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 | 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.
Hallucinations are experiences of perceiving something that is not actually present, such as hearing voices or seeing images that have no external source. Delusions are strongly held beliefs that are inconsistent with reality and are not generally shared by others in the person's cultural or social group. Hallucinations involve perception, while delusions involve thought and interpretation. They can occur separately or together and may have different underlying causes.
Psychosis is a condition involving a significant disruption in a person's ability to accurately perceive, interpret, or understand reality. Hallucinations and delusions are common psychotic symptoms, although psychosis can also involve severely disorganized thinking, speech, or behavior. Psychotic symptoms can occur in several psychiatric conditions, as well as in some medical, neurological, substance-related, or medication-related situations. Experiencing a psychotic symptom does not necessarily mean that someone has schizophrenia.
Psychotic symptoms can have many possible causes. They may occur with psychiatric conditions such as schizophrenia, bipolar disorder, severe depression, or other disorders, but they can also be associated with substance use, medication effects, extreme sleep deprivation, severe stress, neurological conditions, or other medical problems. Because the possible causes are varied, new or unexplained hallucinations, delusions, or other significant changes in perception or thinking should be professionally evaluated rather than assumed to have a particular cause.
Yes. Some unusual perceptual experiences do not necessarily indicate psychosis. For example, people may experience vivid images, sounds, or sensations while falling asleep or waking up, sometimes referred to as hypnagogic or hypnopompic experiences. Hallucination-like experiences can also occur in connection with certain medical or neurological conditions, medications, substances, or severe sleep deprivation. The circumstances surrounding the experience are important when determining whether it represents psychosis or another condition.
No. Hallucinations and delusions can occur in schizophrenia, but they can also occur in bipolar disorder, severe depression, other psychiatric conditions, substance-related states, neurological conditions, medical illnesses, and other circumstances. A person cannot be diagnosed with schizophrenia based on one symptom alone. A comprehensive professional evaluation is needed to understand the nature of the symptoms and determine what may be causing them.
Professional evaluation is especially important when hallucinations or delusions occur while a person is fully awake and cannot be explained by a known circumstance such as falling asleep, medication effects, or substance use. Evaluation is also important when symptoms are new, persistent, worsening, or interfering with judgment, daily functioning, relationships, or the ability to care for oneself. For more information about psychosis and other mental health problems that may benefit from professional evaluation or treatment, see Problems that Usually Need Psychotherapy or Psychiatry Treatment.
Psychotic symptoms can become an emergency when they create an immediate risk of harm or make it impossible for a person to care for basic needs. Command hallucinations that tell someone to hurt themselves or another person are particularly concerning, especially when the person feels a strong urge to follow the commands. Severe confusion, disorganized behavior, severely impaired judgment, or behavior that places the person or others in immediate danger also requires urgent evaluation. In an immediate safety emergency, emergency medical or psychiatric services should be contacted.
Treatment depends on the underlying cause and the nature and severity of the symptoms. A comprehensive evaluation may be needed to determine whether psychiatric, medical, neurological, substance-related, or other factors are involved. Treatment may include psychiatric medication, psychotherapy, medical care for an underlying condition, support for substance-related problems, or a combination of approaches. When psychotic symptoms are significant, psychotherapy may be used as part of a broader treatment plan rather than as a substitute for appropriate psychiatric or medical care.
Yes. Severe or prolonged stress and significant sleep deprivation can contribute to unusual perceptions, impaired thinking, or other symptoms that may resemble or contribute to psychosis in some people. Stress and disrupted sleep can also worsen symptoms in people who already have a psychiatric condition. However, hallucinations or delusions should not automatically be attributed to stress or lack of sleep, particularly when symptoms are new, severe, or occurring while the person is fully awake. Professional evaluation can help determine what may be contributing to the experience.
Yes. Individual Therapy may be helpful as part of a broader treatment plan for someone experiencing psychotic symptoms, depending on the person's condition and treatment needs. Therapy can provide support, help a person cope with distressing experiences, address anxiety or other emotional difficulties, strengthen coping strategies, and support functioning and recovery. When significant psychotic symptoms are present, individual therapy may be used alongside psychiatric or medical care rather than as a replacement for that care.
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