Auditory hallucinations, or hearing voices that are not really there, can be a frightening and disruptive symptom. These phantom sounds are most commonly associated with mental health conditions like schizophrenia. However, research shows that auditory hallucinations can also occur in people with anxiety disorders. So can anxiety actually cause you to hear things that aren’t real? Let’s take a closer look at the connection between anxiety and auditory hallucinations.
What are auditory hallucinations?
Auditory hallucinations involve hearing voices, music, or other noises that do not have an external source. In other words, the sounds are generated by the mind rather than occurring in the outside environment. While visual hallucinations are also possible, auditory hallucinations are by far the most common type.
According to research, auditory hallucinations occur in the following percentages of certain groups:
- 60-80% of people with schizophrenia
- 10-15% of people with bipolar disorder
- 10-15% of people with major depression with psychotic features
- 60% of people with post-traumatic stress disorder (PTSD)
- 20% of people with Parkinson’s disease
However, people without mental illness can also occasionally experience auditory hallucinations. Hypnagogic hallucinations that occur while falling asleep, hypnopompic hallucinations while waking up, and hallucinations from psychoactive drug use are some examples.
The content of auditory hallucinations can vary greatly as well. Some examples include:
- Hearing voices conversing or commenting
- Hearing a voice narrating the person’s actions or thoughts
- Hearing someone call the person’s name
- Hearing music or sounds like ringing, clicking, hissing, etc.
Auditory hallucinations are distinct from physical hearing problems like tinnitus, which causes ringing or buzzing in the ears due to inner ear damage. The sounds from auditory hallucinations seem real at the time but do not have an actual source.
What causes auditory hallucinations?
Abnormal brain activity is responsible for triggering auditory hallucinations. However, our understanding of the precise origins remains limited. Some possible explanations include:
- Impaired communication between brain regions involved in processing sounds and speech
- Overactivity in auditory cortex regions of the brain
- Imbalance between dopamine and acetylcholine brain chemicals
- Faulty connections between brain hemispheres
- Deficits in reality monitoring (ability to distinguish real vs imagined information)
There are also some factors that can make a person more vulnerable to experiencing auditory hallucinations:
- Genetics – Family history of psychosis or schizophrenia
- Stress – High levels of psychological stress
- Trauma – Past traumatic experiences
- Isolation – Lack of social interaction
- Cognitive biases – Jumping to conclusions, over-interpretation
- Physical illness – Conditions like high fever, brain tumor, stroke, etc.
Ultimately, it is not completely understood why some people develop auditory hallucinations while others don’t under similar circumstances. Research into the brain mechanisms behind hallucinations is ongoing.
Can anxiety cause auditory hallucinations?
Although anxiety disorders are not routinely linked to psychotic symptoms like hallucinations, emerging research suggests anxiety may in fact trigger auditory hallucinations for some people.
Several studies have observed connections between anxiety symptoms and auditory hallucinations:
- A 2014 meta-analysis of 20 studies concluded that anxiety significantly increases the chance of experiencing auditory hallucinations.
- A 2016 study of 153 psychiatric inpatients found that severity of anxiety symptoms predicted likelihood of auditory hallucinations.
- A 2017 study of 658 patients diagnosed with schizophrenia found that severity of anxiety symptoms positively correlated with severity of hallucinations.
Furthermore,auditory hallucinations are relatively common in post-traumatic stress disorder (PTSD), an anxiety disorder that can develop after a traumatic event. Rates of hallucinations in PTSD range from 10-15%.
The reasons why anxiety may spark auditory hallucinations likely involve both psychological and biological factors.
On a psychological level, anxiety tends to promote hypervigilance to potential threats. When anxiety is chronic, this can lead to hypersensitivity to sounds and a propensity to misinterpret noises as voices or other phantom noises. Cognitive biases like jumping to conclusions and intrusive thoughts may also contribute.
On a biological level, anxiety is linked to abnormally high activity in the amygdala, the part of the brain that generates fear responses and emotional processing. Overactivity here may produce some of the brain changes thought to underly hallucinations as well. The stress hormone cortisol is also elevated with chronic anxiety, which may impact brain function and chemistry.
So in summary, high anxiety appears capable of inducing auditory hallucinations in some cases, likely due to a combination of psychological and neurological factors. However, it is important to note that the large majority of people with anxiety disorders do not experience this symptom. More research is still needed on the direct causal relationship and mechanisms involved.
Treatments
When anxiety is contributing to auditory hallucinations, comprehensive treatment is recommended. The main treatment approaches include:
Treating the underlying anxiety
This involves psychotherapy techniques like cognitive behavioral therapy (CBT) and medications like antidepressants, benzodiazepines, and beta blockers. Addressing sources of stress and learning anxiety management skills is essential.
Antipsychotic medications
Antipsychotics like olanzapine and risperidone block dopamine activity and may help reduce hallucinations, especially when added to an antidepressant.
Brain stimulation therapy
Repetitive transcranial magnetic stimulation (rTMS) creates magnetic pulses that normalize brain activity patterns. Small studies show rTMS can improve anxiety-related hallucinations.
Grounding techniques
Strategies like focusing on the present moment, smelling strong scents, and holding ice can “ground” the senses and interrupt hallucination episodes.
Cognitive behavioral therapy for psychosis (CBTp)
CBTp helps evaluate the reality of hallucinations and change distorted thought patterns contributing to their occurrence.
With this multipronged approach, anxiety-related hallucinations often improve significantly or remit entirely. However, chronic hallucinations may warrant an evaluation by a psychiatrist.
When to see a doctor
Occasional, brief auditory hallucinations are not always a major cause for concern. But you should make an appointment with your doctor or mental health professional if you experience:
- Auditory hallucinations that are frequent or long-lasting
- Hallucinations along with other psychotic symptoms like delusions
- Suicidal or violent hallucinations
- Hallucinations causing significant life impairment
- New onset of hallucinations without any family history
A medical exam and consultation with a psychiatrist can determine if anxiety is the underlying issue, or if another condition like schizophrenia, bipolar disorder, depression, PTSD, or neurological illness may be involved. Proper diagnosis and treatment are crucial for managing this disruptive symptom.
Coping tips
Living with anxiety-induced auditory hallucinations while pursuing treatment can be extremely distressing. Here are some self-help coping strategies that may help reduce frequency and severity:
- Challenge negative thoughts about voices – Don’t assume they have real power or meaning.
- Distract yourself with activities – Shift focus away from voices.
- Listen to music or white noise – Helps drown out voices.
- Talk to loved ones – Social support decreases isolation.
- Avoid drugs and alcohol – Can make hallucinations worse.
- Practice stress management – Lower anxiety levels.
- Get enough sleep – Sleep deprivation is linked to hallucinations.
Having social support through loved ones, therapy groups, or crisis lines can also provide invaluable comfort when copeing with this symptom.
Takeaways
While not a prominent feature, research indicates that in some cases anxiety is capable triggering auditory hallucinations. Possible mechanisms include hypervigilance, amygdala overactivity, trauma, and distorted thought patterns. Treating the underlying anxiety, adding antipsychotics, and cognitive behavioral therapy are often effective for improving this symptom. But any persistent hallucinations with anxiety warrant an evaluation for other potential causes. With proper treatment, the prognosis for anxiety-related hallucinations is generally positive.
