Can PTSD Cause Hallucinations?

PTSD (post-traumatic stress disorder) is a mental health condition that can be debilitating and last for a long time, particularly if left untreated. PTSD can develop in the aftermath of a traumatic event during which an individual either feared for their life or safety or that of someone else. 

Research suggests a connection between PTSD and psychosis, including PTSD paranoia, hallucinations, and delusions. But how often are these effects seen, and what is the most effective course of treatment for them? Below, we'll provide information about each of these symptoms as well as what treatments may be helpful.

What is PTSD?

PTSD is a mental health condition caused by an intensely fearful situation, such as participating in active combat, being in a car accident, or surviving domestic violence. A diagnosis of post-traumatic stress disorder requires that a person have experienced a traumatic event that leads to the development of certain related symptoms.

Core PTSD symptoms include avoidance, intrusive memories, emotional reactivity or numbness, sleep disturbances, panic attacks, hypervigilance, and dissociation. These symptoms may also lead to chronic low mood states and negative thinking patterns. Post-traumatic stress disorder symptoms can range from mild to severe and can affect daily functioning, relationships, and overall well-being. These symptoms indicate that the brain's fear response system has become effectively stuck in the “on” position, perceiving threats from relatively harmless stimuli and firing “false alarms.”

While not everyone will develop post-traumatic stress disorder in the aftermath of a trauma, it is a relatively common condition. Scientists are still learning exactly what leads to certain people developing the condition and not others, but it appears to be partially related to genetics and individual vulnerabilities in certain brain structures.

For some people, psychotic disorders may occur secondary to PTSD symptoms. While the link between the conditions is still being investigated, there is evidence of a potential connection.

Can PTSD cause hallucinations?

Hallucinations can be the result of trauma, which causes post-traumatic stress disorder to develop. They can be similar to flashbacks in that you feel as if you are experiencing the trauma all over again. However, PTSD is not the only cause of psychotic symptoms; hallucinations can also result from drug misuse, a head injury, or even monocular disease, among other reasons. While it’s rare to have hallucinations as a result of PTSD, it is possible. If you are experiencing hallucinations, it can be important to speak with a medical professional about their origin and treatment.

How do you know if you're hallucinating?

A hallucination feels incredibly real to the person having it, even though there are no external stimuli to cause it. Many conditions and risk factors can cause hallucinations, such as:

• Anxiety disorders

• PTSD

• Lack of sleep

• Stress

• Substance misuse

• Epilepsy

• Medications

• Extreme grief

• Depression

In addition, some dissociative factors—which often result from childhood trauma like abuse—could also cause hallucinations, including:

• Memory loss and amnesia

• Detachment

• Serious relationship challenges

If you believe that you may be experiencing hallucinations—especially if you have multiple risk factors for psychosis—contact a mental health professional for help as soon as possible. A licensed therapist or psychiatrist can investigate the underlying cause and help you manage symptoms of cognitive and dissociative factors.

What is psychosis?

Psychosis refers to symptoms that cause an individual to be disconnected from reality. Psychotic symptoms are grouped into two distinct categories: positive and negative symptoms.

Positive symptoms are the addition of thoughts, behaviors, and mental states. The person may be aware that these symptoms represent things that are not real or, in more severe cases, may be unable to differentiate between what is real and what isn't. Positive symptoms of psychosis include paranoia, hallucinations, and delusions—more on these below—and can also include racing thoughts, agitation, aggression, and fast speech.

Negative symptoms, on the other hand, represent a loss of functioning for the individual. Negative psychotic symptoms may include an extreme loss of motivation, emotional withdrawal, dissociation, apathy, social withdrawal, and other symptoms. Negative symptoms are seen less frequently with post-traumatic stress disorder (PTSD), but their presence can complicate the progress of treatment.

Hallucinations

Perhaps the most common symptom of post-traumatic stress disorder (PTSD) related to psychosis is hallucinations. You may feel like you are seeing people (visual hallucinations) or hearing voices (auditory hallucinations) that aren't there that relate to the trauma you experienced. Hallucinations can be correlated with, but are distinct from, flashbacks. These are episodes in which you feel like you're reliving the trauma. Dissociation can also be linked to these experiences, where you perceive a disconnect between yourself and the world around you.

Paranoia

Paranoia can cause an individual to lose trust in others and withdraw socially, which can have a circular effect on symptoms of PTSD. Paranoia can make reaching out to others difficult. You may constantly over-analyze the motivations of other people and question whether they are telling you the truth. Those who have experienced child abuse often develop this loss of trust in adults. Paranoia can damage relationships and cause you to become isolated.

Delusions

Paranoia can become so severe that it turns into full-blown delusions. Delusions in the context of PTSD are usually related to trauma in some fashion and can keep a person feeling as though they can't move on from the past. Delusions can be debilitating and difficult to let go of once they are established. 

The connection between PTSD and psychosis

Over the last few decades, researchers have begun to piece together the connection between post-traumatic stress disorder and psychotic disorders. According to a systematic review, lifetime rates of comorbid psychotic disorders in those living with PTSD are estimated at 30%, versus less than 8% in the general population.

Positive psychotic features are most frequently identified as being connected to PTSD, although negative symptoms are sometimes reported in those who have had PTSD for an extended period. Trauma could be a risk factor for both conditions, especially if the traumatic event occurred early in life. Childhood trauma—often the result of childhood abuse—has a strong connection to posttraumatic stress disorder, psychotic disorders, and PTSD with secondary psychotic features.

Can PTSD trigger psychosis?

A traumatic event can trigger an episode of psychosis or comparatively milder, transient psychotic symptoms. Often, psychosis is temporary, brought on by a stimulus that reminds the person of the traumatic event. Symptoms may come and go and be related to the trauma in some fashion. Fear and anxiety are often reported to be direct triggers of positive psychotic symptoms. For example, a certain ringtone could trigger vivid memories of an ex-spouse who caused a person physical harm. 

Treating PTSD with psychotic symptoms

Those with posttraumatic stress disorder who are experiencing signs of comorbid psychotic disorder must often pursue a treatment plan that addresses both conditions. If the psychotic disorder is secondary to PTSD, the latter is usually treated first. Seeking treatment is often the first big step toward recovery.

Preliminary research suggests that atypical antipsychotic medication may help alleviate symptoms of psychosis when it's comorbid with PTSD, but more investigation is needed to make a definitive statement on the effectiveness of this type of medication. Consult with your doctor or primary care physician before starting, stopping, or changing any medication.

The presence of psychotic symptoms with PTSD may also be associated with a higher risk of depression. Depression is commonly treated with therapy and, in some cases, selective serotonin reuptake inhibitors (SSRIs) or other medications as well. Both PTSD and psychotic disorders can persist for a long time on a chronic basis, but treatment can help you effectively manage these conditions.

Psychotherapy is considered the first-line approach for treating PTSD, including PTSD with comorbid psychosis. Cognitive behavioral therapy (CBT) has so far been suggested to be the most effective form of therapy for PTSD. Various types of CBT may be used to help clients with PTSD treat their symptoms, with varying degrees of evidence to support their effectiveness in those experiencing hallucinations after a traumatic event.

Online counseling for trauma and PTSD

Every person should feel comfortable with their therapist, but the therapeutic alliance can be particularly important for those living with the effects of trauma and PTSD. BetterHelp is an online counseling platform that aims to match you with a therapist who makes you feel safe and whom you can trust. While online therapy may not be right for everyone—such as those experiencing active signs of psychosis or other severe symptoms—it can be a convenient alternative for those with mild to moderate symptoms who feel more comfortable with this format than with seeking in-person care.

Research suggests that online counseling can be a powerful tool in reducing symptoms of a mental illness like PTSD. One study, for example, suggests that online therapy can be as effective as in-person therapy in addressing symptoms of PTSD in many cases.