Can PTSD cause hallucinations?

PTSD (post-traumatic stress disorder) is a common behavioral health condition that can be debilitating and last for a long time if left untreated. PTSD occurs in the aftermath of a traumatic event in which an individual either feared for their life or safety or that of someone else. Research has found a connection between PTSD and symptoms of psychosis, including PTSD paranoia, hallucinations, and delusions. But how often are these conditions seen, and what is the most effective course of treatment? In this article, we'll provide information about each of these conditions and explore the connection between the two, as well as what treatments may be helpful.

What is PTSD?

PTSD is a mental health condition caused by an intensely fearful situation, such as participating in active combat, being in a car accident, or surviving domestic violence. A diagnosis of PTSD requires a specific trigger, usually from a traumatic event, that leads to the development of certain related symptoms.

The core symptoms of PTSD include avoidance, intrusive memories, emotional reactivity or numbness, sleep disturbances, panic attacks, hypervigilance, and dissociation. These symptoms may also lead to chronic low mood states and negative thinking patterns. PTSD symptoms can range from mild to severe and can get in the way of the person's ability to lead a normal and fulfilling life. These symptoms indicate that the brain's fear response system has become effectively "stuck" in the “on” position, perceiving threats from relatively harmless stimuli and firing false alarms.

While not everyone will develop PTSD in the aftermath of a trauma, it is a common condition that affects up to 14 million adults in the United States. We're still learning exactly what leads to certain people developing the condition and not others. It appears to be partially related to genetics and individual vulnerabilities in certain brain structures.

For some people, psychotic disorders may occur secondary to PTSD symptoms. While the link between the conditions is still being investigated, there is evidence of a connection.

Can PTSD cause hallucinations?

Hallucinations can be the result of trauma, which triggers PTSD to develop. They can be similar to flashbacks in that you feel as if you are experiencing the trauma all over again. Be aware, however, that PTSD is not the only cause of psychotic symptoms; hallucinations can result from drug abuse, a head injury, or even monocular disease, among other reasons. While it’s rare to have hallucinations as a result of PTSD, it is possible. If you are experiencing hallucinations, it can be important to speak with a medical professional about their origin and treatment.

How do you know if you're hallucinating?

A hallucination feels incredibly real to the person having it, even though there are no external stimuli to cause it. Many risk factors can cause hallucinations, such as:

• Anxiety disorders

• PTSD

• Lack of sleep

• Stress

• Substance misuse

• Epilepsy

• Medications

• Extreme grief

• Depression

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

In addition, some dissociative factors, many of which result from childhood abuse, could also cause hallucinations, including:

• Memory loss and amnesia

• Detachment

• Relationship challenges

If you believe that you are experiencing hallucinations, contact a mental health professional for help. A professional therapist can help you manage symptoms of cognitive and dissociative factors and look after your well-being. 

What is psychosis?

Psychosis refers to symptoms that cause an individual to be disconnected from reality. Psychotic symptoms are grouped into two distinct categories: positive symptoms and negative symptoms.

Positive symptoms are the addition of thoughts, behaviors, and mental states. The person may be aware that these symptoms represent things that are not real (referred to as "insight") or, in more severe cases, may be unable to differentiate between what is real and what isn't. Positive symptoms of psychosis include:

• Paranoia: You may feel like someone or something is out to get you. You may think you're being followed or listened to, or you may have obsessive thoughts that someone is trying to conspire against you.

• Hallucinations: A hallucination is the perception of something that is not real. Hallucinations can be visual, auditory, tactile (physical), or even smells or tastes. You may hear voices when there's no one around, smell a scent with no apparent source, or see shadowy figures that don't exist.

• Delusions: A delusion is a belief that you hold on to despite evidence showing it is not true. An example of a delusion is believing you can communicate with TV show characters or that someone in the government has put a tracker in your car. Delusions can also be present on a smaller scale, such as the feeling that someone is always watching you.

Other positive symptoms are sometimes apparent, including racing thoughts, agitation, aggression, and fast speech.

Negative symptoms, on the other hand, represent a loss of functioning for the individual. Negative symptoms include a severe loss of motivation, emotional withdrawal, dissociation, apathy, social withdrawal, and other symptoms. Negative symptoms are seen less frequently with PTSD, but their presence can complicate the progress of treatment.

The connection between PTSD and psychosis

Over the last few decades, research has begun to piece together the connection between PTSD and psychotic disorders. Lifetime rates of comorbid psychotic disorders in those living with PTSD are estimated at 30%, versus less than 8% in the general population. One study of over 5,000 people in the U.S. showed 52% experience correlated PTSD and psychotic symptoms.

Positive symptoms are most frequently identified as being connected to PTSD, although negative symptoms are sometimes reported in patients who have had PTSD for an extended period. Trauma could be a risk factor for both conditions, especially if the traumatic event occurred early in life. Childhood trauma, often the result of childhood abuse) has a strong connection with both PTSD and psychotic disorders.

Can PTSD trigger psychosis?

A traumatic event can trigger an episode of psychosis or comparatively milder, transient psychotic symptoms. Often psychosis is temporary, brought on by a stimulus that reminds the person of the traumatic event. Symptoms may come and go and be related to the trauma in some fashion. Fear and anxiety are often reported to be direct triggers of positive psychotic symptoms. For example, a certain ringtone could trigger vivid memories of an ex-spouse who caused them physical harm. 

Paranoia, hallucinations, and delusions

Persons with PTSD may experience one or more of the following symptoms, depending on the severity of their trauma exposure.

Paranoia

Paranoia can cause an individual to lose trust in others and withdraw socially, which can have a circular effect on symptoms of PTSD. Paranoia can make reaching out to others difficult. You may constantly overanalyze the motivations of other people and question whether they are telling you the truth. Those who have experienced child abuse often develop this loss of trust in adults. Paranoia can damage relationships and cause you to become isolated.

Hallucinations

Perhaps the most common symptom of PTSD related to psychosis is hallucinations. You may feel like you are seeing people or hearing voices that aren't there that relate to the trauma you experienced. Hallucinations can be correlated with, but are distinct from, flashbacks. These are episodes in which you feel like you're reliving the trauma. Dissociation can also be linked to these experiences, where you perceive a disconnect between yourself and the world around you.

Delusions

Paranoia can become so severe that it turns into full-blown delusions. Delusions in the context of PTSD are usually related to trauma in some fashion and can keep a person feeling as though they can't move on from the past. Delusions can be debilitating and difficult to let go of once they are established. 

Diagnosis by a qualified professional is essential to receiving proper treatment. A diagnosis can give you a clear picture of your condition and help you receive the most effective treatment.

How to treat PTSD with psychotic symptoms

Those with PTSD experiencing comorbid psychosis must often pursue a treatment plan that addresses both conditions. If the psychotic disorder is secondary to PTSD, the latter is usually treated first. Seeking treatment is often the first hurdle to overcome at the start of recovery.

Preliminary research has shown that atypical antipsychotic medication may help alleviate symptoms of psychosis when comorbid with PTSD, but more investigation is needed to make a definitive statement on the effectiveness of this type of medication. Please consult with your doctor or primary care physician before considering any medication options.

The presence of psychotic symptoms with PTSD may also be associated with a higher risk of depression. Depression is commonly treated with selective serotonin reuptake inhibitors (SSRIs). Both PTSD and psychotic disorders can persist for a long time on a chronic basis. Treatment can help you effectively manage these conditions.

Psychotherapy is considered the first-line approach for PTSD, including that with comorbid psychosis. Cognitive-behavioral therapy (CBT) has so far been found to be the most effective form of therapy for PTSD. Various types of CBT have been used to help patients with PTSD treat their symptoms, with varying degrees of evidence to support their effectiveness in patients experiencing hallucinations after a traumatic event.

Online counseling with BetterHelp

Every person should feel comfortable with their therapist, but the therapeutic alliance can be particularly important for those living with PTSD. BetterHelp is an online counseling platform that aims to match you with a therapist who makes you feel safe and whom you can trust. When you meet with an online counselor who specializes in trauma and recovery, you can be sure that you're in a safe space where you can speak your truth and begin to process what you've been through. Therapists aren’t here to judge but rather to help you overcome traumatic experiences. BetterHelp therapists also let you go at your own pace. There's no timeline for healing from trauma, and your counselor understands this. You can take as much time as you need to sort through your concerns. 

The efficacy of online counseling

Research shows that online counseling can be a powerful tool in reducing symptoms of PTSD. This study, for example, found that online therapy is a valuable option for people with PTSD and is more efficient than face-to-face treatment. Web-based therapy can maintain the important therapeutic relationship found in more traditional therapy treatment settings, which means you will still have the opportunity to develop a strong connection with your counselor.