# Characteristics of people with bipolar disorder I with and without auditory verbal hallucinations

## TL;DR

People with bipolar disorder I who experience auditory hallucinations have more severe symptoms and face greater socioeconomic challenges.

## Contribution

This study is one of the first to explore the impact of auditory verbal hallucinations in bipolar disorder I.

## Key findings

- Individuals with AVHs had higher manic and positive symptom scores.
- Those with AVHs reported lower socioeconomic status and higher unemployment rates.
- The presence of AVHs may indicate more severe illness and long-term hardship.

## Abstract

Approximately half of people with bipolar disorder type I (BD-I) report the presence of psychotic symptoms at least at some point during their illness. Previous data suggest that more than 20% of people with BD-I report the presence of auditory verbal hallucinations (AVHs), or “voice-hearing” in particular. While work in other disorders with psychotic features (e.g., schizophrenia) indicates that the presence vs. absence of AVHs is associated with poorer clinical outcomes, little is known about their effects on clinical and socioeconomic features in BD-I.

We investigated whether people with BD-I (N = 119) with AVHs (n = 36) and without AVHs (n = 83) in their lifetime differ in terms of demographic features and clinical measures. Relations with AVHs and other positive symptoms were explored.

People with BD-I and AVHs vs. without AVHs had higher manic and positive symptom scores (i.e., higher scores on the hallucinations, delusions, and bizarre behavior subscales). Further, a greater proportion of those with vs. without AVHs reported lower subjective socioeconomic status and tended to have higher rates of unemployment, thus, speaking to the longer-term consequences of AVH presence.

Our findings suggest that people with BD-I with AVHs exhibit more severe psychotic features and manic symptoms compared to those without. This might be associated with more socioeconomic hardship. More in-depth characterization of people with BD-I with/without AVHs is needed to fully understand this subgroup’s unique challenges and needs.

The modest sample size of the AVH group and a study population with low racial diversity/representation may limit generalizability.

The online version contains supplementary material available at 10.1186/s40345-025-00369-8.