Patients with internal hallucinations did not differ from those with external hallucinations on severity of other symptoms. However, they reported their hallucinations to be more emotionally negative, distressing, and long-lasting, less controllable, and less likely to remit over time. They also were more likely to experience voices commenting, conversing, or commanding. However, they also were more likely to have insight into the self-generated nature of their voices. Patients with internal hallucinations were not older, but had a later age of illness onset.
Although always perceived as if other-generated, they may be heard as coming from some external location or from inside the head. Some patients perceive only “external” hallucinations, others only “internal”, and still others experience both types.
Hypotheses
Our primary hypotheses, based mainly on clinical observation, were that patients whose auditory hallucinations were partly or wholly internal would report them to be more negative and distressing than patients whose hallucinations were exclusively external, and that internal hallucinators also would be more likely to report voices commenting, conversing, and commanding.
Based on Copolov et al.’s findings, we anticipated that patients whose hallucinations were exclusively internal would have more insight regarding their origins than patients with any external hallucinations.
Based on the findings of Copolov et al. and Nayani and David, we expected that patients with internal hallucinations would not differ from those with external hallucinations only on overall severity of positive, negative, general, or total symptoms.
Based on Nayani & David’s idea that internal hallucinations may be a more fully developed stage of the phenomenon, we tested whether patients with internal hallucinations were older and had a longer duration of illness than those with external hallucinations only.