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.

Address the effects of visual hallucinations

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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.

Address the effects of visual hallucinations

Work with a licensed therapist online

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.