Patients with pseudohallucinations perceive sensory impressions that are not preceded by an external stimulus. They are aware of the unreality of their perception, unlike in an actual hallucination. Febrile states and fatigue are sometimes the most common causes of pseudohallucinations.
What are pseudohallucinations?
Perception determines a person’s reality. Through his sensory systems, a person forms an impression of external reality and is eventually able to respond appropriately to the environment. The first instance of every perception is the binding of a stimulus molecule to the free nerve endings of the sensory cells. Pathological perceptions need not be preceded by an external stimulus. For example, perceptions that have no underlying environmental stimulus are known as hallucinations. Thus, the binding of external stimulus molecule to sensory cell is absent for hallucinations, although the affected person perceives them as real perceptions. Hallucinations can be substance-related or psychically induced and are in principle conceivable for any sensory area. Physically non-existent objects can be seen in the context of hallucinations. Non-existent voices can be heard, non-existent touches can be felt and non-existent smells as well as tastes can be perceived. A similar phenomenon is present in pseudohallucination. However, unlike the hallucinator, the pseudohallucinator knows that the sensory impressions perceived do not correspond to real perception.
Causes
Pseudohallucinations, unlike true hallucinations, are not usually caused by psychosis or substance abuse. Often, the supposed sensory perceptions occur during the falling asleep or waking stages, in which case they are referred to as hypnagogic or hypnopompic hallucinations. In addition, trance states and meditation can give context to the pseudohallucination. The same applies to states of exhaustion with severe fatigue or clouding of consciousness due to pathological processes such as fever. In states of affect, there may also be a subvariant of pseudohallucination called hysterical pseudohallucination. A special case of pseudohallucination is caused by some disease syndromes. At this point, the Charles-Bonnet syndrome should be mentioned, which leads to visual illusions due to a visual impairment. Sometimes also real hallucinations change into pseudohallucinations in the regression phase. Basically, there are smooth transitions between the two phenomena. A clear demarcation is difficult under certain circumstances.
Symptoms, complaints, and signs
The nature and context of the pseudohallucination determine the symptoms a pseudohallucinant suffers from in an individual case. Depending on the context, visual, auditory, gustatory, or tactile pseudohallucinations may occur. From perceived voices to whole objects, tastes, or touch, pseudohallucination can affect all sensory systems. The most important feature of pseudohallucination and at the same time the only reliable criterion of differentiation from true hallucination is the conscious judgment of the perceived as unreal, which is made by the patient himself. What accompanying symptoms are present in addition to the pseudohallucinations depends on the larger context of the hallucinatory event. For example, in the context of physical exhaustion, accompanying symptoms may include headache, persistent fatigue, or lassitude. The accompanying symptomatic context of Charles Bonnet syndrome, on the other hand, is visual disturbances. In pseudohallucinations due to disease processes, nonspecific disease symptoms such as fever or signs of infection are again to be expected.
Diagnosis and course of the disease
The diagnosis of pseudohallucinations is often a balancing act. In many cases, the phenomenon overlaps with manifest hallucinations or at least can easily merge into them. The medical history provides initial clues and gives the assessor important information about the patient’s mental state. In the diagnosis of pseudohallucinations, evidence must be provided that the patient judges what he or she perceives to be unreal. If, on the other hand, he judges the apparent sensory perceptions to be real, the diagnosis amounts to manifest hallucinations.The cause of the phenomenon is elucidated for both pseudohallucinations and true hallucinations in the course of further diagnostics and may require organ-specific testing. Patients with pseudohallucinations have a much better prognosis than those with hallucinations. However, the fact that pseudohallucinations often progress to true hallucinations turns out to be prognostically unfavorable.
Complications
As a result of pseudohallucinations, affected individuals suffer from a significantly reduced quality of life. In most cases, this involves the perception of sensory impressions that are not present. This can lead to social difficulties in particular. It is not uncommon for patients to suffer from depression or other psychological upsets as a result of the pseudohallucinations. The affected persons can also put themselves in danger of death. Furthermore, the patient suffers from severe headaches and a marked fatigue and a reduced ability to cope with stress. The patients themselves are permanently tired and not infrequently also suffer from visual disturbances. The pseudohallucinations are usually associated with an underlying disease, so that the further course of this disease depends very much on the underlying disease and its treatment. As a rule, however, those affected suffer from fever or other infections and inflammations. The treatment of pseudohallucinations is based on the treatment of the underlying disease. It cannot be universally predicted whether this will be successful. However, in some cases, the pseudohallucinations occur because of psychological complaints, so psychological treatment is necessary.
When should you see a doctor?
As soon as psychological abnormalities become apparent, there is cause for concern. If the affected person perceives things, smells, sounds, or people in his or her environment that are not present when viewed objectively, this phenomenon should be observed. In most cases, it is a short-term irritation that does not last or has a recurrent character. In case of permanent or repeated irregularities of sensory impressions, action is required. A visit to the doctor is necessary as soon as perceptions occur in which there is basically no external stimulus. If the affected person begins to communicate with imaginary persons in the firm conviction that they are real, a doctor must be consulted. If there are sudden flashes of insight, hearing of voices or tactile irregularities, medical clarification should be sought. If there is a fever, persistent overexertion, headache or fatigue, a physician should be consulted. If sleep disturbances, behavioral abnormalities, disorders of the sensory organs or a state of exhaustion are present, the affected person needs help. Disturbances of consciousness, restlessness or a depressed mood should be examined and treated. If the affected person seems absent, his participation in social life decreases, there are more interpersonal conflicts or an aggressive appearance, a visit to the doctor is advisable. If daily obligations can no longer be fulfilled, a doctor must be consulted.
Treatment and therapy
Whether a pseudohallucination requires treatment and how the phenomenon is ultimately treated depends on the circumstances of the hallucinatory event. For example, no treatment is indicated for a single occurrence. The patient observes himself or herself after the pseudohallucinatory event. If further events of the same type occur or the boundary between reality and unreality becomes blurred, treatment may be required. In principle, the patient’s quality of life is the primary consideration. As soon as the pseudohallucinatory events noticeably impair the quality of life, treatment makes sense. The type of treatment in this case depends on the context of the pseudohallucinations. Pseudohallucinations caused by physical exhaustion, for example, can be easily countered by the affected person paying attention to his or her sleep volume and, if necessary, taking forced leave. If the patient feels strongly disturbed by the perceived scenarios, although or precisely because he recognizes their unreality, conservative medical treatment can be given in the short term. Sedatives are suitable in this case for symptomatic relief of the problem.However, the persistent administration of medication in the context of pseudohallucination should be avoided, as otherwise an addiction to medication could develop with a later transition to real hallucinations. More appropriate in cases of persistent pseudohallucinations with a disturbing effect on the patient is cognitive behavioral therapy, in which the patient learns to abandon his or her own disturbance with regard to the perceptions.
Prevention
Pseudohallucinations cannot be entirely prevented because the phenomena may occur in the context of fever or fatigue states, and both of these states are part of every person’s physiological bodily responses.
Follow-up
The distinctive power of truth and imaginary is lacking in the sufferer when an actual hallucination is present. In a pseudohallucination, the sufferer is quite aware of what is not real about his experience. His power of judgment remains present. Aftercare for pseudohallucinations proceeds on a behavioral therapy level. The aim is for the patient to live as unrestrictedly as possible. To this end, he learns how to deal with the disease appropriately under the supervision of a psychotherapist. Crucial for a favorable prognosis is the patient’s ability to continue to differentiate between the real and the hallucinated. This ability should be preserved even after the follow-up treatment has been completed. It is “practiced” with the help of jointly developed methods in the therapy sessions and later in everyday life. This procedure is particularly advisable after a stay in a psychiatric ward. The patient must be guided step by step as he returns to his familiar environment. Moreover, the aftercare should prevent the emergence of an actual hallucination. The address of the treating therapist becomes the point of contact for the sufferer. There, the sufferer receives advice and support if everyday tasks cannot yet be managed on their own. In case of an unexpected deterioration after a stable phase, the patient should definitely visit the psychotherapeutic practice. The specialist can intervene and, if necessary, arrange for hospitalization.
What you can do yourself
Everyone knows the mental capers that our minds do before falling asleep. Suddenly, images appear that are surreal and indicate to the person that he is drifting off to sleep. Upon waking, a similar thing often happens: the surreal images slowly turn into real perceptions, and the sufferer wakes up. Fortunately, patients with pseudohallucinations are aware that their perceptions are not real. Therefore, they can generally cope well, possibly even downright enjoy them. It is possible, however, that the pseudohallucinations are based on a visual disorder, Charles Bonnet syndrome. A hallucinatory migraine attack or a particular form of dementia could also trigger the pseudohallucinations. In any case, affected persons should have this clarified and treated by an appropriate specialist. Further measures are not necessary for those affected, unless they suffer from the pseudohallucinations. In that case, psychological treatment is recommended, including relaxation techniques. Group therapy sessions have also proven effective for pseudohallucinations. Various self-help groups also offer advice, support and assistance on the Internet. In more severe cases, it is advisable to ask the treating psychologist about antipsychotics, anticonvulsants or serotonin antagonists. These medications can relieve symptoms.
