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“[Hearing voices is] an experience that, when considered in good faith, is as profound and complex
as human consciousness itself.”
Smith (2007)
“Dissociation must occur in some form for a mind
to hear part of itself talking and to experience that as non-self talking.”
Ross (1997)
Adversity & Psychosis
“Our findings suggest that clinicians should routinely inquire about adverse events in childhood…when working with patients with schizophrenia or similar diagnoses” (p.9).
‘Schizophrenia’
•Dopamine, serotonin and norepinephrine irregularities
•Reversed cerebral asymmetry
•Hippocampal damage
•Ventricular enlargement
•Cerebral atrophy
Traumagenic Neurodevelopmental Model of Psychosis
(Read et al., 2001, 2008, 2014)
TRAUMA
Trauma
Moskowitz, A., Schäfer, I., & Dorahy, M.J. (2008). Psychosis, Trauma and Dissociation: Emerging Perspectives on Severe Psychopathology. Wiley-Blackwell.
Longden E, House AO, Waterman MG (in submission). Associations between auditory hallucinations, dissociation and psychological distress in first episode psychosis: a case control study.
Pseudo-random sample: 31 cases with AVH and 31 non-hallucinating controls.– Demographic variables
• Age, gender, ethnicity, marital status, housing status, employment status, years in education.
– Clinical variables• Medication use, anxiety, stress, depression, psychosis in first degree
relatives, illness duration.
DES-II scores the only significant predictor of AVH when controlling for pre-onset adversity exposure (LSC-R scores) and anxiety, stress and depression (DASS-21 scores): OR=5.91; 95% CI: 1.94-17.94; p=.002.
Voice phenomenology (n=46)
•PSYRATS-AH: emotional characteristics, physical characteristics, cognitive appraisals.•DASS-21 scores (anxiety, depression, stress) were the only variable to retain significant associations with emotional (β=.43, t = 2.38, p=.02) and physical (β=.35, t = 2.14, p=.03) characteristics. •Total victimisation adversity (β=.37, t = 2.49, p=.02) was the only variable to retain significant associations with cognitive appraisals.
Longden, E., Corstens, D., Escher, S., & Romme, M. (2012). Voice hearing in a biographical context: A model for formulating the relationship between voices and life history. Psychosis, 4(3),224-234.
The Construct: “Cracking the Code”
1. Voice identity 2. Voice characteristics3. Triggers for the voices4. History of the voices5. Person’s life history
• Who/what might the voices represent?• What problems might the voices represent?
Corstens, D. & Longden, E. (2013). The origins of voices: Links between voice hearing and life history in a survey of 100 cases. Psychosis, 5(3),270-285.
• 100 individuals (80% diagnosed with schizophrenia spectrum disorders).
• Average length of voice hearing was 18 years.• At least one form of childhood adversity was
reported by 89%.
Who or what do the voices represent?• Apparent in 78% of cases (e.g., aspects of self, a family
member, a past abuser).
What problems do the voices represent?• Apparent in 94% of cases (e.g., low self-worth, anger,
shame, guilt).
Crisis
InsightRecovery
Adapted from Dillon, J. (2010). The personal is political. In S. Benamer (Ed.), Telling stories? Attachment based approaches to the treatment of psychosis (pp. 23–49). London: Karnac Books.
Relapse DenialMAINTENANCE