Schizophrenia: Hallucinations and Delusions

Hallucinations and delusions are among the most common symptoms of schizophrenia. Both are considered positive symptoms, meaning they are not seen in healthy people.

Though the words are sometimes used interchangeably, each is a different experience.

Hallucinations are defined as experiences and sensations that are not perceivable to others. To the person experiencing them, however, they may seem real, urgent, and vivid. Roughly 70% of people with schizophrenia will experience hallucinations.

Auditory hallucinations are most commonly experienced by people with schizophrenia and may include hearing voices—sometimes multiple voices—or other sounds like whispering or murmuring. Voices may seem angry or urgent and often make demands on the hallucinating person.

Visual hallucinations involve seeing objects, people, lights, or patterns that are not actually present. Visualizing dead loved ones, friends, or other people they knew can be particularly distressing. Perception may be altered as well, resulting in difficulty judging distance.

Olfactory hallucinations involve the sense of smell or taste, both good or bad, that are not actually present. This can be particularly dangerous if a person believes he is being poisoned and refrains from eating.

Tactile hallucinations are feelings of movement or sensation on your body that are not actually present, such as hands on your body or insects crawling around or inside you.

Having hallucinations, in and by itself, does not indicate schizophrenia. People with mood disorders, schizoaffective disorders, other mental health conditions, and neurodegenerative diseases such as Alzheimer's and Parkinson's may also hallucinate. Hallucinations can occur when falling asleep (known as hypnagogic hallucinations) or when awaking (known as hypnopompic hallucinations). Those who consume psychoactive substances such as alcohol, marijuana, cocaine, and LSD may also experience sensory disturbances.

Delusions are defined as beliefs that conflict with reality. Delusions are one of the most common symptoms of schizophrenia. These beliefs might include:

Persecutory delusions: When a person believes a person, group, or organization is mistreating or harming them despite contradictory evidence.

Erotomanic delusions: When a person believes another is in love with them, despite no evidence. This other person is often a celebrity or person in power.

Somatic delusions: When a person believes they have an illness or their body is affected by a strange condition, despite contradictory evidence.

Grandiose delusions: When a person believes they have superior abilities or qualities (i.e. talent, fame, wealth) despite no evidence.

Sometimes a person will experience a recurring theme in their delusions over a period, which makes them seem more convincing to the individual experiencing them.

Try to stay calm and avoid feeling overwhelmed, confused, or fearful of someone experiencing hallucinations or delusions. A tranquil disposition can help the individual connect to reality. Here are some additional tips:

Encourage openness

Our understanding of hallucinations and delusions suggests that they can be triggered by a wide range of conditions. For those who experience them, they may feel shame and/or fear, which can make a productive conversation challenging. Try gently explaining that you cannot see or hear what they are experiencing and need help understanding it.

Be patient

Try to be sympathetic. Hallucinating is a very consuming experience. Speak slowly and clearly and frequently use the person’s name. Managing your own anxiety will encourage the hallucinating person to be more responsive.

Reinforce reality

Don’t argue with the hallucinations or deluded observations. It isn’t useful to challenge the person who is struggling. Instead, refrain from being judgmental; work to stay engaged, talking with a calm voice and making concerted efforts to understand what the person is experiencing; express to them that you each have your own perceptions of the world; do not focus on correcting their psychotic thinking or encourage their distorted reality; and emphasize that you are there as a support and can get help, if need be.

Ask for help

If you feel ill-equipped to help someone experiencing psychosis, get help. Find out if there is a trusted friend, family member, community resource, or mental health expert/health care provider that is monitoring their care, whom you can reach out to. If safety is a concern, whether it involves you or the one who is experiencing thought disturbances, call 911 or, if you feel safe, bring them to an emergency room at your local medical center.

Helpful online resources include the National Institute of Mental Health, National Alliance on Mental Illness (NAMI) (which also offers support groups and other in-person resources), and The Child Mind Institute.

Hallucination and delusion can be scary to witness, but medication, therapy, psychoeducation, and family support can make a difference. The symptoms may never disappear completely, but people plagued by these problems can learn to manage them. If you know someone with schizophrenia, seek out more education and training to help your loved one cope and even thrive with schizophrenia.