Voices to reckon with: perceptions of voice identity in clinical and non-clinical voice hearers

Abstract

The current review focuses on the perception of voice identity in clinical and non-clinical voice hearers. Identity perception in auditory verbal hallucinations (AVH) is grounded in the mechanisms of human (i.e., real, external) voice perception, and shapes the emotional (distress) and behavioral (help-seeking) response to the experience. Yet, the phenomenological assessment of voice identity is often limited, for example to the gender of the voice, and has failed to take advantage of recent models and evidence on human voice perception. In this paper we aim to synthesize the literature on identity in real and hallucinated voices and begin by providing a comprehensive overview of the features used to judge voice identity in healthy individuals and in people with schizophrenia. The findings suggest some subtle, but possibly systematic biases across different levels of voice identity in clinical hallucinators that are associated with higher levels of distress. Next we provide a critical evaluation of voice processing abilities in clinical and non-clinical voice hearers, including recent data collected in our laboratory. Our studies used diverse methods, assessing recognition and binding of words and voices in memory as well as multidimensional scaling of voice dissimilarity judgments. The findings overall point to significant difficulties recognizing familiar speakers and discriminating between unfamiliar speakers in people with schizophrenia, both with and without AVH. In contrast, these voice processing abilities appear to be generally intact in non-clinical hallucinators. The review highlights some important avenues for future research and treatment of AVH associated with a need for care, and suggests some novel insights into other symptoms of psychosis.

The Representation of Agents in Auditory Verbal Hallucinations

“…In a related manner, there might be a connection between the agent represented and the distressing nature of the voices. For example, Badcock and Chhabra () show, in a comparison between clinical and non‐clinical voice‐hearers, that the perceived identity of the voice correlates strongly with the distress caused. Furthermore, the fact that a history of childhood sexual and emotional abuse, but not physical abuse, is linked to the likelihood of AVH, may suggest a connection with relationship trauma (Bentall et al ., ).…”

Auditory verbal hallucinations and continuum models of psychosis: A systematic review of the healthy voice-hearer literature

“…Several narrative reviews have been published on AVHs in healthy populations (Badcock and Chhabra, 2013, Badcock and Hugdahl, 2012, de Leede-Smith and Barkus, 2013, Johns et al, 2014, Larøi, 2012). However, these tend to be broader (e.g.…”

Emotional self–other voice processing in schizophrenia and its relationship with hallucinations: ERP evidence

“…Auditory hallucinations (the subjective perception of sounds in the absence of an external stimulus; Woodruff, ) are experienced by up to 70% of schizophrenia patients, most often as voices (auditory verbal hallucinations, AVH; Nayani & David, ). Similar to the experience of listening to an external voice, hallucinated voices convey information about the identity and emotional content of the message, suggesting some overlap of the mechanisms involved in AVH and human voice perception (e.g., Badcock & Chhabra, ). However, it is possible that the experience of AVH is associated with specific abnormalities in voice information processing pathways (i.e., identity, speech, affect; Belin, Fecteau, & Bédard, ).…”