In our recent study, we focused on the phenomenologically complex and nuanced interrelatedness of self, voices, and delusions. We investigated the prevalence of co-occurring Auditory Verbal Hallucinations (AVHs) and delusions in schizophrenia compared to bipolar disorder with psychosis; the correlations between AVHs and forms of delusions; and if there are sub-categories/clusters of AVHs and forms of delusions that are distinct and identifiable and what is the symptom presentation of these sub-categories/clusters?
Our study found two distinct clusters of AVHs and forms of delusions: AVHs paired with thought delusions (Cluster One) and AVHs paired with thematic delusions (Cluster Two). These clusters begin to disentangle the intrasubjectivity of voices and delusion by characterizing Cluster One: AVH and Thought Delusions as a structure that centres on alterations of self and internal/external boundaries, while Cluster Two: AVH and Thematic Delusions centres on exaggerated processes of social internalization (guilt) or externalization (jealousy/delusions of infidelity).
As phenomenological psychopathologists have long contended, we found that participants with schizophrenia spectrum disorder were more likely to fall into Cluster One: AVH and Thought Delusions and those with bipolar psychosis into Cluster Two: AVH and Thematic Delusions. Nevertheless, neither group was diagnostically pathognomonic. Cluster One: AVH and Thought Delusions participants also showed elevated disorganized, cognitive and depressive symptoms, but not negative symptoms or excitement. Future research would be needed to further unpack whether these differences in severity are tied to diagnosis (schizophrenia versus bipolar) or more strongly to predominant pattern of delusions.
