What are hallucinations?
A hallucination is a sensory experience that occurs without an external stimulus to account for it. A person may hear, see, feel, smell or taste something that other people cannot perceive in the same environment. These experiences can feel vivid and real to the person having them. They should not be dismissed or treated as though the person is choosing to experience them.
Hallucinations are not a diagnosis on their own. They may be associated with different mental or physical health conditions, certain substances or medications, and changes in sleep. For this reason, an assessment considers not only the type of experience, but also when it began, how often it occurs and how it affects daily life.
What are the different types of hallucinations?
Hallucinations are commonly described according to the sense involved:
- Auditory hallucinations: Hearing voices, music or other sounds when there is no audible source. A voice may seem to call the person’s name or speak directly to them.
- Visual hallucinations: Seeing shapes, lights, objects, animals or people that are not actually present.
- Tactile hallucinations: Feeling touch, tingling or movement on the skin without an external cause.
- Olfactory hallucinations: Smelling an odour when there is no identifiable source nearby.
- Gustatory hallucinations: Experiencing a taste without eating or drinking anything that would explain it.
People do not necessarily experience all types, and the experience can vary over time. Some hallucinations are brief or occur in particular situations; others may recur and cause distress. The content of an experience alone does not establish a diagnosis or indicate how dangerous someone is.
How are hallucinations related to psychosis?
Psychosis describes a group of symptoms that can affect how a person interprets and evaluates reality. Hallucinations may occur as part of psychosis. Another symptom associated with psychosis is a delusion: a strongly held belief that does not fit the person’s cultural context and persists despite clear evidence to the contrary. Changes in thinking, speech or everyday functioning may also be present.
Experiencing a hallucination does not by itself mean that a person has psychosis. Psychotic symptoms can occur in some schizophrenia spectrum conditions, as well as in bipolar disorder or severe depression. Certain medications, alcohol or other substances, neurological conditions and other physical health problems may also be associated with hallucinations. Brief sensory experiences while falling asleep or waking up can occur in a different context and need to be understood accordingly.
A clinician may ask when the experiences began, how long they last, whether they recur, what medications or substances the person uses, and whether there have been changes in sleep, health or daily functioning. A diagnosis requires a broader assessment; it cannot be determined from one symptom alone.
How can psychotherapy offer support?
Hallucinations may bring fear, confusion, loneliness or difficulties in daily life. Psychotherapy can provide a safe, non-judgmental space to explore the emotions connected with these experiences. Sessions may focus on how the experiences affect the person, the situations in which they arise, and ways to manage the distress they cause.
In therapy, a person may develop strategies for noticing these experiences and coping with their impact. The possible roles of stress, sleep and daily routines can also be explored. The aim is not to dismiss or argue about what the person is experiencing, but to understand their needs and support their wellbeing and day-to-day functioning.
Psychotherapy can be combined with psychiatric or medical assessment when appropriate. The support plan is tailored to the person’s symptoms, needs and circumstances.
