Is This Real….Understanding Hallucinations and Delusions

Hallucinations and delusions are often equated with schizophrenia. There is a common misconception amongst the general public that symptoms of psychosis appear exclusively in those with a diagnosis of schizophrenia. Psychotic features can occur in a diagnosis of schizophrenia, schizophreniform, schizoaffective, bipolar, major depressive disorder, substance use, and with general medical conditions. We are all susceptible to experiencing psychosis even if it be from something seemingly unrelated to psych such as a urinary track infection.

What are hallucinations and delusions? Are they the same?

Hallucinations and delusions are very different. We are going to start by breaking down hallucinations. Hallucinations are false sensory experiences. Hallucinations are sensory misperceptions that could be visual, auditory, tactile, olfactory, and gustatory. These are your 5 senses sight, hearing, touch, smell, and taste. The most common are usually auditory and visual. The rarest being smell and taste.

What does a hallucination feel like? It depends on the individual and the type of hallucination they are having. Hallucinations are not always frightening. I had a patient that reported he saw glitter sprinkling from the sky. It was not upsetting to him because he did not perceive glitter as a threat, but he found it distracting. In other cases, people will experience something that is more distressing. Another individual reported they kept feeling someone touching them and it caused them alarm believing that there was someone in the room with them.

How is a hallucination different from a delusion? For starters, hallucinations are sensory perceptions where as delusions are thought based. One of the most important things to recognize in hallucinations and delusions is how they can and cannot be addressed. Hallucinations can be challenged. It was not hard to convince the patient who saw glitter falling from the sky that his mind was playing tricks on him. He understood that something was amiss and with some psycho-education came to better recognize his hallucinations.

Delusions are very different. Delusions are thought disorders. In other words what you think and believe in your mind is inaccurate. This does not apply to opinions like whether one believes the President is doing a good job or not. A delusion is a firm held belief or idea that is clearly recognized by others as inaccurate. For example, we had a patient who believed that his brain had been stolen by an evil miner and replaced with a demonic brain. The patient believed that with their thoughts and eyes that could hurt others. It was clear that this was a delusion.

Delusions unlike hallucinations are strongly held beliefs that cannot and should not be challenged. Arguing with an individual who believed that they are being watched by the government could cause them to be further suspicious and isolate even more. Instead, be careful in the language you choose. You want to neither endorse nor negate the thoughts. I might say, “It has to be hard feeling like you’re being watched by the government”. In the statement I affirmed how they might be feeling but I did not legitimize the delusion. The best hope for someone with severe delusions is medication.

 

If you or someone you love is experiencing psychosis make sure that you reach out and get support from professionals. This can be overwhelming and scary. I hope that this information helped to answer a few questions. There is hope. Hallucinations and delusions can be treated and managed. Both stories I referenced earlier are of clients who have long since recovered and are no longer experiencing these symptoms. You can do this. If you have any questions please feel free to reach out.

https://www.ncbi.nlm.nih.gov/pubmed/17199051