Developmental Trauma and Voice-Hearing
Research type
Research Study
Full title
Exploring the roles of attachment style and dissociation in the relationship between dissociation and voice-hearing experiences
IRAS ID
325801
Contact name
Bethany Angell
Contact email
Sponsor organisation
Royal Holloway University of London
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 0 months, 31 days
Research summary
Summary of Research
Research shows that people who experience traumatic events in childhood are more likely to hear voices in adulthood and experience distress related to the voices. Two factors which appear to be important in understanding the relationship between childhood trauma and voice hearing are dissociation and attachment style.
Traumatic events in childhood influence our attachment styles, referring to patterns in our relationships. Psychological models suggest that people with secure attachments develop adaptive ways of coping with traumatic experiences, meaning they are less likely to begin hearing voices or experience less distress related to their voices. Alternatively, people will insecure attachment styles are more likely to develop unhelpful ways of responding to voices, which maintain voice-hearing experiences and increases voice-related distress.
Dissociation is a strategy where a person disconnects mentally as a way of coping with distressing/traumatic experiences. This disconnect strategy is thought to lead to voice hearing by causing the person to incorrectly interpret external stimuli (e.g. sounds in our environment) as being caused internally.
This study will involve asking adult voice hearers to complete several questionnaires about their experiences of childhood trauma, dissociation, voice-hearing, and their current attachment style. Previous studies have not asked specifically about the characteristics of traumatic events. However, this is likely to be an important factor. For example, dissociation is more likely to happen at a younger age as this is the most accessible way of coping available to young children. This study will collect information about the age of the child when they experienced trauma and the type of trauma experienced with regards to the person’s relationship to the perpetrator.
This study will recruit voice hearers accessing mental health services regardless of their diagnoses, as previous research has tended to recruit participants with certain diagnoses even though people with various mental health problems hear voices.
Summary of Results
Background:
Research shows that experiencing stress in childhood, particularly through adverse
childhood experiences (ACEs) such as abuse, neglect, or losing a parent, can have
serious, long-lasting effects on a person’s life. These traumatic events are especially
harmful during childhood or adolescence, when the brain and body are still developing,
a period referred to as ‘developmental trauma’. Developmental trauma can impact on
many aspects of children’s development and wellbeing, including how they cope with
stress and their relationships.For example, when children cannot physically escape traumatic experiences, they may
mentally disconnect, a process known as dissociation. Dissociation can manifest in
various forms, such as derealization (disconnecting from the world), depersonalization
(disconnecting from one’s body), intense daydreaming (absorption), or memory gaps
(dissociative amnesia). This coping mechanism is closely linked to developmental
trauma, as it is often the most accessible form of coping for young individuals.
Dissociation has also been connected to the experience of hearing voices, or auditory
verbal hallucinations. This phenomenon, where a person hears voices even when no
one else is present, is often associated with psychosis but can also occur in other
mental health conditions and in the general population and are not necessarily
distressing. Some theories suggest that dissociation during trauma re-experiencing
may cause internal, trauma-related thoughts to be misattributed as external voices.
The severity and distress of these voices may be influenced by the type of dissociation,
although there is debate about whether dissociation increases or reduces voice-related
distress.Developmental trauma can also impact the development of attachment styles, which
are patterns in how individuals relate to others, formed early in life based on how we
are cared for. Both developmental trauma and attachment styles appear to be linked to
voice-hearing. Individuals who have experienced developmental trauma are more likely
to hear voices and find them distressing, and attachment style may also influence how
people relate to the voices they hear. For example, those with insecure attachment
styles, such as attachment anxiety (worrying about relationships) or attachment
avoidance (preferring self-reliance), may find their voices more distressing.
Understanding these connections between developmental trauma, dissociation, and
attachment styles is crucial for developing interventions to reduce the distress
associated with hearing voices.This study:
This study explored how dissociation and attachment influence the relationship
between childhood trauma and voice-hearing. The study involved 33 adults, primarily
females, who completed questionnaires in which they self-reported on their
experiences of trauma exposure, voice-hearing, dissociation and their current
attachment style. Previous research has mainly focused on participants with a
diagnosis of psychosis, however this paper recruited individuals regardless of any
mental health diagnosis. This is because trauma, dissociation and voice-hearing occur
for people experiencing a range of mental health difficulties and even happen as part of
everyday experiences for people without any mental health difficulties. This paper
focused on two aspects of the voice hearing experience; voice severity and voicerelated
distress, as these concepts are most relevant for clinicians helping people who
are distressed by their voices. Voice severity often looks at physical characteristics
such as the volume of the voice or how much it interferes with everyday life, whereas
voice-related distress reflects emotional characteristics such as emotional response or
if the voice is saying negative things.In our analyses of the data collected in this study, we explored how different aspects of
(a) dissociation and (b) attachment style influence the relationships between
developmental trauma and voice-hearing experiences separately, although we are
aware that dissociation and attachment style can also influence each other. This is
these relationships are complex and require larger samples to investigate together in
larger statistical models.Key Findings:
• Higher levels of childhood trauma (ages 0-12 years) were associated with
increased dissociation. However, this relationship was not found to be the same
for trauma experienced during adolescence (ages 13-18) or adulthood (18+).
• Exposure to more types of interpersonal developmental trauma was linked to
higher attachment avoidance and more severe voices.
• The dissociative subtypes of depersonalisation (disconnect from self) and
derealisation (disconnect from world) were the strongest predictor of how
severe the participants perceived their voice to be.
• The relationships between interpersonal developmental trauma, attachment
anxiety and voice-related distress were more complex and appeared to change
at very high levels of interpersonal trauma.
• In individuals with high levels of childhood trauma, dissociation appeared to
reduce the voice-related distress, suggesting that it could serve as a protective
mechanism.
• Some exploratory evidence suggests that anxious attachment style might
influence the relationship between interpersonal developmental trauma and
voice-related distress.Conclusions:
These results show how complex the relationships between childhood trauma,
attachment, dissociation and voice hearing can be. In this study, dissociation appeared
to buffer against the distress associated with voice hearing. However, this finding is the
first of its kind and, therefore, future research needs to replicate these results to
confirm this relationship. The findings of this study highlighted that it is difficult to
accurately measure people’s experiences of developmental trauma and attachment
style on questionnaires and this might have affected our results. However, the findings
point towards the need for thorough assessment of voice hearing experiences in
clinical intervention, playing close attention to attachment styles and whether the
person is using dissociation. It also highlights the requirement for targeted clinical
intervention that considers the complex interaction of all four concepts.REC name
West of Scotland REC 4
REC reference
23/WS/0089
Date of REC Opinion
21 Jul 2023
REC opinion
Further Information Favourable Opinion