Schizophrenia is a mental health condition that usually appears in early adulthood or late adolescence. Symptoms can include hallucinations, where a person experiences things that do not exist outside of the mind, such as hearing voices and seeing figures.

Schizophrenia is not a common condition, affecting around 0.25–0.64% of people in the United States. According to the National Health Service (NHS) in the United Kingdom, hearing voices is the most common hallucination that a person with schizophrenia experiences.

Hallucinations may feel real to the individual experiencing them, with studies and brain scans showing areas of the brain lighting up when they hear these voices.

Hallucinations can be frightening, or they can be friendly and pleasant. Each person will experience hallucinations differently and may have various triggers. While some may be able to cope with experiencing hallucinations, others may find it affects their ability to manage their day or live independently.

Treatment for schizophrenic hallucinations can include antipsychotic medications and therapy such as cognitive behavioral therapy (CBT). With treatment and support, those with schizophrenia can effectively manage their symptoms and live healthy, fulfilling lives.

This article explains what hallucinations are, particularly hallucinations as a symptom of schizophrenia. It also details causes, treatment, and ways to get support.

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Hallucinations are sensory experiences that can appear real to a person but are, in fact, part of their imagination.

Schizophrenic hallucinations are psychotic symptoms where a person can see, hear, smell, taste, or feel things that are not there. Older research from 2010 suggests that 70% of those with schizophrenia experience hallucinations.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) states that hallucinations are one of the five hallmark symptoms of schizophrenia.

Schizophrenic symptoms usually fall under “positive” or “negative” categories, meaning they are behaviors or experiences that affect a person’s life.

Hallucinations are “positive” schizophrenia symptoms falling under different categories:

  • Visual hallucinations: This can mean seeing physical objects or people that are not there. It can include loved ones who have died, imaginary characters, or distorted images.
  • Auditory hallucinations: This can mean things a person hears, such as voices, music, crying, ringing, and unknown languages.
  • Tactile hallucinations:This includes feeling things that are not there, such as the sensation of something on the skin.
  • Olfactory hallucinations: Also known as phantosmia, this refers to smelling things that are not there. Common examples include burnt toast or the smell of burning.
  • Gustatory hallucinations: This refers to imaginary tastes, such as bitterness or sourness.

2020 research suggests that up to 80% of people with schizophrenia experience auditory hallucinations. Many will experience multiple types at the same time, known as multimodal. A 2016 study involving 750 participants with schizophrenia found that 53% experienced multimodal hallucinations.

Another hallmark symptom of schizophrenia is delusions. Delusions are strong beliefs usually not held by others and can go hand in hand with hallucinations. However, hallucinations are sensory, while delusions involve thoughts. Both are forms of psychosis, which is a disconnect from reality.

Examples of the two forms together include a person:

  • believing creatures live under the skin, combined with the tactile hallucination of feeling things that are not there or the visual hallucination of seeing the skin crawl
  • having paranoid delusions — being suspicious of others and their motives, including seeing imaginary authority figures that are conspiring against them
  • believing they can communicate with the dead, along with the visual hallucination of seeing people who are no longer alive

According to the NHS, the exact causes of schizophrenia are unknown. Hallucinations likely result from irregularities within the brain, including chemistry, structure, experiences, and more.

Schizophrenia may result from a combination of factors, including:

  • Genetics: Schizophrenia can run in families, but there are no specific genes that are the direct cause of it. Studies suggest multiple genes can increase a person’s risk of developing the condition.
  • Brain structure: Certain areas of the brain may appear different in size in those with schizophrenia.
  • Environment: Environmental factors and lifestyle experiences may contribute to developing schizophrenia, including experiencing stressful situations such as poverty, danger, or issues at birth.

Some studies show an increase in brain activity of those experiencing hallucinations, particularly in certain parts such as the hypothalamus and paralimbic regions. Another 2021 study found a link to spontaneous activation in the brain, triggering sensory experiences.

Hallucinations can also occur outside of schizophrenia, such as:

Treatment for schizophrenic hallucinations involves managing symptoms such as hallucinations so they can have minimal effect on daily living.

  • Antipsychotic medications: These can help relieve the symptoms of psychosis, making them less intense or less frequent. Antipsychotic drugs can include first-generation antipsychotics, which block dopamine receptors in the brain to prevent signaling.
  • Psychotherapy: Therapy can help a person manage symptoms such as hallucinations. Therapies can include CBT, behavioral skills training, and cognitive remediation interventions. CBT may also help people manage symptoms such as anxiety and stress.

Supporting those with schizophrenic hallucinations can be challenging, particularly if they are distressing. However, some hallucinations may be comforting or nonfrightening, and a person may not feel the need to seek help regarding these.

The National Institute of Mental Health (NIMH) recommends the following ways to offer help and support:

  • Encourage a person to get treatment.
  • Try not to dissuade or discourage a person’s hallucinations, as they may seem real to them.
  • Try not to encourage delusions.
  • Always be respectful and supportive, particularly when hallucinations seem frightening or distressing.
  • Always involve a mental health professional, such as a psychiatrist or psychologist with experience in dealing with schizophrenia.

The National Alliance on Mental Illness (NAMI) offers numerous support groups for those facing challenges with mental health.

Schizophrenia does not have to be a debilitating condition. With treatment and support, hallucinations do not need to have a negative effect on life. Practicing self-care is also important in helping with the quality of life.

Self-care includes:

  • caring for mental and physical health
  • being attentive to one’s needs
  • maintaining a relationship with a community mental health team
  • avoiding alcohol, illegal drugs, and smoking, if applicable

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 and then 988.

Click here for more links and local resources.

Schizophrenia can cause symptoms such as hallucinations. These may include a person experiencing things that do not exist outside the mind, such as voices, bodily sensations, or figures.

Treatment can include antipsychotic medications, talking therapies such as CBT, and a community mental health team to ensure help and support.