Does This Mean I Am “Hearing Voices”?

Reader’s Question

I have my own internal voice plus another which is male, aggressive and rude. It can be like having running commentary, being verbally abused or having a conversation with another person, but all in my head. I suffer from it mainly when I feel under pressure or stressed. Does this mean I am ‘hearing voices’? Should I be on medication, even though I am able to lead a fairly normal life — job, marriage, friends, home etc.?

Psychologist’s Reply

The presence of a distinct internal voice that you do not recognize as being produced by your own thoughts would qualify as “hearing voices”. The type of voice you describe — verbally abusive, the running commentary, internal arguments, aggressiveness, etc. — is also consistent with “hearing voices”.

“Hearing voices” is a common description of auditory hallucinations. This type of hallucination appears to be linked to the availability of the neurotransmitter Dopamine in the brain. As the level of Dopamine increases in the brain, the “voices” become clearer, louder, more frequent, and more aggressive. In the first stages the voices sound like mumbling in another room. They then become clearer and gradually become abusive. Under stress, the “voices” do increase in terms of volume and frequency.

Dopamine is also linked to suspiciousness and paranoia, as well as other severe psychiatric symptoms. For this reason, as the “voices” increase you’ll gradually become suspicious if not paranoid. You’ll begin to feel your thoughts are being read by others or that they are being influenced by something external to you. Other types of hallucinations and sensations may develop as well. In short, these are symptoms that can be very intrusive in your life.

I would recommend a psychiatric consultation. In many cases, the use of a single medication can control these voices. I’d seek psychiatric consultation as soon as possible and for good reason. If your Dopamine levels reach the paranoia stage, you may be become suspicious about treatment and consultation and reject help, something that will eventually lead to more severe psychiatric symptoms. Dopamine is also associated with agitation, being irritable, and having an sense of being “hyper”. For this reason, this is unlikely to go away on it’s own and may actually be increasing and producing the level of stress you are currently experiencing.

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