The Mighty Logo

9 Types of Hallucinations and Delusions You May Not Know About

The most helpful emails in health
Browse our free newsletters

Written by Felix Kalvesmaki

I had my first psychotic experience when I was 16. I sat in my desk chair at my parents’ house, in the middle of spring break, wondering why I felt cameras on me. I looked around my room — between books on my bookshelf, under my bed, behind the chess board I kept on my dresser — and found nothing. But I still felt watched. And I couldn’t shake that feeling.

I didn’t 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 — they were what I was experiencing. Delusions are firmly-held beliefs that are clearly false to everyone except the person affected. They’re fundamental aspects of my schizoaffective disorder — a diagnosis combining a mood disorder, like depression or bipolar disorder, with schizophrenia. I didn’t know it then, but I was going through my first psychotic break — an experience often described as a “break from reality.”

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 “consensual reality.” 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 it’s 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 — those firmly-held, false beliefs mentioned earlier. “If you believe the FBI is after you when there’s no evidence of that, that’s a delusion,” 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 aren’t there.

There are lots of different types of hallucinations and delusions people can experience. Sure, the first ones that come to mind may be “hearing voices” or believing you’re at the center of a grand government conspiracy — 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, let’s 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 you’re 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 don’t always have to do with some sort of chase — they just relate to feeling endangered. “We [see a lot of clients with] paranoid delusions,” Olesker said. “[Many think] someone is poisoning them.”

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 you’re 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 you’re seeing signs on the highway, and it says ‘exit 29,’ and you’re like, ‘Oh, I’m 29 years old, this is telling me to exit here, that means you’re gonna kill me, and my time is over, because it’s exit 29.’ And then I see this license plate and it says ‘JUD,’ and that’s part of my middle name. So you’re 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 there’s 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 it’s really more of a spiritual, religious experience, generally they’re 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 that’s making things worse. If it’s 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.

“Somatic delusions [are when you think] there’s something physically going on, or wrong, when there’s not,” Olesker said. “You’re pregnant and you’re not, or one foot is 10 times bigger than the other one.”

Now that we’ve covered the different types of delusions somebody experiencing psychosis can have, let’s take a look at hallucinations.

Types of Hallucinations

1. Auditory Hallucinations

Auditory hallucinations, which occur when you hear something that isn’t 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.

“All of us will experience auditory hallucinations of some sort,” Olesker said. “[For example], if you think you hear your name, and no one’s really calling your name. But people with a psychotic disorder who are hearing voices will hear something way more intense.”

Auditory hallucinations are typically more vivid and disruptive than simply hearing something that isn’t there. While experiencing an auditory hallucination, you might be told something you don’t want to do — like hurt yourself or others. However, Olesker also pointed out the voices are not always negative or pessimistic.

“They could hear a conversation happening, they might hear someone narrating what they’re doing,” Olesker said. “The voices could be friendly, they could be hostile. They could be voices that they know, or not.”

2. Visual Hallucinations

Visual hallucinations — or seeing things that aren’t actually there — can be common in psychotic episodes. These hallucinations could be seeing something from your everyday life that’s not really there — like someone you know for example — or something more “abnormal” like seeing a deceased loved one.

“[You] might see something no one else sees,” Olesker said. “You’ll see somebody looking at something, and they’re very sure they feel like somebody’s outside of the window… Or they might say, ‘You don’t look like yourself, you look like this other person today.’”

3. Tactile Hallucinations

Tactile hallucinations, feeling things that aren’t there, are less common than auditory or visual hallucinations, but Olesker said they are still often reported.

“I’ve definitely seen a lot of people with tactile hallucinations,” she said. “Somebody 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.”

Drug-induced psychosis can occur with many different kinds of drugs, from LSD 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.

“It took a year after getting off that drug for the chemicals in my brain to settle so that I stopped seeing things,” Fergie said. “I’d just be sitting there, seeing a random bee or bunny.”

4. Olfactory Hallucinations

Olfactory hallucinations are scent-related hallucinations, meaning you smell something that isn’t really there. Sometimes referred to as phantosmia, olfactory hallucinations are rather uncommon, according to Olesker.

“I’ve heard people say that they smell something burning, or some really unpleasant smell that no one else can smell.” she said.

Olesker said these kind of hallucinations can occur outside of psychosis in some medical conditions.

“Sometimes you smell something that’s not there as a symptom of a seizure,” she told The Mighty. “So that would also be a hallucination, but that would not be a symptom of a psychotic disorder.”

In addition to seizures, olfactory hallucinations can occur in conditions like Parkinson’s 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 she’s 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.

“They’re unusual, but the sense of taste and smell go together. Usually [people smell] something very noxious,” she said. “Everything smells rotten, or bad, or something gross like burning flesh. Everything will smell like that, or taste like that.”

What to Do If You Experience Psychosis 

If you or somebody you know is experiencing psychosis, Olesker said the chief response should be empathy. It’s not helpful to tell somebody who is experiencing hallucinations or delusions that it’s not real, because that simply won’t register for them.

“It’s not very helpful to try to talk someone out of a delusion because they truly believe it,” Olesker said. “Say ‘I believe that you believe that,’ ‘I understand that’s what you’re experiencing.’”

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 what’s going on, the better. If they’re in distress, I would urge them to seek out a psychologist, somebody who’s experienced in these things, to speak with them and find out a little bit more of what’s going on.

It’s 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 “getting help” section, and go from there.

If you’ve experienced psychosis, know you’re not alone. Despite what you may have heard or read, there’s hope. Arenella noted it’s possible to live a full life with psychosis — it’s not a death sentence.

“People can and do function with hearing voices and having delusions, it’s not necessarily like you can’t do anything and your life is over,” Arenella said. “It 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.”

For more on what it’s like to live with psychosis, check out the following Mighty stories:

Can you relate?

GettyImages photo via Victor_Tongdee.

Originally published: May 13, 2019
Want more of The Mighty?
You can find even more stories on our Home page. There, you’ll also find thoughts and questions by our community.
Take Me Home