Written by Felix Kalvesmaki.Â
I had my first psychotic experience when I was 16. I sat in my desk chair at my parentsâ house, in the middle of spring break, wondering why I felt cameras on me. I looked around my room â between books on my bookshelf, under my bed, behind the chess board I kept on my dresser â and found nothing. But I still felt watched. And I couldnât shake that feeling.
I didnât shake it, actually, for about a year. And it was a long year, full of fear and self-loathing and suicidal ideation. When I was 17, I was put on antipsychotic medication for the first time. It was liberating, honestly. Nothing like what pill-shamers described being on medication was like.
My mind felt clear, free from unfounded anxiety and paranoia. Free from incessant need to glance over my shoulder. Free from delusions.
Delusions â they were what I was experiencing. Delusions are firmly-held beliefs that are clearly false to everyone except the person affected. Theyâre fundamental aspects of my schizoaffective disorder â a diagnosis combining a mood disorder, like depression or bipolar disorder, with schizophrenia. I didnât know it then, but I was going through my first psychotic break â an experience often described as a âbreak from reality.â
But what does that mean? What is psychosis?
Jessica Arenella, Ph.D. told The Mighty that during psychosis, you might have a unique perception of reality that falls outside of what we consider âconsensual reality.â Consensual reality is the most agreed upon way people believe the world to be. For example, most of us can agree the sky is blue, not green.
Psychosis can show up in a whole host of disorders, including schizophrenia, schizoaffective disorder, bipolar disorder and depression. Everyone who has it will live through it differently, depending on the disorder itâs accompanied by, and the type of psychosis you experience.
Psychosis is often divided into two types: delusions and hallucinations. Katherine Olesker, Psy.D., a psychologist and psychosis specialist, provided an example of a delusion â those firmly-held, false beliefs mentioned earlier. âIf you believe the FBI is after you when thereâs no evidence of that, thatâs a delusion,â Dr. Olesker said.
Olesker explained that hallucinations, on the other hand, affect the five senses. Some common examples include hearing voices and smelling things that arenât there.
There are lots of different types of hallucinations and delusions people can experience. Sure, the first ones that come to mind may be âhearing voicesâ or believing youâre at the center of a grand government conspiracy â but it can get a lot more complicated than that.
Because of this, I wanted to break down four different kinds of delusions and four types of hallucinations people who experience psychosis can have.
First, letâs explore the kinds of delusions you can experience.
Types of Delusions
1. Persecutory Delusions
Persecutory delusions are a form of paranoia that make you believe youâre being targeted or persecuted. Dr. Arenella said the specific persecutor, or entity believed to be chasing you, can vary from person to person. Arenella said a persecutor could be anything, from the government to specific person to a spirit.
Olesker emphasized these delusions donât always have to do with some sort of chase â they just relate to feeling endangered. âWe [see a lot of clients with] paranoid delusions,â Olesker said. â[Many think] someone is poisoning them.â
2. Referential Delusions
Referential delusions occur when you believe neutral events or objects you encounter in your day-to-day life contain a personal message specifically for you.
Arenella told The Mighty that when youâre experiencing a referential delusion, you might think signs around you are related to you. For example, you may see numbers or letters and extrapolate personal meaning from them.
When youâre seeing signs on the highway, and it says âexit 29,â and youâre like, âOh, Iâm 29 years old, this is telling me to exit here, that means youâre gonna kill me, and my time is over, because itâs exit 29.â And then I see this license plate and it says âJUD,â and thatâs part of my middle name. So youâre thinking that things around you are all referring back to you.
3. Religious Delusions
Like its name suggests, a religious delusion is a delusion involving religious content. Olesker said two examples of religious delusions include believing you are sent on a mission from God or are actually a deity or higher power yourself.
Arenella told The Mighty thereâs a line between ordinary worship and religious delusion, though sometimes it may be difficult to determine which is which. She said diagnosing is largely a matter of clinical judgment.
If somebody is preoccupied with a religious belief and itâs really more of a spiritual, religious experience, generally theyâre not in distress the way somebody with a religious delusion is. Usually, that person might be taking risks or interacting with people in a way thatâs making things worse. If itâs part of some sort of psychiatric episode⌠it tends to lead to more maladjustment.
4. Somatic Delusions
Somatic delusions are delusions relating to your physical body. These delusions can be medical in nature or simply have to do with your perception of your body.
âSomatic delusions [are when you think] thereâs something physically going on, or wrong, when thereâs not,â Olesker said. âYouâre pregnant and youâre not, or one foot is 10 times bigger than the other one.â
Now that weâve covered the different types of delusions somebody experiencing psychosis can have, letâs take a look at hallucinations.
Types of Hallucinations
1. Auditory Hallucinations
Auditory hallucinations, which occur when you hear something that isnât truly there, are some of the most common hallucinations. Though not all of us experience psychosis, Olesker said most of us have some understanding of auditory hallucinations whether we realize it or not.
âAll of us will experience auditory hallucinations of some sort,â Olesker said. â[For example], if you think you hear your name, and no oneâs really calling your name. But people with a psychotic disorder who are hearing voices will hear something way more intense.â
Auditory hallucinations are typically more vivid and disruptive than simply hearing something that isnât there. While experiencing an auditory hallucination, you might be told something you donât want to do â like hurt yourself or others. However, Olesker also pointed out the voices are not always negative or pessimistic.
âThey could hear a conversation happening, they might hear someone narrating what theyâre doing,â Olesker said. âThe voices could be friendly, they could be hostile. They could be voices that they know, or not.â
2. Visual Hallucinations
Visual hallucinations â or seeing things that arenât actually there â can be common in psychotic episodes. These hallucinations could be seeing something from your everyday life thatâs not really there â like someone you know for example â or something more âabnormalâ like seeing a deceased loved one.
â[You] might see something no one else sees,â Olesker said. âYouâll see somebody looking at something, and theyâre very sure they feel like somebodyâs outside of the window⌠Or they might say, âYou donât look like yourself, you look like this other person today.ââ
3. Tactile Hallucinations
Tactile hallucinations, feeling things that arenât there, are less common than auditory or visual hallucinations, but Olesker said they are still often reported.
âIâve definitely seen a lot of people with tactile hallucinations,â she said. âSomebody who thinks there are bugs crawling on their skin, which can also be a side effect of drug abuse, but that would be a psychotic symptom.â
Drug-induced psychosis can occur with many different kinds of drugs, from LSDÂ to marijuana. Singer Fergie spoke publicly about her experience with meth-induced psychosis in 2017 and how even after she stopped taking drugs, hallucinations persisted.
âIt took a year after getting off that drug for the chemicals in my brain to settle so that I stopped seeing things,â Fergie said. âIâd just be sitting there, seeing a random bee or bunny.â
4. Olfactory Hallucinations
Olfactory hallucinations are scent-related hallucinations, meaning you smell something that isnât really there. Sometimes referred to as phantosmia, olfactory hallucinations are rather uncommon, according to Olesker.
âIâve heard people say that they smell something burning, or some really unpleasant smell that no one else can smell.â she said.
Olesker said these kind of hallucinations can occur outside of psychosis in some medical conditions.
âSometimes you smell something thatâs not there as a symptom of a seizure,â she told The Mighty. âSo that would also be a hallucination, but that would not be a symptom of a psychotic disorder.â
In addition to seizures, olfactory hallucinations can occur in conditions like Parkinsonâs disease and brain tumors, as well as after a head injury or upper respiratory infection. Olfactory hallucinations in these cases are likely not associated with psychosis.
5. Gustatory Hallucinations
Gustatory hallucinations are taste-related hallucinations. In her years of practice, Olesker said sheâs never met somebody who has experienced a gustatory hallucination, though she said they can happen.
Arenella told The Mighty gustatory hallucinations often coincide with olfactory hallucinations.
âTheyâre unusual, but the sense of taste and smell go together. Usually [people smell] something very noxious,â she said. âEverything smells rotten, or bad, or something gross like burning flesh. Everything will smell like that, or taste like that.â
What to Do If You Experience PsychosisÂ
If you or somebody you know is experiencing psychosis, Olesker said the chief response should be empathy. Itâs not helpful to tell somebody who is experiencing hallucinations or delusions that itâs not real, because that simply wonât register for them.
âItâs not very helpful to try to talk someone out of a delusion because they truly believe it,â Olesker said. âSay âI believe that you believe that,â âI understand thatâs what youâre experiencing.ââ
Arenella agreed and made sure to note that visiting a professional is often helpful. She told The Mighty:
The person undergoing these things is usually pretty freaked out themselves. I think the more you can listen and validate whatâs going on, the better. If theyâre in distress, I would urge them to seek out a psychologist, somebody whoâs experienced in these things, to speak with them and find out a little bit more of whatâs going on.
Itâs important to keep in mind that if you or somebody you know is experiencing psychosis, treatment can help. The National Institute of Mental Health offers the Recovery After an Initial Schizophrenia Episode (RAISE) resources for those experiencing first-time psychosis. In addition, on their page about psychosis, Mental Health America offers a resource that allows people who believe they are experiencing psychosis to find the help they need and deserve. Scroll to the bottom of the page, look for the âgetting helpâ section, and go from there.
If youâve experienced psychosis, know youâre not alone. Despite what you may have heard or read, thereâs hope. Arenella noted itâs possible to live a full life with psychosis â itâs not a death sentence.
âPeople can and do function with hearing voices and having delusions, itâs not necessarily like you canât do anything and your life is over,â Arenella said. âIt can take a while to figure out how to live with those experiences in a way that is productive, but it certainly can be done.â
For more on what itâs like to live with psychosis, check out the following Mighty stories:
- What Itâs Like Experiencing Hallucinations You Enjoy
- Psychosis Isnât All About Seeing Demons in the Mirror
- Why We Need to Stop Believing People Who Experience Psychosis Are Dangerous
- Exploring the Connection Between Psychosis and Self-Harm
Can you relate?
GettyImages photo via Victor_Tongdee.