Running Commentary Voices
Running commentary voices are auditory hallucinations that narrate a person's actions as they happen, often speaking about the person in the third person, as a sports commentator might describe a player. The commentary typically tracks ordinary, moment-to-moment activity rather than making a single dramatic statement.
This pattern has traditionally been given particular weight in psychiatric assessment as one of a small set of first-rank features that clinicians are taught to ask about specifically, though, like any single symptom, it is not sufficient on its own to establish a diagnosis.
Also known as
- Third-person voices
- A closely related pattern in which one or more voices discuss the person using 'he' or 'she' rather than addressing them directly.
Recognition features
- The voice or voices describe the person's actions as they are performed, in real time
- Content is usually mundane and observational ('he's picking up the cup now') rather than abstract or philosophical
- Often experienced as coming from two or more distinct voices, sometimes discussing the person between themselves
- Distinct from a voice that speaks directly to the person using 'you'
Eliciting it at interview
- Ask specifically, since patients rarely volunteer this level of detail unprompted: "Do the voices ever describe what you're doing, almost like a commentary, as you're doing it?"
- Clarify whether the voice speaks to the patient or about them, since the grammatical person is the key discriminating detail
- Ask whether more than one voice is present and whether they seem to talk to each other about the patient
Distinguishing features
- Differs from an imperative hallucination, which issues commands rather than narrating ongoing action
- Differs from thought echo, which repeats the person's thoughts rather than describing their physical actions
- Differs from paranoid ideation about being watched, which is a belief rather than a perceptual experience, though the two often occur together
Common misconceptions
- That this symptom alone confirms a diagnosis of schizophrenia; it substantially raises the likelihood of a psychotic process but must be weighed alongside the full clinical picture
- That the commentary is always hostile; while frequently distressing, some patients describe the tone as neutral or even, occasionally, kind
Related phenomena
Auditory Hallucination · Thought Echo
Practice this
A man reports hearing two voices, speaking to each other about him in the third person, describing his actions as he performs them in real time: 'he's picking up the cup now... he's putting it down again.' What is this? · A woman describes a single voice that speaks directly to her, saying 'you are worthless, you should stop trying', appearing at moments unrelated to what she happens to be doing at the time. Before revealing the answer: is this running commentary voices? · A patient describes hearing a voice that seems tightly linked to what they are doing or thinking. Before revealing the answer, decide what single question distinguishes running commentary voices from thought echo. · You are assessing a patient for auditory hallucinations and want to establish whether running commentary voices are present. Before revealing the answer, decide what you would ask. · Explain why the specific, real-time link between the voice's content and the patient's ongoing behaviour is what defines running commentary voices, rather than simply the voice's third-person phrasing.
Illustration
A 26-year-old man describes two voices that talk about him as he moves through his day: "They said 'he's opening the fridge again' this morning, and then one of them said to the other 'watch him, he's going to check his phone next.' It's like being narrated the whole time." He finds it exhausting more than frightening, and it has been going on for about three weeks.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 3, 'Disorders of Perception'.