What Does Hearing Voices Sound Like With Schizophrenia?

About 75 percent of people with schizophrenia report hearing voices at some point. These voices sound and feel very different from person to person.

Hearing voices is called an auditory hallucination. This means hearing something that isn’t actually there, even though it feels real to the person experiencing it.

This article explains what it’s like to live with this symptom, how the voices might sound, when or how often they show up, and how to manage them. If you or a loved one has schizophrenia, learning more about this symptom can make it less overwhelming. With the right treatment plan, many people manage their symptoms well and live a meaningful, fulfilling life.

Auditory Hallucinations in Schizophrenia

Hearing voices is the most common type of hallucination in schizophrenia. The terms “auditory hallucinations” and “hearing voices” are often applied interchangeably in this context. However, auditory hallucinations don’t always involve hearing voices. Some people hear sounds like music or mechanical noises that aren’t really there.

To the person hearing them, these hallucinations can be indistinguishable from reality. They can be deeply upsetting or frightening, especially during a first episode of psychosis.

Auditory hallucinations are a positive symptom of schizophrenia. In this case, “positive” means there’s an extra experience added to how the brain normally works. Other positive symptoms include delusions (firmly held false beliefs) and disorganized speech, thoughts, or behavior.

Auditory hallucinations aren’t limited to schizophrenia. People with other mental health conditions, such as bipolar disorder, schizoaffective disorder, and post-traumatic stress disorder (PTSD), can also have this symptom. Even in the general population, an estimated 5 percent to 28 percent of people report the experience of hearing voices.

What Do the Voices Sound Like?

Some people hear voices clearly, as if someone else is speaking in the same room. Others report that the voices sound far away, muffled, or distorted. The voices might speak in full sentences, single words or phrases, or whispers. Some people hear a single voice, while others hear several that might talk to them or each other. A voice may sound familiar or like it belongs to a stranger.

People describe the voices in many ways, such as:

• Loud or quiet
• Male, female, genderless, or childlike
• Internal or outside in the environment

The nature of the voices can change over time or come and go. Some people have reported hearing the voice of a close friend or family member who recently passed away.

Unlike some symptoms of schizophrenia, hearing voices can be treated with certain medicines, such as antipsychotic medications. Treatment may not always make the voices go away completely, but it can usually make them quieter and easier to handle.

How Hearing Voices Can Affect People With Schizophrenia

For some people with schizophrenia, hearing voices can be stressful, leaving them exhausted, confused, or scared. Others might find the voices annoying but otherwise unobtrusive. In rare cases, these voices might even provide a sense of comfort, amusement, or companionship.

Command Hallucinations

Command hallucinations are voices that tell a person to do something. Some commands can be harmless, like “turn on the light.” Other commands can be dangerous, telling someone to harm themselves or others, stop taking their antipsychotics, or isolate themselves from loved ones.

Hearing demands from voices is quite common in schizophrenia. In one study, more than 80 percent of people with schizophrenia who heard voices said that the voices gave them instructions. While not everyone obeys, these voices can feel threatening and persuasive — especially if the person believes the voice comes from a higher power or someone they know.

This type of hallucination is considered a serious concern. If you or someone you care about is hearing voices that tell them to do something harmful, it’s important to get help from a psychiatrist (a doctor who specializes in mental health conditions) right away.

Noncommand Hallucinations

Noncommand hallucinations are voices that don’t give instructions. These voices may:

• Criticize what you’re doing
• Comment on your appearance or thoughts
• Mock or insult you
• Talk to each other, not you
• Repeat certain words or phrases

Even if they don’t give commands, the voices can be very distressing. Many people feel worn down by the constant noise, especially if the voices are hostile, threatening, or sarcastic. Some people may avoid daily tasks, social situations, or even speaking out loud just to avoid triggering the voices.

Why Do People Hear Voices in Schizophrenia?

Scientists aren’t sure why some people with schizophrenia hear voices. One theory is that the brain’s speech and hearing systems become confused. Studies show that when people with schizophrenia hear voices, the same parts of the brain light up as when they hear real people talking. This could mean the brain is misinterpreting the person’s own thoughts as if they’re coming from someone else.

The body’s defensive system may also play a role. In recent studies, people who heard harsh or critical voices had stronger physical reactions to stress. Their heart rates increased, their pupils widened, and their brains reacted more strongly to unpleasant images. This suggests that some voices may trigger the fight-or-flight response, even when there’s no real danger.

Although the underlying mechanisms aren’t yet clear, most psychiatry researchers agree that hearing voices likely involves a mix of genetics, brain changes, and life experiences.

When Do Auditory Hallucinations Happen?

Auditory hallucinations don’t always follow a set pattern, but certain situations could make them more likely. For example, voices often appear during periods of heightened anxiety or stress. They may also get worse when you lack sleep or feel isolated or overwhelmed.

Hallucinations can occur daily, occasionally, or during short-term episodes of psychosis. Voices might come and go throughout the day or happen more predictably, such as in the evening, when you’re alone, or when you’re trying to concentrate.

Managing Auditory Hallucinations in Schizophrenia

Hearing voices can feel overwhelming, but effective treatments are available. Antipsychotic medications help balance brain chemicals and can reduce how often voices appear or how intense they are. While these common treatments can help, they may also cause side effects, so it’s important to work with your healthcare team to find the best fit for you.

Talk therapy, especially cognitive behavioral therapy (CBT), is another helpful option. CBT teaches you how to cope with voices, respond to them differently, and feel more in control. The voices won’t disappear overnight, but CBT can help you manage them more confidently.

A newer treatment, transcranial magnetic stimulation (TMS), may also provide some benefit. This noninvasive procedure involves magnetic pulses to change activity in certain parts of the brain. The U.S. Food and Drug Administration (FDA) has approved TMS for major depressive disorder and obsessive-compulsive disorder but not yet for schizophrenia. Researchers are still studying its potential benefits.

Support groups, group therapy, and family education can also make a big difference by reducing feelings of isolation and building understanding. If you or a loved one is living with schizophrenia and hearing voices, you’re not alone. By working with a mental healthcare professional, you can explore treatment options and take the next step toward relief, recovery, and improved well-being.

Talk With Others Who Understand

MySchizophreniaTeam is the site for those with schizophrenia and their loved ones. On MySchizophreniaTeam, people come together to ask questions, give advice, and share their stories with others who understand life with schizophrenia and other mental health conditions.

Do you have auditory hallucinations that include hearing voices? What treatments or strategies have helped you the most? Share your thoughts or start a conversation in the comments below.