We think that this is the first study in India comparing phenomenological variables of AVHs head-to-head and finding out domains that differentiate them among each other. Moreover, in India, this kind of study is hard to find. However, few studies exist in literature comparing these phenomenological variables between major psychiatric groups. Hence, it would be clear from the above studies that AVHs differ between different psychiatric disorders in various domains such as clarity, loudness, intensity, tone, distress, frequency, and self-control.
To summarize, phenomenological variables recognized for AVH are aplenty however, classifying hallucinations according to these variables was inconsistent and mostly based on clinical case observations. Clarity was the most reliable, whereas reality-testing (insight) was the least reliable characteristic. Characteristics of AVH such as loudness, clarity, location, and reality were parameters used to assess the reliability of patients' reports. They concluded that AVHs are more commonly experienced inside the head and that the accompanying distress and coping mechanism get better with time. Nayani and David examined some more variables of AVH, namely, personification (familiarity, accent, and gender), coping mechanism and degree of control, number of voices, linguistic complexity, and insight and reality testing. It was then discovered that the aforementioned variables could be applied as discriminatory indicators among the differential diagnoses of psychotic illnesses. Numerous variables were studied including frequency, location in inner or outer space, similarity to externally perceived speech, loudness, constancy, effect on behavior, causal attribution, affective reaction, and content. With time, emerging studies have further detailed out the various characteristics of AVH. Since AVHs comprise male, female, or gender-ambiguous voices being heard either inside or outside the head, these studies proved the subtypes of such hallucinations having multiple neural correlates, instead of a singular. For example, there are studies proving that neural correlates perceiving the AVH were different for different locations of perception (e.g., inside the head or outside the head) and also different for different genders of the sound heard. Moreover, it was observed that even the neuropathology of AVH found its basis in the phenomenological characteristics of the same, in support of which there is ample literature as evidence. This diversity has been the backbone of various classifications of AVH.
This was mandated due to AVH differing along multiple phenomenological variables among psychotics, for example, insight of AVH, systematized or repetitive content, and quality of the “voices,” being few of the many. Attempts have been made to find out the characteristics of AVH that differentiate between major psychiatric disorders. Later on, studies have shown that auditory verbal hallucinations (AVHs) are not unitary phenomenon and varied in between major psychiatric disorders in many different domains. Furthermore, a hallucination should have a sufficient sense of reality, such that it resembles an actual perception, and the perceiver feels he/she has no voluntary control over its occurrence. In addition, a hallucination occurs during the awake state, thereby setting it apart from lucid dreams, for instance.
The most contemporary and apt definition has been given by David, stating: a hallucination is as “a sensory experience, occurring in the absence of a corresponding stimulation of the relevant sensory organ”. Later on, various definitions of hallucinations were put forward. However, this simple definition was not enough to describe this complex phenomenon. The word “hallucination” owes its origin to the Latin word, “hallucinare,” translating to “wander through the mind.” French psychiatrist Esquirol derived the term hallucination to describe the phenomenon of perception without stimulus.
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