Sam: I have these kinds of voices as part of anorexia, a disorder underpinned by anxiety. It is hell. These voices are not uncommon in anxiety disorders and depression, they are just not often talked about by sufferers, probably due to the connotation that it is related to psychosis and therefore makes you a “bad” person (when of course it doesn’t, even if it were psychosis).
There are fundamental differences between these sorts of voices and auditory hallucinations. For starters, people with anxiety will experience the voices inside their brain, whereas people with psychosis will experience the voices as being outside their head even if they know they aren’t real. With anxiety, the voices are not audible; with auditory hallucinations you really can hear them just as you can hear someone talking to you. The type of voices that people with anxiety and similar conditions experience is often misdiagnosed as psychosis; it takes a trained eye to ask the right questions and see the difference.
It is great that your son opened up to you about this, as he can now learn how to cope with and fight the voices. And if it does turn out to be bipolar-related hallucinations, then you have caught it early and are experienced and well-equipped having helped your eldest.
Mama Bear: Did you ever feel scared by these voices?
Sam: I am scared by what the voices can compell me to do because such actions hurt my loved ones and could kill me. More than anything though, I find them distressing, much like how it would be distressing to have someone hurling abuse at you 24/7, threatening and taunting you, screaming at you to do this, do that, don’t do this or that.
I can understand why they would be particularly scary to a child, especially if it has come on relatively suddenly.
A caveat: sometimes the voices aren’t scary at all, sometimes they try to convince me that they are my best friends, acting in my best interest, that I will feel a whole lot better if I do what they say. And I DO feel better if I do what they say, but this feeling is only temporary. When I was younger the voices were not at all scary or distressing because I just did what I was told and had no insight as to the nature of what was gonig on.
Mama Bear: Do they feel like your own thoughts or do they sound to you to be different people in your head?
Sam: They don’t feel like my own thoughts, or really like thoughts at all to be honest. It feels foreign/alien. I consider it to be my illness(es) talking.
Mama Bear: Are they brought on when you feel a surge of anxiety, but quiet when you are feeling good?
Sam: Oh, most definitely! It should be noted, though, that they further aggravate any anxiety/distress that I have to begin with, so it can be a vicious cycle.
This is actually one of the reasons why I know equivocably that the voices are not ME. They are significantly muted when I am well.
Mama Bear: What can you do to live with them?
Sam: I have found a number of things helpful:
- Dialectical Behavioural Therapy (DBT). This is used most often in people with Borderline Personality Disorder and/or who self-harm, but it teaches a number of skills which are excellent for improving distress tolerance. I think it would be too complex for a child, and I don’t know of anyone adapting it for children, but a therapist or psychologist with training in DBT could certainly teach some age-appropriate principles and skills. You might find this website useful: http://www.dbtselfhelp.com/ particularly DBT Lessons -> Distress Tolerance.
- Cognitive Behavioural Therapy (CBT). This is an evidence-based therapy for anxiety disorders. It has been adapted for children but you would need to find someone with specific training. CBT has helped strengthen my own “healthy voice”.
- Distraction techniques. When it is particularly “noisy” in my head listening to music or having a television playing in the background helps give me something else on which to focus. I find this is particularly important at night time, when the voices tend to be at their worst (probably because there are less distractions at night time!). Sometimes music/tv isn’t enough and I have to distraction further by doing something else with my hands/brain such as playing a game on my iphone. If I am really anxious and do not have something to do with my hands, I have a tendency to sub-consciously start hurting myself and will not realise until someone points it out to me. Talking to someone also helps distract me from the voices. Sometimes I may not be able to engage in conversation, but hearing someone talk still helps. I find it most helpful when the person talking is calm and talkes about something else. Of course, there is a time and place to talk about these things but that time is generally not when I'm in a state of severe distress!
- Many people benefit from guided meditation or other forms of meditation. I personally find these things aggravating as it ends up just being me and the voices duking it out in my head. I do find pilates helpful though, because while it is relaxing there’s still enough for me to concentrate on.
- High intensity cardiovascular exercise. You know how anxiety creates a surge of adrenaline and cortisol? It is basically the body prepping you to fight a battle which doesn’t necessary exist, like a bear chasing you or whatever. Exercise is a good way to release these stress hormones, but it must be suitably intense. This is more for the anxiety than the voices but since they play into each other, it is worth noting.
(NB, in the unlikely event that a parent with an AN child is reading this, please note that I am not allowed to exercise unless I am at a healthy-enough weight to do so and am eating enough to account for the energy expenditure. DO NOT permit exercise otherwise!).
- Doing the Opposite. I do the exact opposite of what the voices tell me to do. Doing the Opposite makes one’s anxiety shoot through the roof in the short term but it helps over time. It takes a lot of practice.
Mama Bear: Did you ever feel like something bad would happen if you didn’t follow through with the voices’ commands?
Sam: Oh yes. I would become fat, I would be greedy, a sloth, disgusting, repulsive, lazy. I would be a failure, amount to nothing, and let everyone including myself down. To avoid these outcomes I had/have to do whatever the voices say.
This probably sounds very similar to OCD, but when I’ve had OCD episodes they are very much intrusive thoughts, not intrusive voices.
Mama Bear: Do you remember how old you were when it started?
Sam: I don’t know when it started. I became more aware of them when they became particularly vicious during treatment for anorexia. However, I am certain that they were there while the anorexia was developing, but that they were silenced by doing what I was told, so I was not bothered by them.
It is possible that they were there earlier. Looking back, I had sub-clinical depression and anxiety when I was a mere four year old, along with what I would call proto-anorexic thoughts and behaviours (scary!).
Mama Bear: Thanks so much for giving this insight, it’s really helpful for understanding my little one!
Sam: It is a pleasure. I do not often respond to blog posts but I thought in this instance I might have something to offer.
I do not believe that parents can prevent their children developing mental illnesses, particularly those which strong biological links (bipolar disorder, anorexia nervosa, some forms of anxiety and depression). You should NEVER blame yourselves! There are, however, so many things you can do to help your child cope and whip their illness into submission. Your sons are so blessed to have you guiding and advocating for them.
Ooh, I just realised that I left off a vital component of my “what helps me cope with the voices” list: my superhero dog, Malcolm! When I am particularly distressed he will insist upon climbing onto my chest and he will refuse to move until I have calmed down. There is something about the weight of his body laying on me which is particularly beneficial. I have since learnt that this is one of the skills they teach to psychiatric and autism service dogs. He has no such training!
Mama Bear: Thank you once again Sam for sharing with us and give Malcom a hug for us! I remembered your advice the other night about your dog’s body weight calming you down, so when my youngest couldn’t calm down at bedtime I climbed on top of him (we don’t have a dog so I had to make do) and gave him a heavy hug, letting my body weight rest on him. It worked! He calmed down and went to sleep. I will admit though, a dog would be much more fun under these circumstances!