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3 December, 2011

Survivors of childhood sexual abuse may have hallucinations in every modality of the special senses, and even go beyond those to what I consider to be “sixth sense” hallucinations.  The latter are fascinating in their clinical and sensory implications.  That survivors can have multi-modality hallucinations is in itself a wild fact.  Truly psychotic people actually rarely have such a wide range of perceptual disturbances and yet, if detected by clinicians, the perceptual disturbances of survivors, ironically, often lead to being misdiagnosed as being psychotic.  There’s so much to be said about these hallucinations that it will take more than one post to do them justice.  We’ll approach them modality by modality, perhaps covering more than one per post but not all in one.  The incidence of hallucinations (indeed all of the symptoms experienced by survivors) increases under conditions of nighttime, the survivor being alone and there a ‘day residue’ of stress (i.e. having had a bad day).  Not all survivors have all of the types of hallucinations, but some types are so common that virtually all survivors will have auditory hallucinations.



These hallucinations involve sounds one might hear if there was a cat burglar in the home: Sounds of footsteps, scraping against a wall, odd bumps and even sounds of breathing.  Such hallucinations have prompted more than one survivor to call 911, only to be embarrassed that nothing is found by the law enforcement personnel that respond.  It is the rare survivor who has not experienced this particular hallucination.  Simply having this one symptom, regardless whatever else may be known about a person, raises the probability of a history of childhood sexual abuse to a very high level.


This hallucination occurs in what is called a hypnagogic state, the transition phase of slipping from wakefulness into sleep.  Just as the survivor slides toward sleep, she will be startled back into full consciousness by a loud, booming sound.  Those sounds are usually described as an explosion or something like a huge dungeon door slamming shut.  There is no clinical confirmation, but I suspect that being shocked into wakefulness is a defense against sleep and thus against nightmares.  See the page about nightmares and you will understand why a survivor might develop defenses against sleep itself.  The survivor, more dramatically than non-survivors, has monsters in her basement.  There’s a guard who sits in the kitchen by the door to the basement but those monsters want out.  If the guard nods off, the monsters will get into the kitchen.


Survivors who are mothers, primarily, have this hallucination.  They will hear their child crying, or crying out in distress even though the child may be, for instance, away at school.  The experience is so compelling that survivors will range from uneasy to frantic until they check on the child if he/she is in the next room, or even call a school to if the child is away.  If one considers the aspect of the survivors’ PTSD hallucinations as intrusive memories, it’s not hard to understand why this particular hallucination is so common. The reader might recall that themes of children being in danger occur as well in nightmares.


Another common experience, perhaps unusual in that it can occur in the presence of many people, is the survivor hearing someone call out to her by her name, nickname or other common greeting when no one has done so.  Sometimes this hallucination is pesky, occurring many times over.


When the abuse experienced has been particularly severe or prolonged, or symptoms exacerbated by drug use, “hearing voices” is common.  Often these hallucinations are what are referred to as hallucinations of concept. That is, they don’t involve the experience of sensory organs (in this case the ears) being involved.  These “voices” are heard in the middle of the head, much as one experiences listening to a monaural sound with head phones on.  Sometimes such voices are persecutory.  They may vilify the survivor, suggesting she is garbage and even make comments to the effect that she is so useless she should kill herself.  They may even elevate to what are called command hallucinations, telling the survivor directly that she should indeed kill herself.

This kind of hallucination in particular is what often gets survivors misdiagnosed as being psychotic – even schizophrenic.  One difference is that the hallucinations are usually, if not always, hallucinations of concept rather than hallucinations of percept in which the voices have a location and distance in space apart from the survivor’s body.  In a sense, the farther a phenomenon like this is from the mind, the more serious it Is – the more disowned and attributed to outside sources it is.  The further outside of the psyche auditory hallucinations occur in survivors, the more elementary (unelaborated) they tend to be.  Thus, survivors may indeed hear voices coming from “outside” but those are often sounds of indistinct mumbling, rather like a radio playing in another room such that what’s being said can’t really be made out clearly.  These particular hallucinations can border on, and perhaps represent, a sort of low level of multiple personality disorder.  They can involve multiple voices carrying on conversations about the survivor, and may even come to be experienced as having distinct identities.  Interestingly, there may be one or more voices that are defenders of the survivor, standing up for her in the context of all the negative discussion being carried on by the other voices.  As noted previously, survivors can have hallucinations in every sensory modality.  Next in this series about hallucinations, we’ll explore visual hallucinations.

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