Although hallucinations are not one of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria for posttraumatic stress disorder (PTSD), they are increasingly documented in PTSD. They are noted in the absence of clear delusions, formal thought disorganization, disorganized speech, or behavior, ruling out a comorbid psychotic disorder like schizophrenia as a better explanation for these hallucinations. Hallucinations in both PTSD and schizophrenia share phenomenological features. We propose that hallucinations in PTSD, like those in schizophrenia, might be explained in terms of aberrant predictive coding, specifically the misapplication of strong prior beliefs that vitiate perceptual inference. This approach highlights the broader relationship between trauma and psychosis. Under predictive coding, the nervous system organizes past sensory data into an internal model of the world. Under stress, the brain prioritizes speed over accurate encoding. However, memories for traumatic experiences are typically strongly consolidated, to avoid similar experiences in future. In PTSD, this could lead to a world model comprised of inaccurate but overly precise prior beliefs, that can be triggered by stimuli tangentially related to the index trauma, resulting in hallucinations. Crucially, this evidence accumulation depends upon the relative precision of prior beliefs and sensory evidence (supplied in the form of prediction errors). Our basic argument is that stressful situations induce belief updating, in terms of precise prior beliefs, that are difficult to undo. These unduly precise, trauma-related beliefs then constitute perceptual hypotheses, memories, or narratives that bias subsequent experience. This prior bias may be so severe that sensory evidence is effectively ignored; that is, treated as very imprecise, in relation to prior beliefs. Such an account may lead to cognitive therapies for hallucinations aimed at strong prior beliefs, and the exciting prospect of combining such therapies with drugs that modulate neuroplasticity and enhance the adaptive consolidation of more appropriate priors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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创伤后应激障碍中的幻觉：来自预测编码的见解。

尽管幻觉不是《精神疾病诊断与统计手册》第五版 (DSM-5) 创伤后应激障碍 (PTSD) 标准之一，但越来越多的幻觉被记录在 PTSD 中。它们在没有明显的妄想、正式思维混乱、言语或行为混乱的情况下被注意到，排除了精神分裂症等共病精神障碍作为对这些幻觉的更好解释。创伤后应激障碍和精神分裂症的幻觉具有共同的现象学特征。我们认为，创伤后应激障碍（PTSD）中的幻觉，就像精神分裂症中的幻觉一样，可以用异常的预测编码来解释，特别是对削弱知觉推理的强烈先验信念的误用。这种方法强调了创伤和精神病之间更广泛的关系。在预测编码下，神经系统将过去的感觉数据组织成世界的内部模型。在压力下，大脑会优先考虑速度而不是准确的编码。然而，创伤经历的记忆通常会被强烈巩固，以避免将来发生类似的经历。在创伤后应激障碍中，这可能会导致一个由不准确但过于精确的先前信念组成的世界模型，该模型可能由与指标创伤无关的刺激触发，从而导致幻觉。至关重要的是，这种证据积累取决于先前信念和感官证据（以预测误差的形式提供）的相对精度。我们的基本论点是，压力情况会导致信念更新，就精确的先前信念而言，这是很难撤销的。这些过于精确的、与创伤相关的信念构成了感知假设、记忆或叙述，这些假设、记忆或叙述会影响随后的经历。这种先前的偏见可能非常严重，以至于感官证据实际上被忽视了。也就是说，相对于先前的信念，被视为非常不精确。这样的解释可能会导致针对强烈先验信念的幻觉的认知疗法，以及将这种疗法与调节神经可塑性和增强更适当先验的适应性巩固的药物相结合的令人兴奋的前景。（PsycInfo 数据库记录 (c) 2020 APA，保留所有权利）。