Childhood adversities are associated with inner speech or internal monologue in adults with psychosis, according to an article published in Psychiatry Research. The study authors stressed the importance of involving people with lived experience of childhood trauma and psychosis in research projects on hearing voices and inner speech.

Cherise Rosen, PhD, of the department of psychiatry, University of Illinois at Chicago, and colleagues recruited patients at an urban academic medical center. The study included 78 participants (49% women; 75% black) between the ages of 21 and 60 who met criteria for schizophrenia (n=57) or bipolar disorder (n=21) with psychosis and had a lifetime history of auditory verbal hallucinations. The participants completed questionnaires assessing inner speech and adverse childhood experiences and rated symptoms related to auditory verbal hallucinations and delusions.

The investigators found a positive association between dialogic inner speech (ie, talking to oneself or asking oneself questions and then answering them) and childhood adversity (P ≤.01), particularly abuse and dysfunction. In addition, other people inner speech subscale scores were positively correlated with adverse childhood experiences (P ≤.01), including neglect and dysfunction. There was also a significant total effect of childhood adversity on both auditory hallucinations and delusions (effect size, 0.55; P =.009), and an indirect effect of childhood adversity on auditory hallucinations via dialogic inner speech.

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The investigators could not assess causation due to the cross-sectional nature of the study; other limitations included small sample size. They noted that a revised version of the Varieties of Inner Speech Questionnaire (VISQ) was completed after the design of this study, and incorporating the new VISQ could change the estimated effects of childhood adversity on auditory verbal hallucinations.

“These findings highlight the importance of approaches that help to protect against the impact of childhood adversity,” wrote the investigators. “Results of this research also suggest a need for developing interventions that integrate the link between childhood adversity, inner speech and voices,” they added.


Rosen C, McCarthy-Jones S, Chase KA, et al. The role of inner speech on the association between childhood adversity and ‘hearing voices’ [published online Feb 14, 2020]. Psychiatry Res. 2020;286:112866.