ArticleBJPsych open2019
The comments of voices on the appearance of patients with psychosis: 'the voices tell me that I am ugly'.
Article in BJPsych open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- The experience of body image in people with psychosis and psychotic-like experiences: A co-produced mixed-methods systematic review and narrative synthesis.Psychology and psychotherapy · 2026Pooled it
- Hunger pain and its reduction; qualitative insight from people with schizophrenia on semaglutide.International journal of qualitative studies on health and well-being · 2026Article
- Core beliefs in psychosis: a systematic review and meta-analysis.Schizophrenia (Heidelberg, Germany) · 2025Review
- Exploring challenges to medication adherence aacmong young and middle-aged adults with coronary heart disease in China: a qualitative study.Frontiers in cardiovascular medicine · 2025Article
- Understanding the relationship between oral health and psychosis: qualitative analysis.BJPsych open · 2023Article
- The psychological journey of weight gain in psychosis.Psychology and psychotherapy · 2022Article
Corrections and comments
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Authors and funding
15 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThere are high rates of obesity and low self-esteem in patients with psychosis. The occurrence of negative voice content directly about appearance is therefore plausible. Derogatory comments about appearance are likely to be distressing, increase depression and contribute to social withdrawal.
aimsTo systematically assess the occurrence of voice content regarding appearance and identify correlates.
methodSixty patients experiencing verbal auditory hallucinations at least once a week in the context of non-affective psychosis completed a measure assessing positive and negative voice content about appearance. They also completed assessments about body image, self-esteem, psychiatric symptoms and well-being.
resultsFifty-five (91.7%) participants reported hearing voices comment on their appearance. A total of 54 (90%) patients reported negative voice content about their appearance with 30 (50%) patients experienced negative appearance comments on a daily basis. The most common negative comment was 'the voices tell me that I am ugly' (n = 48, 80%). There were 39 (65%) patients who reported positive voice content on appearance. The most frequent positive comment was 'I look as nice as other people' (n = 26, 43.3%). Negative voice content about appearance was associated with body image concerns, paranoia, voice hearing severity, depression, worry, negative self-beliefs and safety-seeking behaviours. Positive appearance voice content was associated with greater body esteem and well-being and lower levels of depression and insomnia.
conclusionsVoice content about appearance is very common for patients seen in clinical services. Negative voice content may reflect - and subsequently reinforce - negative beliefs about one's appearance, low self-esteem, worry and paranoia. DECLARATION OF INTEREST: None.
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