Why Do I Hear Voices In My Head? How To Receive Mental Health Support

Experiencing voices in your head can be alarming and scary, and it might leave you wondering what is happening. If you hear voices in your head, whether they concern you or not, it may help to learn more about the potential causes of these voices and how to reach out for support. Understanding voices in your head and what they mean can bring clarity and help you explore any necessary treatment options, such as therapy or medical help. 

Why do I hear voices in my head?

People hear voices in their heads for different reasons, and they might each hear a different type of voice. Hearing voices can indicate several symptoms, mental health conditions, and causes. In some cases, hearing voices in your mind can be part of an inner thought monologue that occurs throughout your daily life. In other cases, speaking to a licensed psychologist to understand what might be occurring for you can be valuable. 

Hearing voices talking in your head when no one is speaking may also be due to auditory hallucinations. You're not alone if you experience these, as 5% to 28% of US adults have experienced auditory hallucinations. 

In an article comparing auditory hallucinations across different mental illnesses, Sommer, Koops, and Blom note, "If social or occupational functioning is undiminished, (auditory) hallucinations may not be part of any disorder or syndrome." In their study, they concluded that for different diagnoses, significant clues would be the absence or presence of visual hallucinations and other symptoms such as:

• Delusions
• Formal thought disorder (disorganized thinking)
• Parkinson's disease 
• Seizures
• Delirium (in older individuals) 

Causes of hearing voices 

There are a few causes of auditory hallucinations and voices, including the following: 

• Psychotic or mood disorders, including schizophrenia, bipolar disorder, and schizoaffective disorder 
• Neurological disorders, including Parkinson's disease or dementia 
• Sensory deprivation, including hearing loss 
• Substance use 
• High levels of stress, anxiety, and worry
• Traumatic life experiences
• Severe major depressive episodes with psychotic features

If you are struggling with substance use, contact the SAMHSA National Helpline at 1-800-662-HELP (4357) to receive support and resources. Support is available 24/7.

Some prescription medications may also cause musical ear syndrome, diagnosed when a person hears music in their head. There are variations in the way people experience auditory hallucinations. In a 2015 study, Angela Woods and colleagues identified the following features from a cohort of 153 participants:

• 81% heard multiple voices
• 69% heard multiple voices with characterful qualities
• 46% heard literal voices (e.g., it sounded like a person was talking next to them)
• 66% reported bodily sensations simultaneous to hearing the voices (these were often identified as having negative content, such as violent or abusive voices) 
• 31% reported positive emotions when hearing the voices, while 31% felt neutral

For many years, it was often assumed that every person had an internalized voice that chattered incessantly and negatively. However, this notion has been challenged by Russell Hurlburt (Ph.D.), Professor of Psychology at the University of Nevada, Las Vegas.

Does everyone have an inner voice?

In his research over the past forty years, Russell Hurlburt has focused on the nature and workings of conversations and thoughts people hear in their heads and the commonalities of one's inner experiences. Using a method that he calls Descriptive Experience Sampling (DES), subjects become more aware of their inner thoughts and processes by recording them in detail the moment after they occur. 

In DES, subjects are given a beeper to carry while engaging with their day-to-day life. The beeper is programmed to make a sound occasionally throughout the day. Every time the beeper sounds, the person records their internal process at that moment. Hurlburt explains to his clients, "We're going to try to tease apart your experience of your inner voice from your presuppositions about your inner voice. If there are words in your inner experience, I would like to know exactly what they are."

Hearing voices vs intrusive thoughts

In some cases, it may be difficult to distinguish the experience of hearing voices from having intrusive thoughts. 

Intrusive thoughts vs hearing a voice in your own head

There may be some ways to distinguish intrusive thoughts from auditory hallucinations. For example, intrusive thoughts almost always feel like they're coming from your own head or in your own voice. Conversely, auditory hallucinations could sound like a stranger’s voice, hearing background noises, or voices coming from an external source. 

Not everyone talks in their head

Through his research, Hurlbur found that subjects often report no words, voices, or images in their mind. About 25% of his cohort recorded inner-talking experiences, which varied from one person to another. Many reported not hearing words when the beeper went off or mentioned inner processes that involved images or sensory experiences. Of all the participants, only one woman reported internal chatter 95% of the time.

In his own words, Hurlburt notes, "My research says that there are a lot of people who don't ever naturally form images, and then there are other people who form very florid, high-fidelity, technicolor, moving images. Some people have inner lives dominated by speech, body sensations, or emotions and yet others by "unsymbolized thinking" that can take the form of questions like, 'Should I have the ham sandwich or the roast beef?'"

Hurlburt ascribes these variations to differences in personality and behavior. He mentions that those who engage in inner talk tend to be more confident, while persons who think in pictures have difficulty when attempting to empathize with others. Hurlburt and colleagues also found in a study with 24 women experiencing bulimia that these women experienced strikingly complex mental processes. 

Newer exploratory research and theories suggest that the inability to hear your thoughts or picture images and sensations in your mind may be referred to as aphantasia. Although there are limited studies on this concept and why it occurs, a significant community of individuals see "nothing" in their minds but live through instinct and working memory instead of visual, auditory, or tactile ideas. 

Are inner thoughts always negative?

Hurlburt found in his studies that inner talk may not always be negative. 

He states, "I have found on many occasions, maybe even most occasions, that people are mistaken about their own inner experience." He ascribes this to the notion that individuals tend to assess their inner voices as negative things after the fact. 

If you're interested in recording your inner voice as Hubert did in his study, you can follow the below steps: 

• To replicate Hurlburt's beeper prompts, set your phone to sound an alarm that sounds randomly each day. It can also be limited to going off at specific times if this suits your situation better.
• When the beeper sounds, take the time to record your thoughts and what you felt the moment you heard the sound. Ask yourself what you are feeling, seeing, or sensing at the moment, and be as specific as possible. Write this down or make a voice recording for later reflection.
• In his studies, Hurlburt interviewed the individuals at the end of each day to separate real experiences from assumptions about experiences. For instance, if the subject noted, "I thought that I didn't want to drink so much coffee," Hurlburt would ask, "What do you mean by 'think?' Did you see an image, feel a sensation, or hear a sound at that moment?" You can ask a friend or spouse to assist you with this step.

Cultural differences and the experience of hearing voices

In some non-Western cultures, even the experience of hearing voices outside of one’s own head could be interpreted as a positive experience. Due to cultural differences, auditory hallucinations can be perceived as normal or even welcome in some parts of the world, rather than a threat to a person’s mental well-being or self-worth. 

Why does my inner voice sometimes disappear?

Dolores Albarracin and colleagues conducted three studies examining the conditions that cause people to talk to themselves. In one article, these researchers found that people tended to talk to themselves as if they were another person when they needed to exercise explicit self-control or self-regulation, especially in adverse situations. 

Albarracin says this activity often occurs when a person is anxious or worried. For them, the inner voice becomes a "surrogate parent" who tells them how to act. The researchers coined the phrase "fragmented self-talk" to describe this phenomenon, referring to the internal split that appears to occur in situations requiring self-regulation.

Is self-talk positive? 

Studies suggest that you can positively affect your motivation by asking yourself questions. Albarracin and colleagues (2010) have shown that by asking yourself if you will complete a task (i.e., "Will I exercise for ten minutes tomorrow?") instead of telling yourself that you will do it ("I will exercise for ten minutes tomorrow"), you may be more likely to complete it. This way, you may build inner motivation that increases your chances of manifesting the desired outcome. However, this field is still being studied.  

Family intervention and supporting someone else

It can be difficult to solve problems when you’re feeling disconnected from reality. People who are hearing voices are may not always be aware of their condition or the risks to their mental health. In some cases, it may be necessary for families or other support people to create a plan to intervene. This could be crucial for certain populations such as adolescents, young people, and older adults. 

How to support someone with psychotic symptoms

When someone else is experiencing psychotic symptoms, there may be some things you can do to help. If you notice patterns of disturbing behavior or early signs of psychosis, you may want to: 

• Get them to a safe place.
• Use a calm and soothing voice to comfort them.
• Offer a gentle distraction while you decide how to move forward.
• If the person is aggressive or threatening harm to themselves, call 911 or seek emergency medical help.

When should you seek support for hearing voices?

You might find it beneficial to seek support if the voices in your own head are causing you significant distress or prompting you to isolate yourself from your friends and family. It may also be necessary to ask for help when the voices interfere with your ability to work or they’re accompanied by physical illness. If none of the above apply, but you still worry excessively about hearing people who are not there, consider consulting your medical practitioner or healthcare team for an assessment. Taking control of your mental health by making an initial appointment can be a healthy step forward. 

Note that anyone can reach out for therapeutic guidance from mental health professionals, regardless of diagnostic status or concern about mental illness. If you feel nervous about seeking help or face barriers to meeting with a therapist in your area, you can also try online therapy. A growing body of research shows that online therapy platforms can be a valuable component of a treatment plan for those experiencing auditory hallucinations. One study published in Rehabilitation Psychology examined the effects of online therapy on individuals experiencing schizophrenia. Researchers found that online therapy methods decreased symptoms of auditory hallucinations in those with schizophrenia, increasing the ability of those facing treatment barriers to receive adequate care. Schizophrenia and other psychotic disorders may also require antipsychotic medication, among other treatment options. In some cases, peer support groups are recommended. 

If you are experiencing voices in your head or auditory hallucinations that distress you, online therapy can help. Talking therapy through an internet platform like BetterHelp can ensure you don't have to visit a therapist's office. In addition, you may participate discreetly by selecting a "nickname" when you register.