Problems that Usually Need Psychotherapy or Psychiatry Treatment

Hallucinations | Delusions | Psychosis

Hallucinations and delusions are the two types of psychotic symptoms, and they are experienced in psychotic disorders and in other situations as well.  The purpose of this entry is to explain what these symptoms are and what can cause them to occur.

Hallucinations are disorders of perception, while delusions are disorders of thought.  Hallucinations are perceptions of things that are not really there, usually auditory or visual.  They are organized perceptions, not just sensations.  Thus, a ringing sound in the ears or seeing stars when dizzy are not hallucinations.  Auditory hallucinations generally involve hearing voices that are speaking words and sentences, and visual hallucinations generally involve complete images of people or things.

Delusions, on the other hand, are disorders of thought. They involve beliefs that are clearly contrary to reality and that are not shared by others in one’s group or community. Believing that David Letterman’s monologue is really a coded message to you personally would be an example of a delusion. The person experiencing this delusion would be hearing the same words spoken by Letterman as everyone else, but would have disordered thoughts about what these words mean. Some people may regard the religious beliefs of others as delusional, but since these beliefs are shared they are not true delusions.

Hallucinations and delusions can occur separately or together, and may have a variety of causes.  Hallucinations can be caused by use of recreational drugs, particularly hallucinogens, certain medications, extreme sleep deprivation or exhaustion, severe prolonged stress, neurological disorders, and major mental illness, including but not limited to schizophrenia. Delusions can also have several of these causes. People who experience psychotic symptoms are usually afraid that they have schizophrenia, but this is not always the case.

Sometimes people experience what seem to be vivid hallucinations when lying in bed trying to fall asleep.  These are actually hypnagogic states, where the person is actually partially awake and partially asleep.  This is actually a mild sleep disorder rather than true psychosis. It is not dangerous unless the person also sleepwalks.

True psychotic hallucinations are usually visual or auditory. Tactile hallucinations, such as feeling that things are crawling on you, are often caused by drug use or withdrawal. Olfactory hallucinations, involving smell or taste, can be caused by neurological problems. See a neurologist for conditions such as these.

If you experience hallucinations or delusions while wide awake and rested, and have not taken drugs, alcohol, or any psychotropic medications, then this may indicate a psychiatric illness, and consulting with a psychiatrist is then strongly recommended. The psychiatric conditions that can cause this include schizophrenia, bipolar disorder, major depression, delusional disorder, and brief psychotic disorder (temporary and usually caused by severe stress). For all of these, except the last, psychiatric medication will probably be necessary, and psychotherapy alone will not be sufficient, although it may be helpful in addition to medication. Possible medications would include antipsychotics, antidepressants, mood stabilizers, tranquilizers, and others. All of these categories of medication have improved quite significantly over the years in both safety and efficacy, and can be enormously helpful with such problems.

It is also important to understand when psychotic symptoms can be dangerous. Less dangerous auditory hallucinations usually involve hearing voices calling out a person’s name or talking about random subjects. More dangerous are command hallucinations in which the voices are telling a person to do something, and even more dangerous are ones where the commands are to hurt oneself or others. Most dangerous are command hallucinations accompanied by a strong urge to obey the commands. Generally, if someone is experiencing command hallucinations to hurt anyone, then this is a psychiatric emergency and the person should be taken to a psychiatric emergency room right away. If the person is unwilling, then call the police for assistance and they will alert the psychiatric screening units that work with them.

Psychotic symptoms can also be endangering when they are accompanied by severe disorganization or impairment in judgment. In these cases people may be unable to care for themselves or will endanger themselves with peculiar or risky behavior. Again, they should be taken to a psychiatric ER, and police and psychiatric screeners should be contacted if they refuse to go voluntarily.

Thomas B. Hollenbach, Ph.D.

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