Hallucinations and delusions are both disturbing symptoms that are caused by schizophrenia. They are often lumped together and experienced at the same time, but they refer to distinctly different symptoms. Hallucinations and delusions can significantly interfere with your life, and they are just two of the many symptoms of schizophrenia. Learn more about schizophrenia and how hallucinations and delusions might affect you if you have them.

What’s the Difference between Psychosis and Schizophrenia?

Schizophrenia is a serious mental health disorder that can cause a long list of symptoms. People may experience schizophrenia differently. Two people with the disorder can have very different experiences and a unique set of symptoms. Schizophrenia is a mental disorder that’s often characterized by psychosis, which is a set of symptoms that can involve hallucinations and delusions. Schizophrenia and psychosis often go hand-in-hand, and the difference between the two may be difficult to understand when you look at them on a surface level. However, they are in distinct categories. 

Schizophrenia is a mental health diagnosis in the DSM. It describes a disorder that affects a person’s connection to reality. It may be described as a breakdown in the connection between a person’s thoughts, emotions, and behaviors. This breakdown can lead to a break in your perception of reality, actions and emotions that are inappropriate to the situation, withdrawal from real relationships, and increasing engagement with fantasy. Schizophrenia is often defined by the inability to tell the difference between real and imagined thoughts and scenarios. 

Schizophrenia often involves psychosis. Psychosis is not a diagnosable mental health disorder on its own. Instead, it’s a set of symptoms that can be caused by schizophrenia or other mental health problems. Psychosis can also be induced by certain drugs. For instance, a high dose of a stimulant can cause stimulant psychosis, which is a temporary break from reality. 

Psychosis involves symptoms like delusions and hallucinations, though some people can experience one or the other and not both.

What Causes Psychosis?

While schizophrenia and psychosis are both connected, it’s possible to experience one and not the other. Schizophrenia is just one cause of psychosis. There are other disorders that are similar to schizophrenia, like schizoaffective disorder, that can cause uncomfortable psychotic episodes. Psychosis can also be caused by mood disorders like major depression or bipolar disorder. For many, psychosis may be rooted in extreme moods. Very low moods as experienced in major depressive episodes can cause you to experience psychosis related to your self-image or the world around you. You may feel like there are conspiracies against you or that everyone hates you, even strangers in the street. Extremely high moods, as you would experience in a manic episode, may cause you to experience delusions of grandeur or thoughts that you are extremely powerful.

Psychosis may also be caused by very high levels of certain reward chemicals in the brain. Delusions and hallucinations can be caused when your brain becomes overstimulated by a drug or by the sudden lack of a drug. People experience psychosis symptoms after taking a high dose of a stimulant or misusing a powerful stimulant like cocaine. It can also occur in people that stop using a depressant abruptly after becoming chemically dependent.

But psychosis can also be induced by psychedelic drugs like LSD or DMT. These drugs work very differently as compared to stimulants and depressants. But they can cause a break from reality, and they can worsen mental health issues that are associated with psychosis like schizophrenia. 

However, the mechanisms for what causes psychosis may be more complicated than just extreme mood. Psychosis may be caused by multiple factors, not a single problem that can be pinpointed. Genetics, stress, developmental factors, and environmental factors can play a role. Other chronic diseases, outside of the realm of mental health disorders, can work similarly. For instance, heart disease also has genetic, environmental, and developmental components. 

What Causes Schizophrenia?

The cause for schizophrenia, like psychosis, can be difficult to pinpoint. Many mental health problems, and diseases in general, involve multiple factors. Schizophrenia has a strong biological factor, and researchers have studied the link between the disorder and genes. Genetics are often studied by looking at the way something affects twins. Identical twins share the same genetic code, so they can often help illuminate the relationship between genetic and environmental factors. While they share the same genes, they may have different experiences that can also influence the development of mental health issues like schizophrenia. Research indicates that around 50% of your risk of experiencing schizophrenia comes from genetics.

While that’s significant, it means that it’s not inevitable for you to experience the disorder if one or both of your parents do. Other risk factors include:

  • Viral infections that affect the brain
  • Exposure to certain toxins like lead
  • Prenatal malnutrition
  • Childhood trauma or abuse
  • Brain chemistry irregularities
  • High-stress levels
  • Significant life changes like the loss of a loved one

It’s important to note that many of these factors were identified by looking at common factors among people with schizophrenia. It may be unclear how much these risk factors influenced the development of schizophrenia. 

What’s the Difference Between a Delusion and a Hallucination?

delusions vs hallucinations

Hallucinations and delusions are two of the major psychotic symptoms that are caused by schizophrenia. They are often experienced together, but they do refer to different symptoms. Hallucinations refer to a break from reality that affects your senses and perceptions, while delusions affect your thoughts and beliefs. 

 

What are Hallucinations?

Hallucinations are usually associated with seeing or hearing things that other people do not sense. However, some people experience hallucinations that involve smells, touch, and even taste. Hallucinations can be subtle, like noticing something in the corner of your eye and turning to see nothing there. Many people hear voices that whisper or even speak loudly. Sadly, it’s common for voices to put you down or attack your sense of self-worth. Others hear voices that give them commands to do things that they know they shouldn’t do.

Hallucinations can be caused by serious mental health issues, but they can also be caused by everyday issues like a lack of sleep or migraines. Hallucinations may be more common than you think. Research into what is happening in the brain during a hallucination has revealed that the same areas of the brain that activate when you perceive real sights and sounds also activate during hallucinations. The brain is designed to fill in gaps in your senses. Even people that have gone blind or deaf may see or hear things that other people can’t. Hallucinations may be a misfire of the parts of the brain that are meant to supplement our perception of reality.

However, mental health problems like schizophrenia can cause hallucinations that can last for longer than a single moment. In those cases, hallucinations can impair a person’s life by getting in the way of their work, relationships, and personal care. Hallucinations can be disturbing, causing increased stress, anxiety issues, and depression. 

What are Delusions?

People often levy the term delusional at people that disagree with them, but delusional thinking is more than just being mistaken about something. Delusions are false thoughts and beliefs despite reason, logic, and evidence. Delusions can be illogical, like the thought that a news anchor on TV is sending you coded messages. But they may also be more subtle, like the belief that a spouse is unfaithful, despite any evidence or reason to believe so. People with delusions may also resist any evidence against false beliefs, which can make severe delusions very difficult to treat. There are also several types of delusions, and a person may only experience one kind or a mixture. 

The types of delusions include:

  • Persecutory delusions. Persecution delusions involve the belief that forces are working against you. You may think all the people in your life are trying to ruin you or that the government has sent people to kill you. 
  • Infidelity or jealous delusions. This is the belief that a spouse or partner is cheating on you whether they are or not. It can also involve possessiveness or obsession towards another person that’s inappropriate or unhealthy. It can sometimes involve other friends in loved ones outside of romantic relationships.
  • Love or erotomanic delusions. Love delusions are beliefs that someone famous or noteworthy is in love with you, even if you’ve never met. The thought that a celebrity is in love with you may dominate your thoughts and become an obsession. 
  • Grandiose delusions. This is the belief that you are extremely gifted or powerful. You may believe that you are the only person that can solve a particular problem. This kind of delusion is often associated with manic episodes or high moods.
  • Somatic delusions. This is the false belief that something is wrong with you physically. You may believe that you have a disease or physical defect, despite seeing a doctor that reports a clean bill of health. 
  • Mixed delusions. Mixed delusions may involve more than one of the other types. For instance, you may believe that there is a government conspiracy against you and that only you are smart enough to stop it. 

Delusions can dominate your thoughts and alienate you from your friends and family. They can make it difficult for you to concentrate on other life goals or maintain employment. Since they are often resistant to contradiction, they may be difficult to treat with talk therapy without medication or other interventions. 

What Are the Other Schizophrenia Symptoms?

Hallucinations and delusions are just two of the many possible symptoms that are caused by schizophrenia. Schizophrenia symptoms are separated into two categories: positive and negative symptoms. This doesn’t mean that some symptoms are good while other symptoms are bad. Instead, it means that some symptoms add something to normal brain functions while other symptoms take away something.

For instance, hallucinations and delusions are considered positive symptoms. Hallucinations add sensory experiences that are not naturally produced or perceived by your brain. Delusions add thoughts and beliefs that you may not come to otherwise. Another positive symptom of schizophrenia involves erratic or repeated movements that are unconscious or difficult to control.

Negative symptoms may be more subtle than positive schizophrenia symptoms, but they can be equally distressing. Here are some of the most common negative symptoms of schizophrenia:

  • Flat affect. This can refer to monotone or emotionless speech, even when more emotion is appropriate. You may react to very bad and very good news like it was neutral information. Speech may sound robotic, and your facial expressions will remain neutral. 
  • Anhedonia. Anhedonia is the inability to feel pleasure. Things that normally give you mood-lifting feelings and emotions may feel like nothing to you. It may be difficult to achieve feelings of pleasure, which can cause feelings of depression or apathy.
  • Isolation. Isolation is a common symptom of mental health issues. Even common mental illnesses like anxiety and depression can cause you to withdraw from time to time. However, schizophrenia may cause extreme isolation. You may feel like you can’t connect with other people or the world in a meaningful way, so you withdraw and remain by yourself.
  • Depression. Depression is a common symptom of schizophrenia, and it’s often misdiagnosed as a major depressive disorder. Severe depression can even cause psychotic symptoms like persecutory or somatic delusions. 

How is Schizophrenia Diagnosed?

Schizophrenia can be diagnosed with the help of the Diagnostic and Statistical Manual of Mental Disorders, which is the main diagnostic tool that doctors and clinicians use to identify mental health issues. Getting a diagnosis will involve meeting with a healthcare professional and possibly a specialist that has experience with schizophrenia. To get an accurate diagnosis, you may start with a physical examination and lab tests. There is no physical test that can diagnose schizophrenia, but it can rule out other potential causes for your symptoms. In some cases, vitamin deficiencies can cause some mental health symptoms. Issues that cause insomnia and severe fatigue can also cause hallucinations and delusions. 

If your doctor or therapist suspects that your problem is a mental health issue, you may go through a psychological assessment. Your therapist will likely consult the DSM to investigate issues like schizophrenia. According to the fifth edition of the DSM, you must experience two or more schizophrenia symptoms for a significant amount of time during a period of one month. In other words, symptoms can’t be fleeting or few and far between. 

The DSM’s list of schizophrenia symptoms include:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Negative symptoms, like diminished emotional expression

In some cases, only one symptom is necessary if that symptom is severe. The DSM lists bizarre delusions or hearing constant voices that keep a running commentary or talk two one another as severe symptoms. 

Schizophrenia also leads to disorders in your life. If these symptoms disturb one or more areas of your life, like your work or social life, it may point to schizophrenia. This also means that impairment is worse than what it was before your schizophrenia symptoms started. 

In addition to the one month of frequent symptoms, you will also experience at least six months of residual symptoms. These symptoms may be less severe and include things like negative symptoms or odd beliefs.

To qualify as schizophrenia, other disorders that can cause some similar symptoms have to be ruled out. This includes schizoaffective disorder and mood disorders. Substance use issues and other medical issues must also be ruled out. 

How is Schizophrenia Treated?

Because schizophrenia interferes with your perception of reality and your ability to tell the difference between fantasy and reality, it can be difficult and challenging to treat. However, it is a treatable disorder, and treatment can be extremely beneficial in allowing someone with schizophrenia to live a healthy life. Still, it often requires clinicians and therapists that specialize in treating schizophrenia and other issues that cause psychosis. 

Schizophrenia treatment often involves a combination of medication and psychotherapy. It’s often a good idea to reserve long-term treatment with medication until you’ve tried other options, like psychotherapy. However, psychosis can make it difficult to participate in therapy sessions. Hallucinations, delusions, and other symptoms may cause immense anxiety, lower your sense of self-efficacy, or break down your trust in your therapist. For that reason, schizophrenia treatment often involves the use of prescription medications like antipsychotics. 

However, once some of the most disruptive symptoms of schizophrenia have been addressed, psychotherapies can be extremely helpful in the long-term management of schizophrenia. Here’s a breakdown of some common treatment approaches. 

Medications

There are several prescription medications that are used to treat schizophrenia. They fall under the category of antipsychotics, but they are broken down into two categories. The first category is called typical or first-generation antipsychotics. The second category is called atypical or second-generation antipsychotics. Antipsychotic drugs work by interacting with dopamine receptors in the brain. Dopamine is an important brain chemical that’s involved in reward, positive feelings, motivation, and other functions. Its role in the brain is thought to be related to the development of schizophrenia symptoms, including psychosis. They often block receptors to prevent them from taking effect in the brain.

Typical Antipsychotics

The first-generation antipsychotic drugs block specific dopamine receptors in all areas of the brain. In the areas that are tied to some of the positive effects of schizophrenia, like delusions and hallucinations, typical antidepressants can be very helpful. First-generation antipsychotics can alleviate hallucinations and delusions. However, in the parts of the brain that are associated with the negative symptoms of schizophrenia, like flat affect, typical antidepressants can worsen symptoms. For that reason, people with schizophrenia that take typical antidepressants often experience an improvement in some symptoms and worsening of other symptoms. Because of this, typical antipsychotics aren’t used that often, but they may be used to treat specific problems like mania. Some examples of typical antipsychotics include Haldol (haloperidol) and Loxitane (loxapine).

Atypical Antipsychotics

Atypical antipsychotics work in a way that’s similar to the first generation of antipsychotic medications. Second-generation antipsychotics block dopamine receptors like typical antipsychotics, but they also block a certain serotonin receptor called 5-HT2A. Serotonin blocks dopamine receptors in certain brain regions. This may allow the dopamine receptors to be blocked in areas of the brain that are related to positive symptoms but allow them to bind to their receptors in the other areas of the brain that need them. In other words, second-generation antipsychotics may alleviate positive symptoms like delusions and hallucinations without worsening other symptoms. Examples of atypical antipsychotics include clozapine and olanzapine. 

Psychotherapy

When psychotic symptoms are brought under control, other therapy options can be effective and beneficial. Psychotherapy is a broad category of therapeutic approaches that involve examining the psychological causes, consequences, and tools that are related to a mental health problem. Talk therapy is a common form of psychotherapy that often involves individual sessions with a therapist. Group therapy sessions can also be beneficial in helping a person feel less isolated in a disorder. It can also offer practical insights like day-to-day management techniques. 

Behavioral therapies are also commonly used to treat schizophrenia. Cognitive-behavioral therapy is a type of therapy that’s designed to help you identify triggers, thoughts, and behaviors that lead to negative emotions and a relapse of certain symptoms. CBT is also useful in treating other issues that are often associated with schizophrenia, like anxiety, depression, and substance use problems. CBT is centered around developing effective coping mechanisms that can help you avoid negative emotions and destructive behaviors. It also involves developing a sense of self-efficacy, which is the belief that you are capable of overcoming challenges in your recovery.

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