The perception of self-produced sensory stimuli in patients with auditory hallucinations and passivity experiences: evidence for a breakdown in self-monitoring

Background. To test the hypothesis that certain psychotic symptomatology is due to a defect in self-monitoring, we investigated the ability of groups of psychiatric patients to differentiate perceptually between self-produced and externally produced tactile stimuli. Methods. Responses to tactile stimulation were assessed in three groups of subjects: schizophrenic patients; patients with bipolar affective disorder or depression; and normal control subjects. Within the psychiatric groups s ubjects were divided on the basis of the presence or absence of auditory ha llucinations and/or passivity experiences. The subjects were asked to rate the perception of a tactile sensation on the palm of their left hand. The t actile stimulation was either self-produced by movement of the subject's ri ght hand or externally produced by the experimenter. Results. Normal control subjects and those psychiatric patients with neithe r auditory hallucinations nor passivity phenomena experienced self-produced stimuli as less intense, tickly and pleasant than identical, externally pr oduced tactile stimuli. In contrast, psychiatric patients with these sympto ms did not show a decrease in their perceptual ratings for tactile stimuli produced by themselves as compared with those produced by the experimenter. This failure to show a difference in perception between self-produced and externally produced stimuli appears to relate to the presence of auditory h allucinations and/or passivity experiences rather than to the diagnosis of schizophrenia. Conclusions. We propose that auditory hallucinations and passivity experien ces are associated with an abnormality in the self-monitoring mechanism tha t normally allows us to distinguish self-produced from externally produced sensations.