Understanding the Difference Between Hallucinations vs. Delusions

Hallucinations and delusions are often grouped together when talking about various illnesses or conditions, but they’re not the same. While both of them are part of a false reality, a hallucination is a sensory perception and a delusion is a false belief.

For instance, hallucinations can involve seeing someone who isn’t there or hearing people talking when there is no one around. Delusions, on the other hand, can involve someone thinking they are a celebrity when they’re not, for example.

Sometimes illnesses or medical conditions can cause hallucinations and/or delusions, or even psychosis. These illnesses can include:

• Parkinson’s disease
• Huntington’s disease
• brain tumors
• certain forms of dementia, like Alzheimer’s disease
• syphilis
• HIV
• some forms of epilepsy
• stroke
• substance use or withdrawal

Knowing the underlying causes of hallucinations and/or delusions is important, since an accurate diagnosis will help guide treatment.

Hallucinations are sensory experiences that one perceives as real when they’re actually not. They can be caused by medications, substance use, or certain medical or mental health conditions.

Hallucinations can be visual, olfactory (your sense of smell), gustatory (taste), auditory, or tactile. Someone might think they feel bugs on their skin, hear someone talking to them, see something that isn’t there, or even smell something that isn’t present.

Medical conditions that can cause hallucinations can include:

• substance use
• mental illness
• lack of sleep
• medications
• migraine
• seizures
• social isolation
• deafness, blindness, or vision problems
• epilepsy
• high fevers

Delusions are beliefs that are obviously false. They’re symptoms of a disturbance in thinking.

The belief in a delusion isn’t accounted for by cultural or religious background. They also have nothing to do with the intelligence of the person who believes them. These beliefs are held even with evidence of the contrary and despite what almost everyone else thinks.

Delusions can be about almost anything, but common types of delusions include:

• delusion of persecution
• delusion of infidelity
• delusions of love
• delusions of grandeur
• religious delusions
• delusions of guilt or unworthiness
• nihilistic delusions

Conditions that may cause delusions can include:

• schizophrenia
• affective psychosis, like in bipolar psychosis
• delusional disorder

In schizophrenia, an individual appears to have lost touch with reality. It’s often diagnosed after a psychotic episode, which can include hallucinations and delusions.

While these are often symptoms of schizophrenia, hallucinations and delusions present with other symptoms like:

• flat affect
• difficulty with everyday functioning
• problems with thinking and memory

Treatment for hallucinations depends on what’s causing them. Medications may be used, along with counseling.

The specific medication that will be prescribed depends on what the hallucinations are a symptom of. Counseling can help you with insight into what you’re experiencing and work with you to develop coping strategies.

If the hallucinations are because of a medication, your doctor may reduce the dosage of that medication or discontinue it.

Cognitive-behavioral therapy (CBT) is an effective way to treat delusions. CBT therapy is a process that involves building a relationship with a mental health professional, recognizing how delusions are affecting you, and implementing CBT strategies.

If the delusions are part of psychosis, CBT is often used together with antipsychotic drugs.

It can be easy to confuse hallucinations and delusions. Both are symptoms of psychosis, and indicate a break from reality. They also often occur together.

But though the two are related, hallucinations and delusions each have their own unique symptoms. Hallucinations indicate more of a sensory experience, and delusions are a false belief.

There are ways to help treat and manage hallucinations and delusions. With medication and therapy, an individual can manage their symptoms appropriately.

If you or a loved one are living with hallucinations or delusions, talk with your doctor. They can help you with next steps to get help, or refer you to a mental health professional who has more specialization and can provide the support you need.