Abstract

Hear voices without being schizophrenic : Diagnosis impact of the evolution of DSM-IV-R criteria at DSM-5, from two cases

Problematic

Schizophrenia criteria have evolved between DSM-IV-TR and DSM-5, in particular with the removal of the different subtypes of the pathology and the instruction “Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other”. These changes could have a specific impact for the diagnosis of people reporting acoustico-verbal hallucinations.

Materials

In this preliminary research, we illustrate this shift with the study of two women from the non-clinical population who claim to hear voices since several years and who even make it a resource for their mediumship activities.

Methods

In a clinical research approach seeking to reduce the stigmatization of “voice hearing” and to better understand its phenomenology in context, we used Maastricht semi-structured interview developed by Romme and Escher. The data collected during a series of interviews also allow to complete the DSM-5’s dimensional assessment of the severity of psychotic symptoms.

Results

For both subjects, the data indicate a diagnosis of paranoid schizophrenia according to DSM-IV-TR criteria A, whereas no diagnosis could be identified according to DSM-5 criteria. The difference in diagnosis between the last two versions of the DSM focuses on criterion A relating to hallucinations, and in particular acoustico-verbal hallucinations, which have long been considered as almost pathognomonic symptoms of schizophrenia. In the new nosography, the presence of another criterion A is required in order to make the same observation. The integration of these acoustic-verbal hallucinations into finer differential clinical practice could be the common result of a pressure of new mentalities on a classification particularly permeable to this type of influence, and of recent research in favour of a fully dimensional approach to psychotic experiences. These diagnosis hesitations are also discussed with reference to the French Classification of Mental Disorders R-2015, which points to the possibility of an organic disorder in front of the same clinical elements while giving less importance to positive symptoms.

Conclusion

These elements seem to indicate a real evolution in the diagnosis of schizophrenia according to the nosography used and suggest a change in the perception of this pathology by clinicians and users.

Keywords
DSM, Diagnosis, Schizophrenia, Acoustic-verbal Hallucinations, Voice hearers