What Is The Difference Between Delusions and Hallucinations?
In This Article
It can be challenging to distinguish a delusion from a hallucination, but recognizing what sets them apart can help keep a person grounded in reality. Differentiating the two can also inform you of these episodes' potential causes and triggers.
In this article, we’ll go over what each symptom entails, how to identify them, and what you can do to treat such conditions.
Delusion vs. Hallucination: Key Differences
While hallucinations are sensory experiences, a delusion is an inherently false belief. Both are disturbances in reality, but research shows that hallucinations are more common.
How Do Causes Vary?
Hallucinations and delusions typically stem from the same medical conditions, such as:
- Forms of dementia
- Forms of epilepsy
- Substance abuse or withdrawal
Hallucinations and delusions can also result from acute stress, trauma, and sleep disturbances. However, delusions are not as prevalent from these causes.
Remember that hallucinations and delusions do not always indicate a mental illness. This is why getting a diagnosis from a mental health professional is crucial.
How are Delusions and Hallucinations Diagnosed?
Hallucinations and delusions are symptoms of other medical conditions and require treatment for their underlying causes. A mental health professional will diagnose these causes through the following procedures:
- Psychiatric testing and evaluation
- Blood tests
- Drug screenings
- Imaging scans (MRI)
Understanding the Role of Psychosis and Schizophrenia
People with hallucinations and delusions may be experiencing signs of psychosis and schizophrenia.
While psychosis isn’t a condition itself, it’s a mental health problem that causes people to perceive things differently or inaccurately from reality. Hallucinations and delusions co-occur with psychosis, and experiencing these together results in a psychotic episode.
Hallucinations and delusions are also likely to occur in someone with schizophrenia, which causes people to lose touch with reality. They can occur with other symptoms like:
- Thinking and memory issues
- Difficulty performing everyday tasks
- Flat affect, or feeling emotions but being unable to demonstrate them visually
What are Delusions?
Delusions are persistent false beliefs not based on reality. These delusions occur independently of a person’s cultural or religious background, so a person’s intelligence doesn’t influence the delusions they may have.
There are two kinds of delusions:
- Non-bizarre delusions: These delusions refer to plausible circumstances like being stalked, spied on, conspired against, or cheated on.
- Bizarre delusions: These delusions refer to non-plausible circumstances like alien encounters or relationships with imagined beings.
What Are the Different Types of Delusions?
Delusions manifest in people under the following categories:
- Grandiose delusions: Believing they are rich, powerful, famous, talented, or knowledgeable.
- Jealous delusions: Believing their partner is unfaithful to them or their family members have somehow betrayed them.
- Somatic delusions: Believing they have a medical problem or disability they don’t have.
- Persecutory delusions: Believing someone is spying on or mistreating/hurting them.
- Erotomanic delusions: Believing an important person (typically a celebrity) is in love with them.
A person may also experience mixed delusions or a combination of two or more delusions listed above.
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What Causes a Person to Experience Delusions?
While no known direct cause of delusional disorder exists, certain mental illnesses and factors can make its occurrence more likely. Delusions can be linked to the following variables:
A person is more likely to develop delusions if they have family members with the same condition. It isn’t uncommon for a parent with the condition to pass it on to their child.
Abnormal brain regions and conditions like schizophrenia, Alzheimer’s disease, and affective psychosis (common in bipolar disorder) may directly correlate to delusional symptoms.
Stress can trigger delusions, along with persistent alcohol and drug use. These can be a result of individual actions or environmental circumstances.
For example, isolated people, such as immigrants and homeless people, can be more susceptible to stress and more likely to experience delusions. The same is true for people with poor sight and hearing.
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What are Hallucinations?
Hallucinations are sensory experiences a person may think are real, even when they aren’t. These experiences are typically symptoms of a psychosis-related disorder like schizophrenia or as a result of substance use or intoxication.
What Are the Different Types of Hallucinations?
An individual can experience hallucinations in the following ways:
- Auditory: Hearing sounds that aren’t real, like footsteps, noises from devices, or whispering—voices may be negative or positive and may potentially encourage harm to the self or others.
- Olfactory: Experiencing smells that don’t exist or that no one else can smell.
- Visual: Seeing people, objects, or places that don’t exist or that no one else can see.
- Tactile: Feeling movement in the body, like bugs crawling underneath the skin or organs moving around.
- Gustatory: Tasting something strange or unpleasant (typically metallic).
- Presence: Feeling like someone is in the room when they aren’t.
- Proprioceptive: Feeling as though you are flying or floating.
Some hallucinations are sleep-related, including the following:
- Hypnopompic: It occurs shortly after an individual wakes up from sleep and is common in people with sleeping disorders.
- Hypnagogic: Short-lasting and occurs as an individual falls asleep—86% of hypnagogic hallucinations are visual.
What Causes Hallucinations?
Possible causes of hallucinations might include the following:
- Schizophrenia: According to schizophrenia research, 70% of people with the condition experience visual hallucinations, while 60% to 90% experience auditory ones.
- Parkinson’s disease: Sufferers typically experience hallucinations visually.
- Alzheimer's disease and Lewy body dementia: Brain changes may cause hallucinations.
- Brain tumors: Vision-related tumors can cause sufferers to see things that aren’t real.
- Migraines: People with this specific type of headache may experience “auras,” or multicolored crescents of light.
- Charles Bonnet syndrome: Macular degeneration, glaucoma, and cataracts can cause people to see things that aren’t there.
- Epilepsy: Seizures that affect specific parts of the brain can cause hallucinations.
- Psychedelic drug ingestion: magic mushrooms, LSD, etc.
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What Interventions are Available for Hallucinations?
Like delusions, your doctor will treat hallucinations by addressing the underlying cause. Treatments might include:
- Medication for schizophrenia or dementia (antipsychotic drugs)
- Antiseizure drugs
- Treatment for macular degeneration, glaucoma, and cataracts
- Triptans, beta-blockers, or anticonvulsants
- Surgery or radiation
- Individualized or family therapy
Severe hallucinations, delusions, or psychosis may require hospitalization if a person is at high risk of injuring themselves or others.
While it can be challenging to prevent a hallucination, training your mind and adjusting your environment can prevent you from having an episode. You can exercise precautionary measures, such as:
- Equipping your home with good lighting
- Engaging in stimulating activities to stay alert
- Covering mirrors with a removable cloth
- Identifying sounds that may be easily misinterpreted, such as the ticking from a clock or static from a television
Treatment Options for Delusions and Hallucinations
The treatment plan for someone experiencing hallucinations may differ from those experiencing delusions. Ultimately, treatment will depend on the underlying cause.
Delusions are commonly treated with medications and psychotherapy. While it’s notoriously challenging to treat, half of patients respond well to antipsychotic medications.
Below are the primary medications used to treat delusions:
- Conventional antipsychotics: These block dopamine receptors in the brain. Medications include chlorpromazine, haloperidol, loxapine, and trifluoperazine, among others.
- Atypical antipsychotics: These block dopamine and serotonin receptors in the brain and cause fewer movement-related side effects. Medications include aripiprazole, clozapine, paliperidone, quetiapine, and ziprasidone.
- Other medications: Some healthcare providers may prescribe sedatives or antidepressants to treat symptoms that occur with delusions.
Alongside medication, the most common types of psychotherapy used to treat delusions include the following:
- Cognitive behavioral therapy (CBT): Patients can challenge unshakable beliefs by altering thought patterns that lead to negative symptoms.
- Family therapy: Families can learn more effective tactics and coping strategies to support their loved ones.
How You Can Help Someone Experiencing Hallucinations and Delusions
As a family member, friend, or caregiver, caring for someone experiencing psychosis can be challenging, but it isn’t impossible. Here are a few tips when helping someone experiencing hallucinations and delusions:
- Be calm: Don’t get excited, loud, or argumentative. Make the environment safe for the individual.
- Stay neutral: Never argue with someone experiencing a delusion or hallucination, even with evidence to contradict their beliefs. Even the most outlandish experiences are real to the person—you don’t want to invalidate them while they are under heightened stress.
- Educate yourself: Learning the difference between delusion and hallucination can make it easier to identify symptoms and pursue the most appropriate actions.
- Know when to seek medical attention: If the psychotic episode is too much to handle alone, take your loved one to the hospital. As much as possible, attempt to take the person to emergency services with their consent, as they may feel compelled to hurt themselves or someone else.
Frequently Asked Questions on Delusions and Hallucinations
Is hearing voices always indicative of a mental disorder?
No, hearing voices is not always indicative of a mental disorder. However, hearing voices is a hallucination, as it is a sensory experience a person believes is real but isn’t.
Are there any long-term effects of persistent hallucinations or delusions?
Long-term effects of persistent hallucinations or delusions can include impaired social and occupational functioning, increased risk of self-harm or hurting others, and a reduced quality of life.
How can caregivers support someone experiencing delusions or hallucinations?
Caregivers can support someone experiencing delusions or hallucinations by maintaining a calm and non-confrontational approach, encouraging them to seek professional help, and ensuring their safety.
Can these symptoms occur in the absence of a mental disorder?
Hallucinations and delusions can occur without a mental disorder due to substance use, medication side effects, sleep deprivation, or extreme stress.
What's the role of medication in managing these symptoms?
Medicines, such as antipsychotics, may be prescribed by a healthcare professional to manage hallucinations and delusions. This is more common in people with psychiatric disorders to alleviate symptoms and improve their quality of life.
Delusions and hallucinations are symptoms of psychosis and other medical conditions. While hallucinations are more common than delusions, they can occur simultaneously and negatively affect an individual’s quality of life.
The main difference between a delusion and a hallucination is that the former is a false belief in something removed from reality, whereas the latter is a sensory experience. Either may be a symptom of an over-arching mental illness.
The diagnostic process involves psychiatric exams, blood testing, and drug screening. People having delusional thoughts can have their symptoms treated medically and through therapy. It’s best to consult a medical professional if you or someone you know is experiencing hallucinations or delusions for an accurate diagnosis.
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- Gearing et al. “Association of religion with delusions and hallucinations in the context of schizophrenia: Implications for engagement and adherence.” Schizophrenia Research, 2011.
- Cipriani et al. “Understanding delusion in dementia: A review.” Geriatrics & Gerontology, 2013.
- Waite et al. “The patient experience of sleep problems and their treatment in the context of current delusions and hallucinations.” Psychology and Psychotherapy: Theory, Research, and Practice, 2015.
- Van der Gaag et al. “The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: A meta-analysis.” Schizophrenia Research, 2014.
- Rajapakse et al. “Themes of delusions and hallucinations in first-episode psychosis.” Early Intervention: In Psychiatry, 2011.
- Jordaan, G.P., and Emsley, R. “Alcohol-induced psychotic disorder: a review.” Metabolic Brain Disease, 2014.