Demystifying Psychosis: Hallucinations and Delusions

Psychosis, a severe mental dysfunction characterized by a loss of contact with reality, is characterized by perceiving elements from the environment that do not exist. Psychiatrists and medical professionals characterize a psychosis as a mental illnesses exhibiting a severe mental condition where thought and emotions lose contact with external reality. Psychosis is the ultimate escape from reality by retreating to a place of our mind’s own making. A person suffering from a psychotic episode is unable to distinguish the internal experience of the mind from external realities. Appeals to logic typically fail to puncture the overwhelming sense that the psychotic episode is only a construction of the mind.

Psychosis, is most commonly associated with conditions like schizophrenia and bipolar disorder. Psychosis primarily involves two main disconnections from reality—hallucination and delusions. A hallucination is when we see and hear things that do not exist. A delusion is when we believe things that are not true. Psychosis may be a primary disorder or a secondary symptom to neurologic or medical conditions. Psychosis may be a brief psychotic episode occurring under extreme distress. or a reoccurring state associated with a mental or physical disease.

​History of Psychosis

​Psychosis existed long before the name, even before symptoms of hallucinations were given the name dementia praecox by ​German psychiatrist Emil Kraepelin in the late 1800’s. Markedly, Psychosis has gone through “a series of labels, from different variations of the French word ‘demence’ or loss of mind in the 1800s, to dementia praecox, and now to a range of diseases, typically found somewhere on the schizophrenia spectrum (Plumptre, 2022).

Symptoms of Psychosis

The symptoms of psychosis typically are hallucinations, delusions, disorganized thoughts and behaviors, and a list of negative symptoms that impact quality of life.

Delusions

Delusions are “tenacious false beliefs that are maintained despite indisputable evidence of the contrary” (Julayanont & Suryadevara, 2021). Delusional beliefs may be bizarre or possible but no supportable evidence exists, to support the belief. 

For example, I met a woman who was convinced that intruders surrounded her house, possessing “mind-stealing” lasers. No matter the logical evidence to the contrary, she could not let go of the idea that people were surrounding her house, trying to steal her mind.

A bizarre delusion may be:

• thought insertion, characterized by alien thoughts being unwillingly inserted into the brain
• delusions of control, characterized by an individuals actions being manipulated by an outside force
• thought withdrawal, characterized by the stealing of thoughts by an outside entity (Julayanont & Suryadevara, 2021).

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​Others create a theory that sounds plausible, and then treat the unsupported theory as if it was fact, reacting with disdain when others fail to believe the same. This is a delusion as much as the “mind-stealing” invaders.

Hallucinations

A hallucination is “the false perception of sensation that does not correspond with an external stimulus” (Julayanont & Suryadevara, 2021). We may experience hallucinations in any sensory modality: auditory, visual, olfactory, gustatory, tactile, nociceptive, thermoceptive, proprioceptive, and many others.

Our brains are constantly at work receiving and translating senses, from energy flowing through our system to conscious recognition with a label. When psychosis occurs, our brain begins to create its own stories without the preceding sensory input. We think we hear voices, see visions, our feel an injury. However, all these sensations are created without the normal prompting of an external event.

Disorganized Thoughts

Disorganized thinking is revealed by disruptive patterns of speech, indicating a formal thought disorder. Some common thought disorders are:

• Circumstantiality: Over inclusion of trivial or irrelevant details.
• Clang Associations: Thoughts are associated through sounds of the words rather than by meaning, often using words that rhyme that do not have meaningful relation to each other.
• Derailment (synonymous with loose associations): Lack of goal directed speech, jumping from idea to idea without logical connection, leading to nonsensical sentences.
• Flight of Ideas: Quickly jumping from idea to idea, often through rapid and forced speech.
• Neologism: Inventing new words and phrases; or unconventional use of conventional words.
• Perseveration: Repetitive use of words and phrases, or ideas, throughout a conversation, even after the context is no longer relevant.
• Tangentiality: Responses to questions that refer to the general topic without answering the question.
  • ​”Did you eat breakfast this morning?” ” I like to eat cereal.”
• Thought Blocking: Disrupting flow of thoughts leading to sudden starts and stops in speech patterns.

See Thought Disorders for more on this symptom

Disorganized Behaviors

Disorganized behaviors in individuals experiencing psychosis can manifest in various ways, often leading to noticeable discrepancies in their daily functioning and self-care. These behaviors may include a marked lack of hygiene, such as neglecting personal grooming or failing to maintain cleanliness in their living environment.

Additionally, disruptions in nourishment may present themselves through erratic eating habits or refusal to eat altogether, which can contribute further to physical decline. Sleep patterns are also frequently affected; individuals might experience insomnia or oversleeping, both of which can exacerbate the symptoms of psychosis. This combination of factors often creates an alarming picture for observers who witness these changes.

In social contexts, disorganized behaviors become even more evident as individuals may engage in unusual actions that seem out of place. For instance, talking to oneself aloud might occur with no apparent audience present while laughter or yelling at inappropriate moments raises concern among those nearby. Such reactions can lead to social isolation and misunderstandings as others struggle to comprehend the individual’s internal experiences.

Furthermore, some persons may exhibit rigidity in their body language or sudden bursts of catatonic excitement, oscillating between extreme stillness and uncharacteristic energy levels. Overall, these disorganized behaviors serve as significant indicators that something is amiss within the individual’s mental state and warrant attention from caregivers or mental health professionals for appropriate intervention and support.

Negative Symptoms

Schizophrenia is characterized by several negative symptoms. These symptoms include:

• little emotional expression
• avolition (lack of motivation)
• alogia (poverty of speech)
• anhedonia (lack of ability to experience pleasure)
• asociality

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Negative symptoms seriously impair an individual’s ability to function (Schrimpf et al., 2018).

When evaluating symptoms, we must keep in mind, that disfunction always is born from functional behaviors. We all express some of symptoms of disfunction to a lesser degree. When diagnosing an illness, we must determine that the severity of the symptoms are sufficient to be classified as a disorder.

Psychosis is a Common Characteristic of Other Disorders

Rather than being a standalone disorder, psychosis is frequently considered a hallmark symptom of various diagnosable mental health conditions. Its presence can indicate the underlying complexities of disorders such as schizophrenia, bipolar disorder, and major depressive disorder. Each of these conditions exhibits unique characteristics while sharing common features related to psychotic experiences.

For instance, individuals with schizophrenia may endure persistent hallucinations and delusions that profoundly affect their perception of reality. In contrast, those with bipolar disorder might experience psychotic symptoms during manic or depressive episodes, showcasing the fluctuating nature of their mood states.

Similarly, major depressive disorder can lead to severe cases where individuals develop paranoid ideations or delusions amidst overwhelming sadness and hopelessness. Understanding how psychosis interrelates with these broader diagnostic categories not only enhances our comprehension of its impact but also emphasizes the importance of tailored treatment approaches for each individual affected by these complex mental health challenges.

Schizophrenia

Schizophrenia and psychosis are often closely linked, as psychosis is a hallmark symptom of schizophrenia. Individuals diagnosed with schizophrenia frequently experience episodes characterized by hallucinations—seeing or hearing things that aren’t there—and delusions—holding false beliefs despite clear evidence to the contrary. These symptoms severely disrupt their perception of reality, making it challenging for them to engage in everyday life. While schizophrenia encompasses a range of other symptoms such as disorganized thinking and negative symptoms like emotional flatness or lack of motivation, the presence of psychotic experiences is essential for diagnosis.

However, it’s important to recognize that psychosis itself is not exclusive to schizophrenia; it can manifest in various mental health disorders. Conditions such as bipolar disorder and major depressive disorder may also involve psychotic features during specific phases, demonstrating that while all individuals with schizophrenia will experience some form of psychosis, not all cases of psychosis indicate the presence of schizophrenia.

This distinction highlights the complexity of diagnosing and treating mental health conditions, emphasizing the need for comprehensive evaluations by mental health professionals to determine appropriate interventions based on individual circumstances rather than assumptions based solely on symptom presentation.

See Schizophrenia for more on this disorder

Bipolar Disorder

Bipolar disorder and psychosis share a significant relationship, particularly during the manic or depressive episodes that characterize the condition. Individuals with bipolar disorder experience biphasic mood episodes that alternate between periods of intense mania and deep depression. During these phases, especially in mania, psychotic symptoms such as hallucinations or delusions may emerge.

A common manifestation is grandiose delusions where individuals may believe they possess extraordinary abilities or an inflated sense of self-worth—often feeling indestructible (Murphy, 2022a). This heightened state can distort reality, leading to behaviors that are not only impulsive but also disconnected from actual circumstances.

Moreover, it’s crucial to note that while psychosis can be present in bipolar disorder, it does not define the condition itself. Unlike schizophrenia, where psychosis is a core feature throughout much of the illness’s course, in bipolar disorder, these symptoms typically surface intermittently during mood episodes.

Understanding this distinction aids clinicians in developing tailored treatment approaches for individuals with bipolar disorder who exhibit psychotic features. Effective management often involves a combination of mood stabilizers and antipsychotic medications to address both mood symptoms and any accompanying psychotic experiences—ensuring comprehensive care for patients navigating this complex mental health landscape.

See Bipolar Disorder for more on this topic

Major Depressive Disorder

The connection between psychosis and major depressive disorder (MDD) is a critical aspect of understanding the complexities of mental health conditions. The DSM characterizes MDD as a persistent feeling of sadness and emptiness that significantly impacts an individual’s daily functioning. In some cases, this profound sense of hopelessness can culminate in the emergence of psychotic features, such as paranoid ideations or delusions that distort reality.

Individuals may experience irrational fears or beliefs tied to their depression, leading them to perceive threats where none exist or feel an overwhelming sense of guilt about imagined wrongdoings. This intersection highlights how deeply intertwined emotional states can influence cognitive processes, creating a challenging landscape for both patients and clinicians.

Moreover, recognizing the presence of psychosis within major depressive disorder is crucial for accurate diagnosis and effective treatment planning. While many individuals with MDD do not exhibit psychotic symptoms, those who do require more comprehensive care strategies tailored to address both mood dysregulation and distorted perceptions experienced during depressive episodes.

Treatment often involves a combination of antidepressants to alleviate depressive symptoms alongside antipsychotic medications aimed at managing any concurrent psychotic experiences. By addressing these interconnected aspects holistically, mental health professionals can better support individuals with MDD in navigating their challenges and improving overall well-being through targeted therapeutic interventions.

See Major Depressive Disorder for more on this topic

Causes of Psychosis

“A cohesive understanding of the pathophysiology of the major psychotic disorders is lacking, even to the extent of defining whether one or many disease processes are involved” (Corvin & Harold, 2015). This statement underscores the complexity and multifaceted nature of psychosis, highlighting that researchers continue to grapple with identifying definitive biological mechanisms responsible for these conditions. Despite advancements in neuroscience and psychology, a comprehensive model that encapsulates all aspects of psychotic disorders remains elusive.

Factors such as genetic predisposition, neurochemical imbalances, and environmental influences intertwine in ways that complicate our understanding. As research continues to evolve, new insights into brain function and behavior will likely enhance our grasp of how various elements contribute to the onset and progression of psychosis.

While exact pathophysiological mechanisms may still be under investigation, clinicians can often identify specific underlying diseases or conditions contributing to an individual’s experience of psychosis, as presented in the previous section of this article. Beyond these primary diagnoses, other factors such as traumatic experiences, substance abuse issues (including drug misuse), side effects from medications, or physical health problems like traumatic brain injuries may also play significant roles in triggering episodes of psychosis.

Genetic Predisposition

The connection between psychosis and genetic predispositions is a well-established area of research, with strong evidence indicating that genetic factors significantly contribute to an individual’s vulnerability. Family, twin, and adoption studies have consistently shown that psychosis “runs in families,” meaning the risk of developing it is substantially higher for individuals who have a close biological relative affected by the condition compared to the general population.

For instance, twin studies reveal that if one identical twin (sharing 100% of their genes) develops psychosis, the other has about a 50% chance of also developing it, a rate significantly higher than for non-identical twins or the general population. This familial clustering strongly suggests a heritable component, largely due to shared genes rather than shared environment alone.

However, it’s crucial to understand that psychosis is not typically caused by a single “psychosis gene.” Instead, it is considered a polygenic disorder, meaning that multiple genetic variations, each with a small individual effect, combine to increase a person’s overall risk. Researchers have identified numerous genes associated with conditions like schizophrenia and bipolar disorder, many of which play roles in brain development, neurotransmitter systems (like dopamine and glutamate), or the immune system.

For example, variations in genes such as ANK3, CACNA1C, ZNF804A, DISC1, and NRG1 have been linked to increased susceptibility to these disorders, often showing an overlap in genetic risk between schizophrenia and bipolar disorder (Craddock et al., 2009). This complex genetic architecture means that while a genetic predisposition increases vulnerability, it does not guarantee the development of psychosis.

Stress

Early theories of psychosis typically relied on psychological explanations such as stress as the underlying cause.

Rollo May (1904-1994) theorized that neurotic and psychotic symptoms “may be viewed as endeavors to adapt to a conflict situation when the problem causing the conflict cannot be solved.” He continues, “In situations of severest conflict the individual may be powerless to cope with the threat by means of the above-mentioned compromises, and may be forced to renounce a large arena of activity or reality (e.g., ​psychosis)” (May, 2015).

While research has shown that extreme stress is a contributing cause of psychosis, often these breakdowns are temporary in nature. As a result of extreme demands, the mind temporarily finds refuge by fleeing reality. When the challenges of the moment exceed our window of tolerance, something gives. Consequently, in the case of psychosis, the part that gives is our connection to reality.

Other theories, such as the diathesis stress model, propose that disorders develop as “a result of interactions between pre-dispositional vulnerabilities (the diathesis), and stress caused by life experiences” (Murphy, 2021).

Other

• traumatic experience
• extreme stress
• drug and alcohol misuse
• side effects of prescribed medicine
• a physical condition, such as a
  • brain tumour
  • traumatic brain injury
  • ​Alzheimer’s disease

​Treatment

Experiencing psychosis is not merely a temporary setback; it represents a profound disruption in an individual’s mental processes, signaling the need for immediate medical attention and intervention. The complexity of psychosis can stem from various underlying causes, such as neurological disorders or extreme stressors, which necessitate a comprehensive evaluation by mental health professionals. Addressing these conditions promptly is crucial to prevent further deterioration of the individual’s well-being and to facilitate recovery. In many cases, timely treatment can significantly alter the trajectory of an individual’s experience with psychosis.

Pharmaceutical advancements have made significant strides in recent years, offering new hope for those grappling with the debilitating symptoms associated with psychosis. Many modern medications are designed to target specific neurotransmitters in the brain, helping to alleviate negative symptoms such as hallucinations and delusions that impair daily functioning. By managing these severe manifestations more effectively, individuals often report improved quality of life and greater ability to engage meaningfully with their surroundings. This pharmacological support serves as an essential foundation upon which additional therapeutic interventions can be built.

In addition to medication management, therapy plays a vital role in addressing the emotional and behavioral challenges faced by individuals experiencing psychosis. Therapeutic approaches like cognitive-behavioral therapy (CBT) can be particularly effective in reducing anxiety levels while providing patients with coping strategies tailored to their unique situations. Engaging in regular therapeutic sessions allows individuals to process their experiences.

These sessions provide a safe environment. Individuals feel validated and understood in this space. This holistic approach—combining medication with psychological support—empowers those affected by psychosis not only to manage their symptoms but also fosters resilience and enhances overall emotional health on their journey toward recovery.

Prevention

In recent years, significant attention has been directed toward identifying effective interventions for individuals at clinical high risk for psychosis (CHR-P). Evidence underscores the necessity of specialized services tailored to this population, which includes validated psychological interventions that are crucial for optimal outcomes.

Early intervention within the CHR-P group may yield substantial benefits in mitigating the onset of full-blown psychotic disorders. While research continues to delineate the most effective strategies for this demographic, cognitive behavioral therapy (CBT) has emerged as a recommended approach based on meta-analyses demonstrating its advantages over standard clinical control conditions.

Furthermore, ongoing investigation is essential to refine risk stratification and uncover targeted interventions that address individualized quantitative risk signatures linked to both favorable and unfavorable outcomes. Although existing literature indicates promising results from various interventions designed for CHR-P individuals, further studies are warranted. These studies should specify which approaches prove most efficacious within this unique patient population. Current evidence suggests that comprehensive care should be provided across primary and secondary settings where these individuals receive support.

Recommended strategies include implementing indicated primary prevention measures utilizing evidence-based CBT alongside integrated psychological interventions focused on addressing attenuated psychotic symptoms such as brief limited intermittent psychotic symptoms (BLIPS), attenuated psychotic symptoms (APS), or genetic risk and deterioration syndrome (GRD). Additionally, careful consideration must be given to comorbid psychiatric conditions following established guidelines with the ultimate goal of enhancing recovery trajectories, functional status, and overall quality of life (Fusar-Poli et al., 2020).

Associated Concepts

• Neurosis: encompasses maladaptive behaviors and thoughts aimed at relieving anxiety but failing to address the root cause. Typically, these are the disorders that do not include hallucinations and delusions.
• Phenomenology: The study of subjective experience, particularly how individuals with psychosis perceive and interpret their experiences.
• Brief Psychotic Disorder: This disorder is a time-limited mental illness with sudden onset of severe psychotic symptoms. Markedly, this disorder typically lasts less than a month. Stress is often the trigger.
• Dissociative Disorders: These disorders that science formerly referred to as hysteria, current literature now characterizes them as a disconnection between thoughts, memories, surroundings, actions, and identity. They provide an escape from stress and discomfort but can interfere with everyday life and relationships.
• Panic Disorder: This condition is characterized by repeated and unexpected panic attacks. Learn about the symptoms, causes, and potential triggers that fuel these overwhelming anxieties.
• Dementia Praecox: This disorder is now known as schizophrenia, was historically characterized by symptoms like hallucinations, delusions, and emotional withdrawal.
• Ideas of References: This symptom involves perceiving unrelated events as personally significant, often associated with psychotic disorders.

A Few Words by Psychology Fanatic

In closing, psychosis remains one of the most enigmatic and challenging areas of mental health, presenting both profound questions and opportunities for the field of psychology. It compels us to look beyond the symptoms. We must consider the person as a whole—their experiences, their environment, and their journey. As we advance in our understanding through research and clinical practice, we must also strive to destigmatize and humanize the experience of those living with psychosis.

The path to recovery is not just about managing symptoms but about nurturing resilience, fostering understanding, and supporting each individual’s pursuit of their aspirations. We continue to explore with compassion and care. Our aim is to unlock the full potential of treatment and rehabilitation. This offers a beacon of hope to those touched by psychosis. Let us move forward with empathy and science as our guides, working together to illuminate the darkness that psychosis can bring into lives.

Last Update: January 19, 2026

References:

Corvin, A., & Harold, D. (2015). Biomarkers for Psychosis: the Molecular Genetics of Psychosis. Current Behavioral Neuroscience Reports, 2(2), 112-118. DOI: 10.1007/s40473-015-0041-6
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Craddock, N., O’Donovan, M., & Owen, M. (2009). Psychosis Genetics: Modeling the Relationship Between Schizophrenia, Bipolar Disorder, and Mixed (or Schizoaffective) Psychoses. Schizophrenia Bulletin, 35(3), 482-490. DOI: 10.1093/schbul/sbp020
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Fusar-Poli, P., Salazar de Pablo, G., Correll, C., Meyer-Lindenberg, A., Millan, M., Borgwardt, S., Galderisi, S., Bechdolf, A., Pfennig, A., Kessing, L., van Amelsvoort, T., Nieman, D., Domschke, K., Krebs, M., Koutsouleris, N., McGuire, P., Do, K., & Arango, C. (2020). Prevention of Psychosis. JAMA Psychiatry, 77(7), 755-765. DOI: 10.1001/jamapsychiatry.2019.4779
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​Julayanont, P., & Suryadevara, U. (2021). Psychosis. Continuum, 27(6), 1682-1711. DOI: 10.1212/CON.0000000000001013
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May, Rollo (1950/2015). Meaning of Anxiety. W. W. Norton & Company; Reissue edition. APA Record: 1996-97851-000
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Murphy, T. Franklin (2021) The Diathesis-Stress Model: The Link Between Vulnerabilities and Stress. Psychology Fanatic. Published: 9-7-2021; Accessed: 9-11-2022. Website: https://psychologyfanatic.com/diathesis-stress-model/
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Murphy, T. Franklin (2022a). Understanding Mood Disorders: Types and Symptoms. Psychology Fanatic. Published: 9-27-2022; Accessed: 10-9-2022. Website: https://psychologyfanatic.com/mood-disorders/
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Schrimpf, L.; Aggarwal, A.,; Lauriello, J. (2018). Psychosis. Continuum, 24 (Behavioral Neurology and Psychiatry), 845-860.​ DOI: 10.1212/CON.0000000000000602
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