Voices from the storm: A critical review of quantitative studies of auditory verbal hallucinations and childhood sexual abuse

Although an association between hallucinations and sexual abuse has been documented, the relation between specifically auditory verbal hallucinations (AVHs) and childhood sexual abuse (CSA) is less clear. This study reviewed quantitative studies of AVHs and CSA. 36% of psychiatric patients with AVHs, and 22% of non-psychiatric patients with AVHs, reported CSA. At least 16% of the general population with auditory hallucinations also reported CSA. The majority of studies reviewed found that those with AVHs were more likely to be survivors of CSA than individuals without AVHs. 56% of psychiatric patients with CSA reported AVHs, and at least 21% of the general population with CSA reported auditory hallucinations. A majority of studies found survivors of CSA were more likely to report AVHs than individuals without CSA. Ability to impute a causal role for CSA was impaired by such studies' failures to control for potentially confounding variables. Yet, studies of AVH content showed links between the content of voices and the content of CSA in some voice-hearers. It is concluded that although a clear association between CSA and AVHs exists, there is not yet reliable quantitative evidence of a causal relation. Implications for mental health professionals and for future research, are discussed.

Research highlights
► 36% of psychiatric patients with AVHs report childhood sexual abuse (CSA).
► Individuals with CSA are more likely to report AVHs than those without CSA.
► The content of some, but not all, AVHs relate to CSA experiences.
► Studies of CSA and AVHs have not controlled for confounding variables.
► Studies controlling for confounders are needed to assess if CSA may cause AVHs.