Auditory hallucinations: the most common type in schizophrenia

Hearing a voice when nobody is speaking is one of the most universally recognised — and most misunderstood — experiences in psychiatry. About 70% of people diagnosed with schizophrenia experience auditory verbal hallucinations (AVH) at some point, according to a review in Schizophrenia Bulletin hosted by the National Library of Medicine (McCarthy-Jones, 2012). They are also reported by a meaningful minority of people without any psychiatric diagnosis, which has reshaped how researchers think about voices entirely.

What voices actually sound like

People who hear voices describe an enormous variety of experiences. Some hear a single voice; others hear two, three, or a crowd. Voices can be male, female, child-like, or genderless. They may speak in the listener's own language, in a language they don't recognise, or in fragments. They can be loud or whispered. They can come from inside the head, from outside the body, from a specific direction, or from no clear location at all.

Common content patterns include:

• Running commentary — describing what the person is doing in real time
• Two or more voices conversing — often about the listener, in the third person
• Critical voices — insults, accusations, judgements
• Command voices — instructing the person to do something (covered in our command hallucinations article)
• Neutral or pleasant voices — narration, encouragement, conversation

Why the brain produces them

The leading neuroscientific account is that voices arise when the brain misattributes its own internal speech — the silent, near-constant inner monologue most of us run — as coming from outside the self. Functional MRI studies, including work by Shergill and colleagues at King's College London, have shown that the same areas of auditory cortex involved in hearing real speech light up during hallucinated speech.

A related mechanism, called corollary discharge dysfunction, may explain the misattribution. When you speak, your brain normally sends a parallel signal that tags the resulting sound as "self-generated," which is why your own voice doesn't surprise you. In schizophrenia, that tagging signal appears to be weaker or mistimed, so internally generated speech can feel as though it originates from someone else.

Voices outside of schizophrenia

Hearing voices is not exclusive to schizophrenia. Surveys reviewed by the Hearing Voices Network suggest that 5–15% of the general population reports at least one auditory hallucination during their lifetime, often during grief, severe sleep deprivation, fever, or mystical experience. Voices also occur in:

• Bipolar disorder with psychotic features
• Post-traumatic stress disorder, particularly in survivors of childhood trauma
• Borderline personality disorder
• Major depression with psychotic features
• Lewy body dementia and other neurological conditions
• Substance intoxication or withdrawal

What distinguishes voices in schizophrenia from voices in non-clinical populations is often not the experience itself but the surrounding context: distress, lack of control, accompanying delusions, and impact on functioning.

How they are usually treated

Antipsychotic medication

Most antipsychotics reduce voice frequency and distress for many people, with about 60–70% experiencing meaningful reduction within weeks. Clozapine has the strongest evidence for voices that have not responded to other medications — see our clozapine overview.

CBT for psychosis

Cognitive Behavioural Therapy adapted for psychosis (CBTp) helps people examine the beliefs they hold about their voices — for example, "the voice is all-powerful" or "I must obey it." Our guide to CBTp for voices covers this in depth. The approach is endorsed by NICE Clinical Guideline CG178 as a first-line treatment alongside medication.

Avatar therapy

A newer approach in which the person creates a digital avatar that represents the voice and engages with it under therapist guidance. A randomised trial published in The Lancet Psychiatry (Craig et al., 2018) found significant reductions in voice severity. See avatar therapy.

Coping strategies people develop

• Listening to music through headphones
• Talking with someone real to "anchor" attention
• Humming, reading aloud, or any vocal activity (which uses the same brain machinery)
• Naming the voices and setting boundaries with them
• Tracking patterns — many voices are louder when sleep is poor or stress is high

What helps a loved one who hears voices

If someone you love hears voices, the most useful things you can offer are calm, validation, and patience. You don't have to agree that the voices are real to acknowledge that the experience is. Phrases like "that sounds frightening" or "I believe you that you're hearing something" build trust. Arguing about whether the voices exist almost always backfires.

The shift in how voices are understood

Over the last twenty years, the conversation about voices has changed. The old model treated every voice as a meaningless symptom to be eliminated. The newer model — championed by survivor groups, peer researchers, and clinicians like Marius Romme and Eleanor Longden — sees voices as often meaningful experiences that can be related to with curiosity rather than only fought. This doesn't replace medical treatment; it sits alongside it.

Frida and similar tracking tools can help people notice patterns over weeks: which voices appear when, what makes them louder, what makes them quieter. That kind of self-knowledge is the foundation of most successful long-term coping.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.