Hallucinations and Combat Veterans with PTSD

Among combat veterans with PTSD, 30-40% report auditory hallucinations(AH). AH are more frequent in combat veterans with chronic PTSD and it has been suggested that this may reflect a distinct subtype of PTSD that may be under recognized for two reasons: first, patients are reluctant to report AH and, second, more emphasis has, traditionally, been placed on the intrusive images associated with PTSD and less on intrusive auditory hallucinations.

It is important to recognize that such patients do not have the overt changes in affect or bizarre delusions characteristic of other psychoses e.g. schizophrenia.  AH in PTSD appears to be seen more in veterans with higher combat exposure and more intense PTSD symptoms and who report more severe symptoms of hyperarousal. The AH are typically: ego-dystonic; contribute to an increases sense of isolation and shame; associated with feelings of lack of controllability; consist of combat-related themes and guilt; non bizarre; not associated with thought disorders and, overall, more refractory to treatment interventions.  more