Auditory Hallucinations

What are auditory hallucinations?

Auditory hallucinations happen when you hear voices or noises that aren’t there. The sounds you hear may seem real, but they’re not.

A person may perceive auditory hallucinations as coming through their ears, on the surface of their body, in their mind or from anywhere in the space around them. They can occur as frequently as daily or as an isolated episode.

Auditory hallucinations are often associated with schizophrenia and other mental health conditions, but they can happen for several other reasons, such as hearing loss, and aren’t always a sign of a mental health condition.

Researchers estimate that 5% to 28% of people in the United States experience auditory hallucinations. They’re the most common type of hallucination.

Some people experience auditory hypnogogic hallucinations that specifically take place as they’re falling asleep. These types of hallucinations are common and usually not a cause for concern.

What are the types of auditory hallucinations?

The two main types of auditory hallucinations are verbal (hearing voices) and hearing sounds or noises.

Auditory verbal hallucinations (hearing voices)

An auditory verbal hallucination is the phenomenon of hearing voices in the absence of any speaker.

The experience of hearing voices can vary greatly from person to person and even for the same person. They can vary in how often you hear them, what they sound like, what they say and whether they’re familiar or unfamiliar.

The voices may come from a single source, such as a television, or multiple sources. It may be a singular voice or multiple voices. They may talk directly to the person, have discussions with them or describe events taking place.

The voices may be positive, negative or neutral. Sometimes, hearing voices can be upsetting or distressing. They may command you to do something that may cause harm to yourself or others.

Auditory verbal hallucinations most commonly affect people with schizophrenia and/or post-traumatic stress disorder (PTSD), but they can happen to people who don’t have any health conditions.

Hearing sounds or noises

Auditory hallucinations can take the form of hearing sounds or noises, such as music, animal calls, nature sounds or background noises. They may seem like they’re coming from anywhere in the space around you or in your mind. The noise volume can vary from very quiet to very loud.

Is it normal to hear auditory hallucinations?

If you experience auditory hallucinations just as you’re falling asleep (hypnogogic hallucinations) or waking up (hypnopompic hallucinations), it’s considered normal and usually not a cause for concern. Up to 70% of people experience these types of hallucinations at least once.

If you experience auditory hallucinations while you’re wide awake, it may be — but isn’t always— a symptom of a mental health or neurological condition. Talk to your healthcare provider about the hallucinations and any other symptoms you have.

What are the possible causes of auditory hallucinations?

Several situations and conditions — both temporary and chronic — can cause auditory hallucinations.

Scientists don’t yet know the exact mechanisms in your brain that cause auditory hallucinations, but they have a few theories, including:

• Spontaneous activation of the auditory network in your brain, which consists of the left superior temporal gyrus, transverse temporal gyri (Heschl's gyri) and the left temporal lobe.
• An imbalance of dopamine and serotonin, which are neurotransmitters.

Schizophrenia and auditory hallucinations

Approximately 75% of people with schizophrenia experience auditory hallucinations — usually hearing voices.

Schizophrenia refers to both a single condition and a spectrum of conditions that fall under the category of psychotic disorders. These are conditions where a person experiences some form of disconnection from reality. Those disconnections can take several different forms, including experiencing hallucinations.

Schizophrenia is characterized by:

• Psychosis (disconnection from reality).
• Hallucinations.
• Delusions (false beliefs).
• Disorganized speech and behavior.
• Restricted range of emotions.
• Impaired reasoning and problem-solving.
• Occupational and social dysfunction.

Schizophrenia is a chronic condition that may progress through several phases, although the length and patterns of the phases can vary. People with schizophrenia are more likely to experience hallucinations during the active phase.

Other mental health conditions that can cause auditory hallucinations

People with other mental health conditions can experience auditory hallucinations. They affect:

• 20% to 50% of people with bipolar disorder.
• 40% of people with post-traumatic stress disorder (PTSD).
• 14% of people with an anxiety disorder.
• 10% of people with major depression.

Hearing impairment and hallucinations

Auditory hallucinations occur in 16% of adults with hearing impairment, which can take two forms: simple hallucinations (tinnitus) and complex hallucinations (speech and music).

According to studies, the more severe the hearing impairment, the more likely it is that you’ll experience auditory hallucinations.

Neurological causes of auditory hallucinations

Several neurological conditions can cause auditory hallucinations, including:

• Sleep disorders, such as narcolepsy and insomnia.
• Parkinson’s disease.
• Stroke.
• Migraine.
• Brain tumors or lesions in your temporal lobe, brainstem or thalamus.

Other causes of auditory hallucinations

Several other — usually temporary — conditions and situations can cause auditory hallucinations, including:

• Alcohol and recreational drug use.
• Lack of sleep.
• Extreme hunger.
• Certain prescribed medications (as a side effect).
• Extreme stress or grief.
• Infections, such as UTIs, especially in people who are older.
• Recovering from anesthesia after a surgery or procedure.

How are auditory hallucinations treated?

The treatment for auditory hallucinations depends on the cause. Hallucinations caused by temporary conditions, such as extreme hunger or lack of sleep, will stop once the underlying condition has been treated or resolved.

Medications to manage auditory hallucinations

Healthcare providers only prescribe medication to manage auditory hallucinations if they’re part of an underlying chronic condition. Medications include:

• Neuroleptics (antipsychotics): These medications may help decrease the frequency and severity of auditory hallucinations in people with schizophrenia spectrum disorders. The antipsychotic medication clozapine (Clozaril®) is the most effective option for treating symptoms of schizophrenia, including hallucinations, but it can cause dangerous side effects that affect your blood.
• Psychotropic medications: Psychotropic medications, such as antidepressants and mood stabilizers, can help treat auditory hallucinations in people with severe depression or mania.

Psychotherapy (talk therapy) for auditory hallucinations

For people with mental health conditions who experience auditory hallucinations, psychotherapy (talk therapy) can help in conjunction with medication.

Psychotherapy is a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to you and your family.

Types of psychotherapy that can help with auditory hallucinations include:

• Cognitive behavioral therapy (CBT): This type of therapy helps you learn how to modify how you experience auditory hallucinations, ultimately offering an improved sense of control over them. CBT implements reality testing and can be provided in an individual or group setting.
• Acceptance and commitment therapy (ACT): This type of therapy involves active acceptance and achievement of worthwhile goals despite experiencing auditory hallucinations. ACT may help reduce auditory hallucinations and may increase your feeling of control over them.
• Hallucination-focused integrative treatment (HIT): This is a specific treatment for auditory verbal hallucinations (hearing voices) that involves techniques from cognitive behavioral therapy, psychoeducation, coping training, rehabilitation and medication. It emphasizes active family involvement, crisis intervention (when required) and specialized motivational strategies.

How can I stop auditory hallucinations?

If you’re experiencing auditory hallucinations only as you’re falling asleep (hypnogogic hallucinations), they may decrease in frequency if you do the following:

• Get enough quality sleep.
• Follow a regular sleep schedule.
• Avoid alcohol and certain drugs and medications.

If you experience auditory verbal hallucinations (hearing voices) due to a mental health or neurological condition, it’s important to talk to your healthcare provider about them. Aside from medication and talk therapy, other techniques may help you manage and cope with them, including:

• Distraction techniques, such as listening to music on headphones, exercising, cooking or doing a hobby may help quiet the voices.
• Joining a support group with other people who experience auditory verbal hallucinations.
• Taking control, such as ignoring the voices or standing up to them.

When should auditory hallucinations be treated by a doctor or healthcare provider?

Auditory hallucinations have several causes — some of which are normal and harmless. But if you’re experiencing auditory hallucinations that are causing you distress, talk to your healthcare provider.

If you or someone you know is experiencing auditory hallucinations and is detached from reality, you or they should get checked by a healthcare provider as soon as possible.

A note from Cleveland Clinic

It’s important for people experiencing auditory hallucinations to talk about them with their family and healthcare team, especially if they’re causing distress. Auditory hallucinations caused by a mental health condition are usually manageable with treatment and can become disturbing or dangerous if they’re not treated. Discuss all possible symptoms with your healthcare provider, no matter how minor or bizarre you may think they are. Hallucinations can make you feel nervous, paranoid and frightened, so it's important to be with and talk with someone you can trust.