Trauma and the content of hallucinations and post‐traumatic intrusions in first‐episode psychosis

Abstract

Objective Increasing evidence suggests experiences of childhood trauma may be causally related to the development of hallucinations. Cognitive theories of psychosis suggest post‐traumatic intrusions to be a primary mechanism in this relationship. These theories predict that the content of hallucinations will be related to traumatic experiences; however, few studies have investigated this. This study examined the relationship between childhood trauma, the content of hallucinations, and the content of post‐traumatic intrusions in a sample with first‐episode psychosis. Methods Sixty‐six young people aged 15–25 experiencing a first episode of psychosis were recruited from an early intervention service. Participants completed assessments of traumatic experiences, hallucination content, and post‐traumatic intrusion content using a systematic coding frame. The coding frame assessed for three types of relationships between traumatic experiences, the content of hallucinations, and the content of post‐traumatic intrusions: direct relationships (hallucination content exactly matching the trauma/intrusion), thematic relationships (hallucinations with the same themes as the trauma/intrusion), and no relationship (hallucination and trauma/intrusion content unrelated). Results Of those people who reported trauma and hallucinations (n = 36), 22 of these (61%) experienced post‐traumatic intrusions, and of these, 16 (73%) experienced hallucinations that were directly or thematically related to their post‐traumatic intrusions. Twelve people experienced hallucination content directly related to their trauma, six of whom (50%) also had intrusions relating to the same traumatic event as their hallucinations. Conclusions The finding that some people experience hallucinations and post‐traumatic intrusions relating to the same traumatic event supports theories proposing a continuum of memory intrusion fragmentation. These results indicate that early intervention services for young people with psychosis should provide assessment and intervention for trauma and PTSD and should consider the impact of past traumatic events on the content of current hallucinatory experience. Practitioner points Trauma and post‐traumatic stress disorder should be assessed in those experiencing a first episode of psychosis. Interventions for trauma should be offered in early intervention for psychosis services. In a notable proportion of people, hallucination content is related to traumatic experiences. Clinical assessment and formulation of hallucinations requires consideration of how past traumatic events may be contributing to hallucinatory experience. It is important for clinicians to have an understanding of the phenomenological differences between hallucinations and post‐traumatic intrusions when conducting clinical assessments with people with comorbid psychosis and PTSD.

‘I do not know where it comes from, I am suspicious of some childhood trauma’ association of trauma with psychosis according to the experience of those affected

“…In fact, childhood trauma has been extensively investigated as a major risk factor for the development of psychosis in adult life (Catalan et al, 2017;Frissen et al, 2015;Gabínio et al, 2018;Luutonen et al, 2013;Turner et al, 2019). Moreover, recent studies suggest that depending on the type of abuse suffered in childhood, some symptoms may be given priority over others in psychotic disorder, possibly affecting the very phenomenology of the disorder (Isvoranu et al, 2017;Klarić & Lovrić, 2018) and the content of the hallucinations experienced (Peach et al, 2020). Such an association between child abuse and psychosis is not exclusive to this disorder, but any type of adverse event or trauma in childhood can trigger a wide variety of psychopathologies in the adult (Brustenghi et al, 2019;Kaczmarczyk, Wingenfeld, Kuehl, Otte, & Hinkelmann, 2018;Lotzin, Grundmann, Hiller, Pawils, & Schäfer, 2019;Wang et al, 2020).…”

A treatment protocol to guide the delivery of dialogical engagement with auditory hallucinations: Experience from the Talking With Voices pilot trial

“…Despite longstanding associations with psychiatric illness, there is growing recognition that voice‐hearing (‘auditory hallucinations’) is a psychosocially meaningful event with manifest associations between adverse life events and the content of, and responses to, the voices people hear (Corstens & Longden, 2013; McCarthy‐Jones, 2011; Peach et al, 2020). In turn, a proportion of individuals may also experience dynamic relationships with their voices, perceiving them as distinct and separate from their sense of self (Dorahy & Palmer, 2016; McCarthy‐Jones et al, 2014; Romme, Escher, Dillon, Corstens, & Morris, 2009).…”

Trauma and Psychosis: A Qualitative Study Exploring the Perspectives of People with Psychosis

“…Similarly to previous research, participants reported that the content of psychotic symptoms was often related to their traumatic events and the negative feelings associated to them [8,9]. When interviewed, participants reported experiencing many psychosis-related traumas, including being scared because unable to distinguish reality from fantasy, by their hallucinations or by going through several negative hospital experiences.…”

“…Aiming to clarify the relationship between trauma and psychosis, Morrison et al [7] suggested that psychotic and traumatic symptoms are caused and maintained by similar psychological mechanisms and fall on a continuum of trauma-related reactions. In support of this theory, research has shown that hallucinations can be considered a form of post-traumatic intrusion, where the content of psychotic symptoms relates to the traumatic experiences or to the feelings of humiliation, fear and guilt associated with them [8,9]. Hallucinations and other positive symptoms of psychosis have also been linked to dissociation [10,11], another trauma-related response, with researchers suggesting that several symptoms of psychosis are in fact a dissociative phenomenon [12,13].…”