual abuse. Clinical psychology review 31, 983992.
Nayani, TH, David, AS (1996). The auditory hallucination: a phenomenological survey. Psychological Medicine 26, 177189.
Nelson, HE, Willison, J (1991). National Adult Reading Test (NART). NFER-Nelson.
NIMH, Genetics Initiative (1992). Family Interview for Genetic Studies (FIGS) . National Institute of Mental Health: Rockville, MD.
Offen, L, Waller, G, Thomas, G (2003). Is reported childhood sexual abuse associated with the psychopathological characteristics of patients who experience auditory hallucinations? Child Abuse and Neglect 27, 919927.
Phillips, J (2013). Conceptual issues in the classification of psychosis. Current Opinion in Psychiatry 26, 214218.
Raine, A (1991). The SPQ: a scale for the assessment of schizotypal personality based on DSM-III-R criteria. Schizophrenia Bulletin 17, 555564.
Read, J, van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330350.
Rohde, P, Lewinsohn, PM, Seeley, JR (1997). Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. American Journal of Psychiatry 154, 15931598.
Sommer, IE, Daalman, K, Rietkerk, T, Diederen, KM, Bakker, S, Wijkstra, J, Boks, MP (2010 a). Healthy individuals with auditory verbal hallucinations; who are they? Psychiatric assessments of a selected sample of 103 subjects. Schizophrenia Bulletin 36, 633641.
Sommer, IE, Derwort, AM, Daalman, K, de Weijer, AD, Liddle, PF, Boks, MP (2010 b). Formal thought disorder in non-clinical individuals with auditory verbal hallucinations. Schizophrenia Research 118, 140145.
van Lutterveld, R, van den Heuvel, MP, Diederen, KMJ, de Weijer, AD, Begemann, MJH, Brouwer, RM, Daalman, K, Blom, JD, Kahn, RS, Sommer, IE (2014). Cortical thickness in individuals with non-clinical and clinical psychotic symptoms. Brain 137, 26642669.
van Os, J, Kenis, G, Rutten, BP (2010). The environment and schizophrenia. Nature 468, 203212.
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine 39, 179195.
Verdoux, H, van Os, J, Maurice-Tison, S, Gay, B, Salamon, R, Bourgeois, ML (1999). Increased occurrence of depression in psychosis-prone subjects: a follow-up study in primary care settings. Comprehensive Psychiatry 40, 462468.
Wing, JK, Babor, TT, Brugha, TT, Burke, J, Cooper, JE, Giel, R (1990). Scan: schedules for clinical assessment in neuropsychiatry. Archives of General Psychiatry 47, 589593.
Woodward, TS, Jung, K, Hwang, H, Yin, J, Taylor, L, Menon, M, Peters, E, Kuipers, E, Waters, F, Lecomte, T (2014). Symptom dimensions of the psychotic symptom rating scales in psychosis: a multisite study. Schizophrenia Bulletin 40, S265.
Yung, AR, Nelson, B, Stanford, C, Simmons, MB, Cosgrave, EM, Killackey, E, Phillips, LJ, Bechdolf, A, Buckby, J, McGorry, PD (2008). Validation of ‘prodromal’ criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophrenia Research 105, 1017.


Five year follow-up of non-psychotic adults with frequent auditory verbal hallucinations: are they still healthy?

  • K. Daalman (a1) (a2), K. M. J. Diederen (a1) (a3), L. Hoekema (a1), R. van Lutterveld (a1) (a4) and I. E. C. Sommer (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed