On the non-significance of internal versus external auditory hallucinations

Traditionally, auditory hallucinations (AHs) heard outside the head have been regarded as more pathological than those heard inside, partly on the basis that internal AHs are conceptually closer to normal thinking than external AHs. Our data show that many patients hear AHs both internally and externally, and there were very few associations between location and demographic and clinical characteristics of the patients or with other characteristics of the AHs themselves. There was evidence that AHs heard internally were associated with better insight than those heard externally. Of those patients whose AHs included commands, greater proportions of those who heard them externally said they could resist than those who heard them internally or in both locations. There appears to be no consistent differential impact and effect of internal and external AHs, and there was no support for the historical view that internal AHs are more benign. (C) 2003 Elsevier B.V. All rights reserved.