Schizophrenia Hallucinations, Delusions, And More: Symptoms And Treatment Options
The National Institute of Mental Health (NIMH) estimates that the prevalence of schizophrenia and related psychotic disorders is between 0.25% and 0.64% for individuals living in the United States. These individuals can experience varying levels of symptom severity. Regardless of severity, schizophrenia hallucinations, delusions, disordered thoughts, and other symptoms can be common for those living with the disorder. They can often be managed with a combination of prescribed antipsychotic medication and cognitive behavioral therapy.
Primary schizophrenia symptoms
Positive symptoms
Positive schizophrenia symptoms typically impact how a person with schizophrenia thinks or behaves. While these symptoms can vary, two common examples include hallucinations and delusions.
Hallucinations
Although updated evidence may be needed, an estimated 70% of schizophrenia patients experience hallucinations, with auditory hallucinations being the most common. Hallucinations typically involve sensory experiences that may impact a person's sense of sight, hearing, smell, taste, or touch. Each of these potential hallucination types can have its own set of distinct effects.
- Visual hallucinations: Those with schizophrenia may see people, objects, or other visual elements that do not actually exist. These hallucinations may be people they know (including those who are deceased), individuals they’ve seen in movies or television shows, or people constructed entirely by their minds.
- Auditory hallucinations: Individuals living with schizophrenia may hear voices or other noises that aren’t real. These voices may command the individual to complete tasks that could be harmful to themselves or others, or they may comment on the individual’s actions. In some cases, a person with schizophrenia may hold discussions with these voices or hear multiple voices at once.
- Tactile hallucinations: Tactile hallucinations, sometimes referred to as “haptic hallucinations,” may cause an individual with schizophrenia to experience the false perception that they are touching (or being touched by) an object or person. However, tactile hallucinations can be significantly less common than visual or auditory hallucinations.
- Olfactory hallucinations: Olfactory hallucinations can affect one's sense of smell or taste. These smells and tastes, which only exist within a person’s mind, may be pleasant or unpleasant. This could have several impacts on a person with schizophrenia, such as reducing their appetite or causing them to leave areas they believe have a bad smell.
No matter which sense they affect, hallucinations can cause distress for those living with schizophrenia. This distress may be compounded by other symptoms, such as delusions.
Delusions
Delusions, another potentially common schizophrenia symptom, generally involve holding beliefs that are not based in logic or reality. These delusions may fall under a variety of classifications.
- Delusions of grandeur: Delusions of grandeur can lead an individual with schizophrenia to believe they are significantly better than others, often by convincing them that they are more important, wealthy, skilled, or powerful than they actually are. This type of delusion can lead someone to believe they are a celebrity or important historical figure, that they own a major company, or that they have special powers.
- Delusions of persecution: Persecutory delusions can cause a person with schizophrenia to believe that they are being followed, monitored, or accused by a person or group that wishes to do them harm. Along with delusions of grandeur, delusions of persecution may be one of the more common types experienced by those with schizophrenia.
- Delusions of control: Much in the same way that persecutory delusions can lead a person to believe they are being followed or monitored by someone else, delusions of control can involve the belief that someone is controlling one’s thoughts or behavior. For example, a person experiencing delusions of control may think that their family members, classmates, members of the medical community, or government entities are placing thoughts in their brain.
- Delusions of reference: A delusion of reference can refer to the belief that situations or occurrences are significant or specifically related to the individual with schizophrenia. For example, a person may hear a song on the radio and believe the lyrics of the song are written about them or hold a special message for them. In most cases, these occurrences are neutral or coincidental, but a person may believe that they are special and directed at them specifically.
In addition to positive symptoms, individuals living with schizophrenia may also experience negative symptoms. These differ in that, rather than creating new behaviors, negative symptoms typically involve the lack of a certain function.
Negative symptoms
In addition to positive symptoms, individuals living with schizophrenia may also experience negative symptoms. These differ in that, rather than creating new behaviors, negative symptoms typically involve the lack of a certain function. Negative symptoms can affect numerous areas of an individual's life, including the activities in which they partake, how they form relationships, and how they interact with the world around them. These symptoms may include the following:
- Impaired emotional expression: Also known as flat affect, impaired emotional expression can make it difficult to show the physical manifestations of emotion. For example, a person with schizophrenia may struggle to change their facial expression or speak in a varied tone of voice.
- Asociality: Asociality generally refers to a difficulty with or lack of interest in forming relationships with others. While this reduction in social initiative may predate the onset of schizophrenia symptoms, asociality can also be secondary to positive symptoms, such as hallucinations and delusions.
- Avolition: In addition to a lack of interest in socialization, schizophrenia may also cause a lack of motivation to complete important tasks, known as avolition. These tasks may have significant consequences if ignored, or a person may even lack motivation to complete tasks that are necessary for survival, such as eating.
- Anhedonia: Anhedonia typically refers to a reduced ability to experience pleasure or pleasant emotions. In addition, an individual with anhedonia may find it difficult to remember what it is like to experience pleasant emotions. Examples of anhedonia may include an inability to enjoy previously favorite activities, locations, foods, or anything else that was once pleasurable.
In addition to positive and negative symptoms, individuals living with schizophrenia may also experience disorganized symptoms. These symptoms may further impact how a person socializes or maintains relationships with others.
Disorganized (cognitive) symptoms
In addition to positive and negative symptoms, individuals living with schizophrenia may also experience disorganized symptoms. These symptoms may further impact how a person socializes or maintains relationships with others. Disorganized schizophrenia symptoms can impact a person’s ability to think and communicate clearly. Those living with schizophrenia may find it difficult to concentrate on a specific subject or thought pattern. This could cause them to switch rapidly between subjects or become frustrated as they try to focus on their racing thoughts. These disordered thoughts could complicate other activities as well, such as reading a book or watching a movie.
Schizophrenia may also lead to disorganized or changed movement patterns, sometimes referred to as movement disorders. These changes in movement may manifest in a variety of ways, including continuous spasms, muscle contractions, or jerky, irregular movements. While movement disorders may occur independently of medication, they may also be a side effect of common pharmacological treatments for schizophrenia, such as antipsychotics. Be sure to notify your doctor if you’re taking medication and notice any side effects.
How can you treat schizophrenia symptoms?
To determine a viable treatment plan for schizophrenia symptoms, you may want to seek the help of mental health and medical professionals. These trained providers may rule out other physical and mental health disorders, provide an accurate diagnosis, and design a treatment regimen that addresses your unique experience with schizophrenia. Treatments for schizophrenia can vary. According to the NIMH, common treatment options include antipsychotic medications and psychosocial treatments, such as behavioral skills training, cognitive remediation interventions, and cognitive behavioral therapy (CBT). Please note that antipsychotics must be prescribed by a doctor or psychiatrist, and you should always consult your prescribing provider before starting, stopping, or changing the way you take medication.
Not only is CBT frequently recommended by schizophrenia treatment guidelines, but this form of therapy can also be highly effective in conjunction with medication, particularly for positive symptoms. However, in-person therapy may not be available or convenient for everyone who seeks treatment. There are a variety of reasons one may not be able to utilize face-to-face therapy, such as the following:
- Living in a Healthcare Provider Shortage Area (HPSA)
- Lack of reliable transportation
- A desire to use alternative communication formats, such as video conference, online chat, or phone call
- Lack of health insurance
In these situations, it may be helpful to explore alternative approaches, such as online therapy, which can add flexibility, convenience, and customizability to the therapy process.
Research suggests that online therapy may be as effective as in-person therapy. While research specifically focused on the efficacy of online therapy for schizophrenia is still in early stages, a 2022 systematic review of randomized controlled trials reported that, in general, individuals who received therapy through telehealth experienced similar outcomes to those who received therapy face-to-face.
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