Hearing voices telling you to do things can be a sign of a mental health condition called psychosis. Psychosis is characterized by a disconnect from reality, which can include hallucinations like hearing voices, delusions, confused thinking, and disorganized behavior. There are several different causes and types of psychosis, with the most common being schizophrenia, bipolar disorder, depression with psychotic features, drug-induced psychosis, brief psychotic disorder, and delusional disorder.
It’s estimated that about 3% of the population will experience psychosis at some point in their lives. While the experience of hearing voices telling you to do things can be very distressing and feel completely real, it is important to understand that the voices are not real and are a manifestation of the psychosis. Getting an accurate diagnosis and appropriate treatment is essential for managing psychotic symptoms like hearing voices.
What are the causes of hearing voices?
There are several potential causes of hearing voices telling you to do things:
Schizophrenia – Schizophrenia is one of the most common causes of hearing voices. It is a chronic mental illness characterized by psychotic symptoms like hallucinations, delusions, and disorganized thinking and behavior. Schizophrenia affects about 1% of the population.
Bipolar Disorder – During manic or depressive episodes of bipolar disorder, some people may experience psychotic symptoms like hearing voices. Bipolar disorder causes extreme mood swings between depressive and manic highs.
Major Depression – In some cases, severe depression can trigger psychotic symptoms like hearing voices telling you to do things. This is known as major depressive disorder with psychotic features.
Schizoaffective Disorder – This condition involves a combination of schizophrenia symptoms like hallucinations and delusions, along with mood disorder symptoms like depression or bipolar.
Drug-induced Psychosis – Certain drugs like methamphetamine, cocaine, alcohol, and some medications can cause psychotic episodes with symptoms like hearing voices. This tends to resolve once the drug use stops.
Brief Psychotic Disorder – Also called brief reactive psychosis, this involves a brief psychotic episode lasting less than a month, often triggered by extreme stress. Symptoms like hearing voices resolve once the stressor passes.
Delusional Disorder – This condition causes persistent delusional beliefs, like thinking you’re being harmed or harassed. Auditory hallucinations telling you to do things related to the delusions may occur.
Dissociative Identity Disorder – Formerly called multiple personality disorder, this involves “alters” or split identities that may potentially cause voice hearing as distinct personalities emerge.
Psychotic Depression – Clinical depression combined with psychosis can result in hearing voices urging you to act in destructive ways, like committing suicide.
Postpartum Psychosis – New mothers experiencing postpartum psychosis after giving birth may hear voices telling them to harm their baby, though this is extremely rare.
Parkinson’s Disease – Parkinson’s disease has psychotic symptoms in some patients, including hearing voices, as a side effect of medications or as the disease progresses.
Brain Tumor or Lesion – In rare cases, a brain tumor or lesion on the brain can trigger auditory hallucinations.
So in summary, the most common causes are schizophrenia, bipolar disorder, major depression, drug use, and brief psychotic episodes brought on by extreme stress. Consulting with both a psychiatrist and therapist can help get an accurate diagnosis and determine the appropriate treatment options.
When does hearing voices become a mental health issue?
Hearing voices may be considered part of a mental health condition when:
– The voice hearing experience causes significant distress or negatively impacts functioning and daily life activities.
– The person has no control over when they hear voices or what the voices say.
– The voice hearing persists over time, instead of being temporary.
– The person hears multiple voices talking to or about them.
– The voices make commands telling the person to engage in risky, destructive or dangerous behavior.
– The person has delusional beliefs related to the voices that are firmly held, even when evidence shows they can’t be true.
– There is increased confusion, disorganization, or chaotic thinking around the time of voice hearing.
– The person responds to or engages with the voices as if they are real people.
– The voices are accompanied by other symptoms of psychosis like delusions, paranoia, catatonia, or jumbled thoughts and speech.
– There is a decline in social functioning along with increasing isolation and difficulty caring for oneself.
– There are risk factors present like family history of psychosis, drug use, extreme stress, or brain injury.
If the voice hearing causes significant impairment in the ability to work, have relationships, or manage daily activities, it likely requires psychiatric assessment and mental health treatment. Even if symptoms are temporary or mild, seeking help is recommended.
When should you see a doctor about hearing voices?
It’s advisable to see a doctor promptly if you experience any of the following:
– You hear voices frequently or on an ongoing basis. The voices may call your name, narrate your actions, command you to do things, or comment on your thoughts and feelings.
– The voices are very disturbing, negative, threatening, or cause emotional distress. They may tell you to harm yourself or others, shout insults, or make critical remarks.
– You have hallucinations involving other senses, like seeing things that aren’t there. Having hallucinations in multiple sensory modes is a red flag.
– You have delusional beliefs that seem real to you but aren’t based in reality. For instance, thinking you’re being watched, poisoned, plotted against, or controlled by outside forces.
– Your thinking and speech seems disorganized, incoherent, or illogical to others. You may jump between topics erratically.
– You feel confused, fearful, anxious, depressed, or have rapid mood swings around the time you hear voices. The voices may trigger strong emotions.
– You have risk factors like drug use, extreme trauma, family psychotic disorders, recent childbirth, or brain injury.
– The voices are interfering with your ability to work, have relationships, or care for yourself properly. The symptoms persist and get worse over time.
– You sometimes respond to or interact with the voices as if they’re real.
– You have thoughts of harming yourself or others, especially if commanded by the voices. This creates an emergency requiring immediate evaluation.
Don’t delay in seeking medical advice. Early treatment often leads to better management of symptoms and improved long term prognosis. Tell your doctor about all your symptoms to get a proper diagnosis.
What type of doctor treats voice hearing and psychosis?
The following doctors diagnose and treat mental health conditions like psychosis that may involve hearing voices:
– Psychiatrist – This is a medical doctor who specializes in psychiatry and mental health disorders. Psychiatrists can provide official diagnoses, prescribe psychiatric medications, and provide therapy. Seeing a psychiatrist is recommended for suspected psychosis.
– Clinical psychologist – Psychologists have doctoral degrees and advanced training in therapy methods to treat mental illnesses like schizophrenia, depression, and bipolar disorder.
– Neurologist – If an underlying neurological issue like seizure disorder, brain tumor, or dementia could be causing psychotic symptoms, a neurologist can assess brain function and rule out medical conditions.
– Primary care physician – Primary care doctors can conduct initial screenings for mental illness and refer patients to psychiatrists for treatment. They may also monitor medication side effects.
Getting an evaluation from a psychiatrist, and likely also a psychologist, is ideal when dealing with voice hearing. They specialize in differentiating between psychiatric disorders with psychotic features and have expertise in guiding effective treatment. Don’t be afraid to discuss voice hearing openly and honestly with your provider.
Are the voices real?
Despite feeling very real to the person experiencing them, the voices heard during psychosis are not real auditory perceptions coming from an external source. Some key evidence that indicates voice hearing is a hallucination includes:
– Other people cannot hear or perceive the voices. The experience is solely in the mind of the individual hearing voices.
– The voices may have distinct personalities and interact with the person hearing them in complex interplays. This indicates the voices originate from the mind.
– The voices express thoughts, beliefs, and statements that are usually consistent with or relate to the person’s own fears, background, and fixations.
– Medications that block dopamine or glutamate activity in the brain can reduce or eliminate the experience of hearing voices. This suggests abnormal firing of neurons underlies the hallucinations.
– Physical health conditions like seizures and brain lesions that affect the brain can trigger voice hearing. Changes in the brain produce the psychotic symptoms.
– The voices and delusional beliefs associated with them fluctuate and may improve with therapy. A real perception would be static.
– Imaging scans show differences in brain activity and structure when comparing psychotic patients who hear voices to healthy controls.
While the experience of hearing voices can feel completely real and terrifying to patients, medical science confirms that the voices arise from abnormal brain activity during psychotic states rather than having a basis in external auditory reality.
Can young children hear voices?
It’s quite rare for young children under 7 or 8 years old to hear voices or experience other psychotic symptoms. When children do report hearing voices, it requires careful evaluation to determine the cause, including:
– Imaginary friends – Having an imaginary friend that a child talks to frequently is normal at young ages and not concerning by itself. It only becomes worrying if the child seems truly fearful of or distressed by the “friend”.
– Early schizophrenia onset – Schizophrenia nearly always appears in late adolescence and early adulthood. But a very small percentage of children do develop early onset schizophrenia as young as age 5 which requires immediate treatment.
– PTSD – Trauma from abuse, violence, death of loved ones, or other overwhelming events can cause post-traumatic stress in children. They may re-live memories or have flashbacks where voices are heard.
– Mood disorders – Severe depression, anxiety, and bipolar disorder very occasionally emerge in childhood and may be associated with atypical symptoms like voice hearing.
– Developmental disorders – Hearing voices can also be a symptom of conditions like autism spectrum disorders or ADHD in some cases.
– Medication side effects – Some medications for ADHD, seizures, or other medical conditions can cause psychosis and voice hearing as a side effect.
– Physical illness – In rare instances, some physical conditions affecting the brain like seizures, tumors, infections, or autoimmune disorders may trigger voice hearing if they develop early in life.
If a child reports hearing voices, an urgent medical and psychiatric evaluation is crucial to get them help and identify any underlying condition causing the psychotic symptoms.
Conclusion
Hearing voices telling you what to do is a serious symptom that requires proper diagnosis and treatment. While the experience can feel completely real to the sufferer, the voices originate from altered brain functioning rather than having an external reality. There are many potential causes, with the most likely being mental illnesses with psychotic features like schizophrenia, severe depression or bipolar mania, drug-induced states, stressful triggers, or underlying medical conditions affecting the brain. If someone is distressed by voice hearing and it impacts functioning, seeking help promptly from both a psychiatrist and psychologist is key to managing the symptoms safely and effectively. With compassion, the right medications and therapy, and family support, even serious conditions with psychosis like schizophrenia can be managed successfully.
