Hallucination

Overview

A hallucination is when you see, hear, smell, taste, or feel something that is not really there. It can seem very real. Hallucinations are not a disease on their own. They are a symptom that can happen with many health conditions, medicines, lack of sleep, or strong stress. They are different from a delusion, which is a fixed false belief.

Hallucinations are not rare, but they are not a normal part of healthy aging. They are more common in some groups, such as people with certain mental health or brain conditions, older adults with confusion, and people who use alcohol or drugs heavily.

Anyone can have hallucinations, but they are more likely in people with mental health conditions such as psychosis, brain conditions such as dementia or epilepsy, severe infections, substance use, or serious sleep loss. Children can also have hallucinations, especially during fever or illness.

Symptoms

Common symptoms

• Hearing sounds or voices that other people do not hear
• Seeing shapes, people, or animals that are not there
• Feeling touch, crawling, or movement on the skin when nothing is there
• Smelling or tasting something that others cannot smell or taste
• The experience may feel very real and can be brief or last longer
• It may be frightening or calming, and the person may not know it is not real

Symptoms in children

• Young children often have imaginary friends. That is usually pretend and not a hallucination if the child knows it is make-believe.
• True hallucinations in children can include hearing voices or seeing things that are not there.
• They may happen with fever, infection, lack of sleep, stress, or a health condition.
• Get medical advice if hallucinations are repeated, distressing, or come with confusion or other symptoms.

Symptoms in older adults

• New hallucinations in an older adult can be a sign of delirium (sudden confusion) that needs urgent medical care.
• They can also happen with dementia, vision or hearing loss, medicine changes, or other illness.
• Hallucinations with confusion, fever, or a sudden change in behavior need same-day or emergency help.
• Charles Bonnet syndrome (seeing things after vision loss) can cause visions. The person is usually aware the visions are not real.

Causes

Main causes

• Mental health conditions, such as psychosis (a condition where a person may lose touch with reality), schizophrenia, severe depression, bipolar disorder, or post-traumatic stress disorder
• Brain and nerve conditions, such as epilepsy (a condition that causes seizures), dementia, Parkinson's disease, migraine, stroke, or delirium (sudden confusion)
• Substance use or withdrawal, including alcohol and recreational drugs
• Side effects of some medicines, especially after a new medicine or a dose change
• Fever, infection, dehydration, or major body chemical changes
• Severe sleep loss or extreme stress
• Vision or hearing loss, such as Charles Bonnet syndrome (seeing things after vision loss)
• Brain injury or, rarely, a brain tumor

Risk factors

• A family history of mental health or brain conditions
• Living with a mental health condition or a brain condition
• Older age, especially with memory problems or confusion
• Heavy alcohol or drug use
• Serious illness, infection, or dehydration
• Vision or hearing loss
• Long-term sleep problems or extreme stress
• Taking several medicines or a new medicine

When to see a doctor

See a doctor urgently if:

• You have a new hallucination that starts suddenly
• You have hallucinations with fever, recent infection, or feeling unwell
• You have hallucinations after a medicine change
• Hallucinations are getting more frequent or more distressing
• An older adult has new confusion or hallucinations
• You are not sleeping and hallucinations are getting worse
• You feel unable to care for yourself or keep yourself safe

Book a routine appointment if:

• You have had a hallucination that was mild and you are otherwise well
• You have a known condition and notice a change in hallucinations
• A family member or friend is worried about hallucinations
• You want to understand what may be causing the experience
• You feel anxious or upset about a hallucination, even if it has passed

Diagnosis

A doctor will ask about what you saw, heard, felt, smelled, or tasted, and when it happened. They will ask about your health, sleep, medicines, alcohol and drug use, and family history. They may also talk with someone who knows you. The aim is to find the cause, not to blame you.

Tests that may be done

• Blood and urine tests to check for infection, dehydration, or body chemical changes
• A review of all medicines, including those bought without a prescription
• A physical and neurological exam
• Vision and hearing tests
• Brain scans, such as CT or MRI, if the doctor thinks a brain condition may be involved
• An EEG (a brain wave test) if seizures are possible
• A mental health assessment if a mental health condition may be involved

What to expect at your appointment

The assessment may take time. You may be referred to a specialist, such as a psychiatrist (mental health doctor), neurologist (brain and nerve doctor), or older adult team. Bring a list of medicines and notes about when hallucinations happen. You can ask questions and take a trusted person with you.

Treatment

Treatment depends on the cause. The first step is to treat any medical problem, review medicines, and keep the person safe. Care may involve your family doctor, a mental health team, a brain specialist, or other services. The goal is to reduce distress and help you live as well as possible.

Self-care at home

• Keep a simple diary of when hallucinations happen, what they are like, and what was going on before
• Try to keep a regular sleep routine and rest when you can
• Avoid alcohol and recreational drugs, as they can make hallucinations worse
• Take medicines exactly as prescribed and ask your doctor before changing anything
• Reduce stress where possible and plan quiet time
• Have a trusted person you can call if you feel frightened
• Make your home safer if hallucinations could cause falls or accidents
• Keep up with vision and hearing checks

Medical treatments

Doctors may treat the underlying condition, adjust medicines that may be causing hallucinations, or offer talking therapy and family support. Some people need care from a mental health or brain specialist. In some conditions, a specialist may prescribe medicine to reduce hallucinations, but this is always chosen and monitored by a qualified clinician.

When is surgery considered?

Surgery is not a usual treatment for hallucinations. Rarely, a specialist may treat a brain problem that is causing them, such as a growth or a seizure focus.

Living with this condition

Hallucinations can be unsettling for you and those around you. A calm, steady routine and a clear plan for what to do when they happen can help. Tell someone you trust and keep in touch with your healthcare team. If hallucinations are distressing, do not cope alone.

Lifestyle tips

• Keep regular sleep and wake times
• Stay connected with friends, family, or a support group
• Avoid too much caffeine, alcohol, or recreational drugs
• Build in quiet time and gentle activity
• Ask for help with money, housing, or daily tasks if stress is building up

Diet and exercise

There is no special diet that treats hallucinations. Eat regular balanced meals, drink enough water, and move your body in a way that feels safe for you. A healthy routine can support sleep, mood, and overall health.

Mental health and emotional wellbeing

Hallucinations can cause fear, shame, or isolation. They can also be linked with anxiety, depression, or trauma. These feelings are real and deserve support. If you have thoughts of harming yourself or others, contact your local emergency services or a crisis line in your country right away. You do not have to face this alone.

Prevention

Not all hallucinations can be prevented, because they can be caused by many different conditions. You can lower some risks by managing health conditions, getting regular check-ups, reviewing medicines with your doctor, avoiding heavy alcohol and drug use, treating infections early, and protecting your sleep.

Vaccines

Some infections that can cause fever and confusion may be prevented by routine vaccines recommended in your country. Ask your doctor or pharmacist which vaccines are right for you.

Screening programmes

There is no routine screening test for hallucinations. Regular check-ups can help find and treat health conditions that may cause them, especially if you have a long-term condition or take several medicines.

Complications

If left untreated

• Injury from falls, accidents, or acting on hallucinations
• Not being able to care for yourself or keep a job
• Worsening mental health, including anxiety, depression, or suicidal thoughts
• Social isolation and strain on relationships
• Missing a serious medical cause, such as an infection or brain condition
• Poor sleep and more confusion

Long-term outlook

Many people improve when the cause is found and treated. Some people need ongoing support, and recovery can take time. With the right care, most people can live safely and well. Seeking help early is a sign of strength.

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