Visual Hallucinations: Exploring Psychosis Disease
While it’s difficult to measure how common visual hallucinations are, current estimations suggest that as much as 7% of the general adult population will experience a visual hallucination at some point in their lives. Estimates also tell us that roughly 33% of people with first-episode psychosis experience visual hallucinations.
Individuals with psychosis may also experience auditory, tactile, olfactory, and gustatory hallucinations. In this article, we’ll explore different types of visual hallucinations, what causes them, and available treatment options.
Types of visual hallucinations
People can experience visual hallucinations in different ways. For example, some people with psychosis experience visual hallucinations more frequently than others. Some people may see more detailed, three-dimensional visions, while others may see images that look more like illustrations. Scientists recognize three common types of visual hallucinations:
- Simple: People experiencing simple visual hallucinations typically see basic imagery, like shapes, lines, colors, and lights.
- Complex: People experiencing complex visual hallucinations see visions of figures, faces, scenes, or objects.
- Negative: People experiencing negative visual hallucinations have a lack of perception or denial that a certain object or person exists, even if they’re looking right at them. Put simply, individuals who experience negative hallucinations may be looking directly at something but fail to see it.
Describing psychotic vs. nonpsychotic hallucinations
Both people who experience and people who do not experience psychosis can experience hallucinations. However, there tend to be a few key differences in how hallucinations manifest and are experienced between the two groups.
- Frequency and intensity: In individuals with psychosis, visual hallucinations are usually more likely to be frequent, intense, and persistent, as opposed to those without psychosis.
- Content: Visual hallucinations in individuals with psychosis are often associated with delusional beliefs or other psychotic symptoms. These hallucinations might be complex and bizarre and may involve frightening or threatening imagery. In contrast, visual hallucinations unrelated to psychosis may be more random, fleeting, and typically unassociated with delusions or other psychotic symptoms.
- Perception of reality: People with psychosis often have difficulty discerning between hallucinations and reality. They might believe their visual hallucinations are real and act on them accordingly. People experiencing visual hallucinations unrelated to psychosis are typically more likely to recognize that their visions aren’t real and may be able to dismiss them more easily.
Visual hallucinations and mental health disorders
Visual hallucinations can be associated with a wide variety of mental health disorders featuring psychotic symptoms, most of which are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) under the categorization of psychotic disorders. The DSM-V is a manual or guide used by mental health professionals in the US to help them diagnose mental health patients.
Psychotic disorders typically emerge in the late teenage through early adult years and share a core set of symptoms:
- Hallucinations: Hallucinations can be auditory, visual, tactile, olfactory, or gustatory.
- Delusions: Delusions can be defined as false, irrational beliefs not based on reality. Individuals with delusions often continue to hold on to their beliefs despite being presented with evidence to the contrary.
- Disordered thinking and speech: Disorganized, often bizarre thoughts can result in disorganized, nonsensical vocabulary and speech patterns.
- Disordered behaviors: Disordered behaviors are generally characterized as disorganized behavioral patterns that may appear random, agitated, and sometimes inappropriate for the circumstances. Catatonia, a state in which an individual ceases to move or respond to outside stimuli, can be another behavioral symptom of psychosis.
Most people with psychotic disorders also experience impairments in cognitive, social, or occupational function, as well as mood-related symptoms like anhedonia or diminished affect.
Psychotic disorders that may contribute to hallucinations
Many different types of psychotic disorders may cause people to experience hallucinations, including:
- Schizophrenia: A severe, chronic disorder usually characterized by distorted thoughts, perceptions, emotions, and behaviors. Many people with schizophrenia also experience secondary cognitive, social, and mood-related symptoms.
- Schizophreniform: A disorder similar to schizophrenia, but it typically has a shorter duration, and symptoms can be milder.
- Schizoaffective disorder: A disorder that usually features core psychotic symptoms plus symptoms of a mood disorder, such as bipolar or major depressive disorder.
- Brief psychotic disorder: A disorder that typically involves a more sudden onset of psychotic symptoms than other psychotic disorders, but only lasts for one day to one month.
- Substance-induced psychotic disorder: A disorder that is generally the result of substance use. Symptoms usually occur during or shortly after intoxication or withdrawal from the substance and can vary in severity. Once the effects of the substance wear off, the symptoms typically subside.
- Psychotic disorder due to a medical condition: A disorder that normally involves psychotic symptoms that are the result of a temporary or chronic medical condition.
Other mental health disorders that may cause visual hallucinations
Some disorders aren’t necessarily classified as psychotic disorders, but may cause hallucinations related to psychosis, including:
- Bipolar disorder: A mood disorder featuring severe mood swings that include alternating episodes of mania and depression. When hallucinations are present, this disorder is usually specified as bipolar disorder with psychotic features.
- Major depressive disorder: A mood disorder normally characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities that were once enjoyable. Among its many symptoms, major depression may also present psychotic features like hallucinations.
- Borderline personality disorder (BPD): A personality disorder usually characterized by a pattern of unstable relationships, self-image, emotions, and behavior. People with BPD may experience intense mood swings, impulsivity, and emotional dysregulation. Alongside its core symptoms, BPD can present psychotic symptoms like hallucinations and delusions. While auditory hallucinations may be the most common type experienced in association with BPD, some individuals experience visual hallucinations as well.
Causes of visual hallucinations such as Charles Bonnet Syndrome
While hallucinations often emerge as a symptom of psychotic and other types of mental health disorders, various factors can trigger or cause visual hallucinations.
Neurological and ophthalmological conditions affecting vision
Conditions affecting certain brain areas associated with the visual system can cause visual hallucinations. These include, but aren’t limited to, the following:
- Alzheimer’s disease
- Parkinson’s disease
- Dementia
- Charles Bonnet Syndrome
- Certain types of epilepsy
- Brain tumors
- Migraines
- Certain types of stroke
People with most types of medically induced psychosis understand that their hallucinations are caused by their condition (with the exception of dementia-related conditions) and are usually aware that what they are experiencing isn’t real.
Brain abnormalities and disease
Abnormalities in the structure and function of some brain regions, such as the right hemisphere, may cause hallucinations. These can result from traumatic brain injury (TBI), lesions, infection, or abnormal brain development.
Trauma and stress
Research into how trauma, stress, and their biological processes may induce visual hallucinations is ongoing. However, some studies point to an association between severe, long-term stress and visual hallucinations, particularly in individuals with PTSD.
Examples of traumatic experiences that may trigger episodes of psychosis, including visual hallucinations, include those listed below:
- The sudden death of a loved one
- War
- Natural disaster
- Assault
- Accident
Research also suggests a potential relationship between hallucinations and childhood trauma.
Medications or illicit substance use
Substance-induced psychosis is listed in the DSM-V as a psychotic disorder featuring at least one psychotic episode resulting from drug use. Hallucinations associated with substance use typically subside during periods of sobriety.
Visual hallucinations may also emerge as a side effect of some prescription medications:
- Antipsychotics
- Mood stabilizers
- Blood pressure medication
- Anticonvulsants
- Certain antibiotics
- Some medications for erectile dysfunction
Sleep disorders
Sometimes referred to as a parasomnia, sleep-related hallucination is a condition in which an individual experiences visual hallucination just after waking (hypnopompic) or just before falling asleep (hypnagogic). The hallucinations are usually accompanied by sleep paralysis and are believed to occur due to disruptions in the normal sleep-wake cycle. They might be linked to other sleep disorders like narcolepsy.
Treatment strategies for visual hallucinations due to psychosis, dementia, and other mental disorders
Treatment for visual hallucinations generally depends on their cause. If visual hallucinations are caused by a medical condition, such as epilepsy, migraine, or a neurological disorder, treating the underlying condition may alleviate the hallucinations.
If, however, the hallucinations are the result of a psychiatric disorder, treatments are typically comprehensive and address both the symptoms and the underlying psychological mechanisms.
Potential treatment approaches are discussed below.
Medication
In general, the most common medications used to treat visual hallucinations (and all psychotic symptoms) are antipsychotics. In some cases, physicians may also prescribe mood stabilizers or antidepressants to treat secondary symptoms. All of these medications must be prescribed and monitored by a doctor or psychiatrist.
Therapy
Cognitive behavioral therapy (CBT) and other forms of psychotherapy can be beneficial in helping individuals cope with and manage visual hallucinations.
Psychosocial support
Family and group therapy can help people with visual hallucinations or similar symptoms connect, share experiences, learn coping strategies, and gain validation. In severe cases of psychosis that impair an individual’s ability to function in daily life, vocational programs that help individuals learn to be self-sufficient can be helpful.
Seeking support in coping with visual hallucinations
Despite the importance of comprehensive treatment, people experiencing psychotic symptoms like visual hallucinations may not seek support. There are several potential reasons for this.
For example, people experiencing psychosis might have difficulty recognizing or acknowledging that they have a mental disorder (a phenomenon called anosognosia), which can impact their willingness to seek treatment. Secondary symptoms like cognitive impairment and emotional dysfunction may also make it challenging for individuals to participate and adhere to a treatment plan.
For many, availability to treatment, scheduling conflicts, worry over stigma, and financial concerns can be the primary barriers to treatment.
While it might not be appropriate in every case, virtual therapy can provide an effective solution to such obstacles for some individuals with psychosis. Online therapy platforms typically eliminate geographical barriers and offer individuals pass to a broader pool of mental health professionals with diverse backgrounds and experience, potentially making it easier to find a therapist who fits their needs.
Online therapy is often more convenient and affordable than traditional therapy without insurance. Additionally, many find it more comfortable to attend sessions from the comfort of home as opposed to in an-office setting.
Takeaway
What is the difference between vision and visual hallucination?
Vision is a human perception of things that physically exist and are real. Visual hallucination is a human perception of something that does not exist in the real world. These are products of the brain without external input.
Can vision loss such as Charles Bonnet syndrome cause a visual hallucination?
Yes. When a person loses his/her vision or has Charles Bonnet syndrome, there is a chance that they may experience visual hallucination. When a person loses their sight due to visual impairment conditions such as macular degeneration, the brain gets less information from the eyes than it's used to. With this, the brain sometimes creates hallucinations. However, it is important to note that not everyone who loses their sight will get Charles Bonnet syndrome.
What can cause visual hallucinations?
Visual hallucinations are caused by abnormalities or chemical reactions in the brain. According to research published in The Primary Care Companion to the Journal of Clinical Psychiatry, titled Visual Hallucinations: Differential Diagnosis and Treatment, certain pathophysiologic mechanisms account for visual hallucinations. The first mechanism involves irritation of cortical centers responsible for visual processing causes. Irritation of the primary visual cortex causes simple visual hallucinations, while irritation of the visual association cortex can cause more complex visual hallucinations.
The second mechanism involves lesions that cause deafferentation of the visual system. For example, in a study that blindfolded healthy subjects for five days, 10 of the 13 subjects experienced hallucinations. Prolonged visual deprivation can be enough to inhibit other cognitive functions and cause someone to experience hallucinations.
Finally, the third mechanism involves the reticular activating system. People who are drowsy or experience sleep disorders are more prone to experience visual hallucinations.
A number of psychiatric illnesses are associated with hallucinations, including:
- psychosis caused by schizophrenia spectrum disorders
- delirium
- dementia, especially Lewy body disease
- Charles Bonnet syndrome, which impacts people who are visually impaired
- Anton’s syndrome
- epileptic syndromes such as occipital lobe epilepsy
- Creutzfeldt-Jakob disease
- peduncular hallucinosis
Visual hallucinations can also be caused by sleep disturbances, seizures, tumors, medication side effects, and migraines. Hypnopompic hallucinations, which are dream-like hallucinations which occur as someone is waking up, are part of the diagnostic criteria for narcolepsy.
How do you know if you are hallucinating?
If you are having a sensory experience that others around you are not experiencing, you are hallucinating. Some types of hallucinations that people experience are listed below.
- Visual hallucinations involve seeing things that aren’t there. These can be mild, such as seeing small flashes of light, or complex, such as seeing an animal that isn’t actually there.
- Auditory hallucinations involve false perceptions of sounds that aren’t really occurring, such as hearing voices or music.
- Olfactory hallucinations occur when you smell odors that aren’t real, such as perfume or rotting food.
- Proprioceptive hallucinations happen when you feel like your body is moving in a way that it isn’t, such as feeling as though you’re flying or as though your body is twisted when it isn’t.
- Multimodal hallucinations, also called complex hallucinations, involve more than one type of sensory input, such as experiencing auditory and visual hallucinations at the same time.
- Presence hallucinations make you feel as though someone is nearby, when no one is actually there.
- Hypnopompic hallucinations occur right as you are falling asleep or waking up and are often a normal part of your sleep cycle. Waking up is often enough to help you determine that you were hallucinating or dreaming.
How do you manage visual hallucinations?
If you are experiencing visual hallucinations, you likely need to consult with a medical professional to treat the condition causing the hallucinations. If someone you love is experiencing visual hallucinations, the way you help manage their hallucinations depends on what condition is causing them. For example, if someone with Parkinson’s disease is seeing upsetting images, it’s recommended that caregivers acknowledge what they are experiencing and then try to distract them.
Are visual hallucinations an emergency?
Visual hallucinations may be an emergency if they indicate someone is experiencing a serious medical issue. For example, hallucinations caused by delirium should be treated immediately. Other conditions and psychiatric illnesses associated with hallucinations that require immediate treatment include brief psychotic disorder, migraine coma, and psychosis.
In older adults, visual hallucinations are often an indicator or cognitive decline. An older adult experiencing these hallucinations may have dementia with Lewy bodies or a similar condition. While this typically doesn’t require immediate care, it can be wise to schedule an appointment with a health care provider as soon as possible.
What do schizophrenic hallucinations look like?
Visual hallucinations experienced by someone with schizophrenia often involve vivid scenes with animals, family members, and religious figures. Occasionally, these hallucinations may include giants. In the article Clinical Significance of Hallucinations in Psychiatric Disorders, the authors note that people with schizophrenia often experience auditory hallucinations, specifically hearing derogatory voices.
Can anxiety cause visual hallucinations?
Hallucinations are rarely caused by anxiety. However, for people with conditions such as Parkinson’s disease, anxiety can cause hallucinations to become worse.
How do you help someone with visual hallucinations?
To know how to help someone with visual hallucinations, it can help to identify what kind of abnormal visual perception is occurring as part of their hallucination.
Elementary visual hallucinations occur when someone sees simple images, such as flashes of light or tessellated patterns. This type of hallucination is typically localized to the occipital primary visual cortex or sensory structures like the retina. Formed visual hallucinations are more complex images such as a person or entire scene. They involve areas of the brain such as the parietal lobe and temporal lobe.
Each type of visual hallucination is associated with different conditions, but not all involve an acute medical issue. For example, someone with a migraine may experience hallucinations known as a migraine aura, seeing lines, dots, and flashes of light in their visual field. In this instance, it may be best to focus on treating the migraine. However, if someone is hallucinating vivid scenes, they could have Lewy bodies or a similar condition.
If you’re unsure of how to help someone experiencing visual hallucinations, you might contact a medical professional to determine what steps to take next.
What medication is used for visual hallucinations?
Various types of medications can be used as hallucinations treatment, depending on what mental health conditions are causing the hallucinations.
- Olanzapine, amisulpride, ziprasidone, and quetiapine may be used to treat hallucinations caused by schizophrenia.
- Neuroleptic medication, specifically intravenous haloperidol, may be used to treat hallucinations caused by delirium.
- Benzodiazepines may be used to treat hallucinations related to delirium tremens.
- Neuroleptic medication and selective serotonin reuptake inhibitors may help treat hallucinations caused by Charles Bonnet syndrome.
- Lewy body disease related hallucinations are often treated by quetiapine or clozapine.
- Parkinsonian hallucinations may be treated by acetylcholinesterase inhibitors; however, these medications may worsen motor symptoms associated with Parkinson’s disease.
When should I be worried about my hallucinations?
Some hallucinations are common. For example, hypnagogic hallucinations are the momentary perceptions you experience right as you’re falling asleep. In the article Hypnagogic and hypnopompic hallucinations: pathological phenomena, researchers found that 37% of study participants experience hypnagogic hallucinations.
However, most other kinds of hallucinations are related to a physical or mental health condition. If you experience hallucinations throughout the day, especially if they are impacting your mental health or overall quality of life, schedule an appointment with your primary care provider to determine what is causing your hallucinations.
Should you tell a delusional person they are delusional?
If someone is experiencing a delusion, it is unlikely they may be swayed by concrete evidence. You are unlikely to convince the person that what they are experiencing is a delusion, but Mental Health America shares that talking about delusions in the right way can be helpful. Help the person identify behaviors and changes that may help alleviate the stress caused by their delusion.
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