Multi-Modal Hallucinations

Abstract

A patient may experience hallucinations in more than one modality simultaneously or at different times and they may or may not appear to emanate from a single source. Current nomenclature is imprecise, often has particular diagnostic implications and fails to distinguish between these different phenomena. This has resulted in considerable confusion with a tendency to dismiss the importance of these symptoms. The various terms in current usage and the presence of these symptoms in a variety of different conditions are examined. To aid further research and improve clinical practice the authors advocate the use of the term multi-modal hallucinations and suggest operational criteria.

Prevalence and classification of hallucinations in multiple sensory modalities in schizophrenia spectrum disorders

“…Terms such as these have the advantage of describing the sensory modalities involved, but fail to indicate whether the hallucinations in these sensory modalities are experienced simultaneously or serially. As noted previously (Chesterman and Boast, 1994), the literature on MMHs suffers from a lack of information on these phenomenological characteristics, and even from the lack of a precise nomenclature with which to address this problem. A proper nomenclature of MMHs should allow us to identify the exact number and nature of the sensory modalities involved, to differentiate between hallucinations in various sensory modalities which are experienced serially or simultaneously, and, in the latter case, to differentiate between incongruent and congruent (i.e., compound) ones.…”

“…In the literature these terms tend to be used interchangeably; however, in some cases they refer to hallucinations experienced in various sensory modalities simultaneously, while in others they refer to those experienced serially (Chesterman and Boast, 1994).…”

“…The most extensive review to date was published by Chesterman and Boast in 1994 and the most recent review prior to that is a chapter in Specht's 1914 German textbook Wahrnehmung und Halluzination (Specht, 1914). During the 80-year intervening period, as well as during the 20 years since the publication of Chesterman and Boast, MMHs have mainly been referenced in case reports (Alroe and McIntyre, 1983;Scher and Neppe, 1989;Benatar et al, 2000;Lim, 2003;Szűcs et al, 2003;Yee et al, 2005;Mollet et al, 2007;Güzelcan et al, 2008;Vita et al, 2008;Bhat et al, 2012;Dogan et al, 2013), in the field of neuropsychiatry (Aarsland et al, 2001), and in studies in the field of transcultural psychiatry (Zarroug, 1975;Al-Issa, 1977;Ndetei and Singh, 1983;Kent and Wahass, 1996;Blom et al, 2010;Johns et al, 2002;Bauer et al, 2011;Hussein et al, 2012;Larøi et al, 2014;Lim et al, 2015;Luhrmann et al, 2015), see Table 1.…”

From Tones in Tinnitus to Sensed Social Interaction in Schizophrenia: How Understanding Cortical Organization Can Inform the Study of Hallucinations and Psychosis

“…These are referred to as multimodal hallucinations. 58 Such simultaneous sensory experiences may be perceptually unrelated (eg, “seeing the devil” while “hearing the voice of a relative” from a different location) or perceptually combined (eg, the voice comes from the hallucinated figure), 58 the combined variant thought to be rare in psychosis. 59 The prevalence of occasional multimodal hallucination in schizophrenia has been estimated as 50%.…”

Borderlinepersönlichkeitsstörung mit psychotischen Symptomen und Parietallappenstörungen

“…Viele namenhafte Autoren wiesen auf Patienten hin, die stark persönlichkeitsgestört sind, aber auch psychotische Symptome aufweisen [6 ± 12]. Chesterman u. Boast beschrieben 1994, wie im englischsprachigen Raum die multimodalen Halluzinationen dieser Patientengruppe allmählich nicht mehr als psychiatrische Symptome, sondern als Teil eines manipulativen und hysterischen Symptomkomplexes gesehen wurden, obwohl keine objektiven Kriterien diese ¾nderung gerechtfertigt hätten [13]. Steinert verdeutlichte 1995 anhand von Patientenkasuistiken, die unserer Patientengruppe ähneln, dass diagnostische Probleme bei Komorbidität von Borderlinestörung und Schizophrenie weiter bestehen und eine angemessene diagnostische Beurteilung mit den gegebenen Kategorien von ICD-10 und DSM-IV nicht möglich ist [14,15].…”