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Ask the Mental Health Expert Archives 2001-2004

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Voices in Her Head

Q. My daughter hears voices in her head but it's not like schizophrenia but more like thought projections. They mostly come to her while looking at pictures, as if the person in the photo is speaking telepathically, and these thoughts become conversations. Her IQ is above average and she said she knows they can't really see or talk to her, but she can't shake those feelings. She also feels like she is never alone, and when she is, she has silent conversations with someone she can't see. Have you ever heard of anything like this?

A.Yes, some of what you describe is commonly seen in certain personality disorders, such as schizotypal PD or borderline PD. For example, individuals with schizotypal PD often report peculiar out-of-body experiences; experiences of clairvoyance or telepathy; feeling an unseen presence in the room, etc.

In general--as seems to be the case with your daughter--the individual can recognize that these experiences are either not real or at least may not be real. That is, they may say, "I know nobody was really in the room with me, but I had such a powerful experience of it that I almost believe it's true."

I think the more important issue is: how does your daughter function in other spheres? Is she frightened of others? Does she always keep to herself? Is she impaired in her everyday social or vocational function? Is she troubled by powerful fears or obsessions?

If the answer is "yes" to one or more of these, then psychiatric consultation is in order. If the answer is "no" to all of the above, I'm not sure the experiences you describe, in and of themselves, really constitute a major problem. However, if your daughter is disturbed by these unusual experiences, that's reason enough to seek professional consultation.

In rare instances, feelings of unreality and hallucinatory-like experiences may be due to a type of epilepsy called "temporal lobe epilepsy"--so your daughter could benefit from a neurological evaluation as well.

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May 2003

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