You know the cameras are everywhere, watching your every move. They are embedded in street lights and often confused with doorbell cameras. In the walls, lights, cars and every public space. You just can’t convince everyone else: we are being watched. The doctors even deny it, but you know it’s real. Though you haven’t ever seen a hidden camera or have evidence of them existing, you live daily within the terrifying belief that they are, in fact, there and watching.
This is the frustration and mindset of someone living with delusions, one of the symptoms of psychosis. Another common symptom of psychosis are hallucinations, sensory perceptions that are not based in reality — such as bugs crawling on your skin or hearing voices.
[READ: Schizophrenia: Symptoms, Causes and Treatment]
What Is Psychosis?
Psychosis is a mental health condition in which there has been some break with reality. Someone who is experiencing an episode of psychosis might be said to be having a “psychotic break” or “psychotic episode,” during which they don’t know what is real and what is not.
However, while both involve a break in reality, delusions and hallucinations are not the same.
“Hallucinations involve sensory experiences that occur without external stimuli — most commonly hearing voices that others do not hear. In short, delusions affect thoughts and beliefs, while hallucinations affect perceptions,” says Jennifer Kim Penberthy, a clinical psychologist and professor of psychiatry and neurobehavioral sciences at the University of Virginia School of Medicine in Charlottesville.
According to the American Academy of Family Physicians, a wide range of conditions can lead to psychosis, which can include delusions or hallucinations, including autoimmune disorders, neurological disorders, certain types of cancer, withdrawal from some medications, hypo or hyperglycemia, and multiple mental health conditions.
If you experience psychosis, you are not alone. In fact, around 15 to 100 people per 100,000 develop psychosis each year, according to the National Institutes for Health. Here’s what to know if you suspect you or a loved one is suffering from delusions, hallucinations or both.
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What Is a Delusion?
A delusion is a “fixed false belief that is not based in reality,” according to Penberthy.
“For example, someone might believe the FBI is tracking them, which is a paranoid delusion or that they have superpowers and have been called to complete some special mission, which would be a grandiose delusion,” says Dr. Jeffrey Ditzell, a psychiatrist in New York City. “Other types include believing that others are controlling their thoughts or actions, or that people around them are sending special messages or signals just for them.”
People might have multiple belief systems that aren’t based in reality, called polythematic delusional systems, or just one single belief system.
Other examples include someone thinking their spouse is replaced with another person entirely who happens to look like them, people being in love with them, a partner cheating on them or others being able to control someone’s bodily movements.
Aubrey Moe, a psychologist with the Early Psychosis Intervention Center at The Ohio State University Wexner Medical Center, shares that those diagnosing delusions must make sure the belief isn’t a part of a person’s culture, and the belief also can’t be changed by advice to the contrary. So, no amount of trying to convince someone that their delusion is false will work if it’s truly a delusion.
Types of delusions
There are different types of delusions. These can be helpful in identifying and communicating the issue with health care providers and include:
— Persecutory delusions. This type of delusion leads people to believe that they or a loved one are being victimized. Also sometimes called paranoid delusions, “often we see people with paranoid or persecutory delusions being concerned that someone or something is trying to harm them in some way or is watching them,” Moe says. Sometimes these delusions “can be terrifying and could potentially harm someone. For example, if you have the delusion that someone in your family is plotting against you, that could result in a very negative outcome.
— Erotomanic delusions. This describes someone who thinks they’re loved by another person, often a very famous person. More than just an obsession, erotomanic delusions have at times led to stalking and other dangerous behaviors.
— Grandiose delusions. This type of delusion results in an over-inflated sense of worth, power, knowledge or identity and leads people to believe they “have special talents and abilities or super powers,” Moe says.
— Jealous delusions. In this form of delusion, the person believes his or her partner or spouse is being unfaithful.
— Somatic delusions. Dr. Cathleen Adams, a psychiatrist with Hartselle & Associates in Rhode Island, says somatic delusions are related to the body and its functions rather than the mind, and may lead a person to believe he or she is sick or has a physical deformity. These “can be some of the most attention grabbing” delusions people experience, and examples include “the belief that someone is infected with worms or is pregnant or has a serious health condition.”
— Delusions of reference. Adams also notes that some people have delusions of reference, meaning that they believe they are receiving messages in the dialogue on a TV program or via other media.
— Dementia-related delusions. Delusions can be quite common” in any type of dementia, but it tends to be more common with Alzheimer’s disease. A common type of delusion that a person with dementia might experience is the conviction that they’re missing out on something they need to be doing. For example, they think they have to go to work, but they’ve been retired for 10 years. Some assisted living communities that offer memory care services now help people with these sorts of symptoms by setting up a room that looks like an office to help the person go through the motions of being at work, which may calm them down and help them feel less disoriented. Another common delusion in people with dementia is the idea that a caregiver is stealing from them.
— Mixed. Any combination of the several types of delusions.
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What Is a Hallucination?
If you find yourself hearing things and turning around thinking “what was that?” you might understand what a hallucination feels like.
“Hallucinations are about perception — experiencing something through the senses that isn’t actually there,” Ditzell says, adding the most common type is auditory, such as hearing voices that aren’t there. “Sometimes it’s whispers, laughter, humming or even full conversations. People can also have visual hallucinations, which might include seeing shadows, flashes of light or vague shapes that look like animals, monsters or even cartoon-like figures,” he says. “These experiences can be really vivid and unsettling and often feel just as real as anything else in the environment.”
Of course, if something feels real to you, it can be difficult to identify it as not real and report it to a mental health professional, complicating the situation. Some other examples include tasting, feeling or smelling something that isn’t there.
Types of hallucinations
Moe describes hallucinations as “a sensory experience that occurs in the absence of an external stimulus.” Hallucinations can occur in any of the five senses, producing five primary types of hallucination:
— Auditory: Hearing voices, music or other sounds that are not produced by an external stimulus. This is the most common form of hallucination and is commonly associated with certain mental illnesses such as schizophrenia.
— Visual: Seeing shapes, colors, objects or people who aren’t physically there. These types of hallucinations are also common in many different mental health disorders and can be very frightening depending on the situation.
— Olfactory: Smelling something — often an unpleasant scent — that isn’t perceived by others in the same space. Also called phantosmia, these hallucinations can occur after a head injury, when the patient has a brain tumor or when a neurological disorder such as Parkinson’s disease is present.
— Tactile: The sensation of bugs crawling over your body or being tapped on the shoulder when no one else is there are just two manifestations of tactile hallucinations that can bring considerable distress for some people. Certain medications, neurological conditions and mental health disorders may trigger these hallucinations.
— Gustatory: Experiencing the taste of something that you haven’t ingested. Often an unpleasant flavor, gustatory hallucinations can occur in people with epilepsy, schizophrenia and other conditions.
What Causes Hallucinations and Delusions?
It’s a myth that you have to have a mental health condition to experience psychosis. Though it can be a part of conditions like schizophrenia, bipolar disorder or severe depression, psychosis can also happen on its own, without a mental health condition.
Some adults might experience psychosis or a psychotic break as they age as a result of conditions like Alzheimer’s or dementia. However, people can also have a psychotic break at any age, potentially from a reaction to a prescription or from using alcohol or drugs.
Like a fever, Moe says, psychosis can be thought of as a symptom rather than a condition in and of itself. A fever signals that something is wrong, but because it can be associated with so many infections, diseases and other problems, simply having a fever doesn’t mean just one thing.
Some conditions that can induce psychosis that may lead to hallucinations and delusions are:
— Schizophrenia, bipolar disorder, depression and other mental illnesses
— Medication side effects and substance abuse
— Brain damage caused by tumors, strokes or injury
— Delirium or fever
— Neurological disorders such as epilepsy, Parkinson’s disease, Alzheimer’s disease and dementia
— Grief or emotional trauma
Overall, psychosis comes from a combination of factors, such as past trauma and stress, genetics and brain differences.
Warning Signs of Delusions and Hallucinations
Both delusions and hallucinations are called “positive” symptoms, not meaning that they are good or helpful, but rather that they involve the added presence of something that’s not already there, Penberthy says.
Both delusions and hallucinations can be seriously disruptive symptoms. In both conditions, you might notice warning signs for delusions and hallucinations as part of psychosis, including:
— Feeling uneasy, suspicious or paranoid about or around others
— Illogical or unclear thinking
— Wanting to be alone or withdrawing from others
— Intense or strange feelings, or a lack of feeling anything
— Personal hygiene or self-care changes/concerns
— Sleep issues
— Inability to tell what is part of reality
— Communication difficulties
— Anxiety
— Low motivation
— Emotional disruptions
— Decreased performance at work or school
Reach out to a medical professional if you suspect you have symptoms on this list.
What Treatments Are Available for Delusions and Hallucinations?
An accurate diagnosis is extremely important. To understand what treatment works best, medical professionals sometimes have to backtrack to look at earlier factors such as stress and trauma. If an underlying medical problem is not detected, you may be referred to a mental health provider such as a psychologist or psychiatrist for further evaluation and treatment.
“As for why some people experience delusions, others hallucinations, or both — it may relate to which brain circuits are most affected. Delusions may involve brain areas associated with reasoning and belief formation, while hallucinations may stem from overactive sensory processing areas, especially in the auditory cortex,” says Renee Solomon, a clinical psychologist at Forward Recovery in Los Angeles.
The treatment approach usually involves prescribing anti-psychotic medications, which can help regulate brain chemistry whether someone has hallucinations or delusions. But, psychotherapy is often also used, and that approach can vary based on the person’s specific symptoms.
“For example, cognitive behavioral therapy for psychosis may help individuals challenge delusional beliefs or develop coping strategies for distressing hallucinations. Supportive therapy, psychoeducation and structured routines are also essential components of comprehensive care,” says Solomon.
Sometimes the delusions or hallucinations go away when the root cause is addressed, such as changing medication if that was the cause, or if an underlying condition improves.
What Is the Outlook for People With Delusions and Hallucinations?
You are not defined by your diagnosis, and can go on to live a happy, healthy, and fulfilling life even if you’ve had hallucinations or delusions.
“With compassionate, evidence-based treatment and support from family, friends and clinicians, many people manage their symptoms and live fulfilling, meaningful lives,” Penberty says. “Reducing stigma, increasing awareness and promoting early intervention are critical. Mental health conditions are medical conditions. And just like physical illnesses, they deserve understanding, attention and effective care.”
Ditzell agrees that therapy often looks different based on whether someone has hallucinations or delusions. “For delusions, cognitive-behavioral therapy (CBT) helps patients gently test the reality of their beliefs. For example, if someone believes they’re being watched, we might work on examining evidence to challenge that belief in a supportive way,” he says. “For hallucinations, the focus is more on coping strategies, like practicing grounding techniques to stay present, such as touching something in their environment, noticing colors or even engaging in deep breathing exercises to bring them back to the present moment.” He adds that both types of treatment aim to help manage symptoms, but with the slight difference in whether they’re dealing with those false belief systems or more sensory experiences.
“With the right support, people can learn to manage their symptoms and live fulfilling lives,” Ditzell says. “Recovery doesn’t mean the absence of struggle. It means building the skills, support systems and resilience to move forward.” He shares that medication is “rarely” enough on its own, and he encourages a more holistic approach — one that looks at both past traumas and current relationships, lifestyle, other health concerns and more.
How Can I Get Help Now?
If you are in a mental health emergency, you can call 911, report to your nearest emergency room or call 988 for more resources.
“And remember: mental health is a journey, not a destination. Some days you’ll feel strong, others not so much. But every step forward, no matter how small, still counts,” Ditzell says.
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What’s the Difference Between Delusions and Hallucinations? originally appeared on usnews.com
Update 05/01/25: This story was published at an earlier date and has been updated with new information.
