Psychosis is a condition where an individual loses some contact with reality. This state affects how the brain processes information, sometimes causing the person to see or hear things that are not present. These sensory experiences are known as hallucinations. A visual hallucination is a perception of a visual stimulus that does not exist externally, and such visions can feel entirely real to the person experiencing them.
Types of Visual Hallucinations
Visual hallucinations exist on a spectrum, ranging from simple to complex. Simple, or unformed, hallucinations are the most basic and can include seeing flashes of light, shapeless colors, or indistinct shapes. Some individuals report seeing geometric patterns, like honeycombs or spirals, which are generated internally by the brain without any external visual input.
More involved experiences are known as complex, or formed, hallucinations. These involve seeing fully formed and detailed objects, animals, or people that are not actually there. In some cases, individuals may witness entire scenes unfold as if they were real. They can be in color or black and white, static or moving, and appear three-dimensional within the person’s environment.
The character of these hallucinations can also differ greatly from one person to another. For some, the visions might be neutral, while for others they can be frightening or distressing. Many individuals with psychosis who experience visual hallucinations report seeing complex forms, most commonly people and animals, and may experience both simple and complex types.
Differentiating Hallucinations from Other Visual Phenomena
Visual hallucinations should be distinguished from illusions, which are misinterpretations of real external stimuli. For example, seeing a face in wallpaper patterns or perceiving a coat rack in the dark as a person are illusions. The difference is that an illusion is a distorted perception of an actual object, while a hallucination has no basis in external reality.
Hypnagogic and hypnopompic phenomena can also be confused with hallucinations. These are vivid, dream-like images that occur while falling asleep (hypnagogic) or waking up (hypnopompic). Unlike clinical hallucinations, which happen when fully awake, these are confined to the transitional states between wakefulness and sleep.
Physiological events within the eye can also cause visual disturbances. Eye floaters are tiny specks drifting through the field of vision, caused by fibers within the eye’s vitreous fluid. Visual snow is a condition of seeing persistent flickering dots. These are not generated by the brain like hallucinations and are based in the physical functioning of the eye.
Underlying Causes of Psychotic Visions
Several psychiatric conditions have psychosis as a primary symptom. Schizophrenia can cause a range of symptoms, including both auditory and visual hallucinations, with studies showing about 27% of individuals with the disorder experience them. Other conditions include schizoaffective disorder, severe forms of bipolar disorder, and major depression with psychotic features.
Medical and neurological issues can also cause visual hallucinations. Delirium, a state of acute confusion, can be triggered by infections or high fevers. Neurological conditions such as brain tumors, certain types of epilepsy, and forms of dementia like Lewy body dementia are also known causes.
Certain substances can induce psychosis with visual components. Psychoactive drugs like LSD and psilocybin have hallucinogenic properties, and psychosis can also emerge during withdrawal from alcohol or benzodiazepines. Additionally, some prescription medications list visual hallucinations as a potential side effect, so a medication review is part of the diagnostic process.
Neurological Basis of Visual Hallucinations
Visual hallucinations are thought to arise when the brain’s visual networks become active without corresponding light hitting the eye. This spontaneous activity leads the brain to generate its own perceptions, which are experienced as real. This process is comparable to a television displaying an image despite receiving no broadcast signal.
Neurotransmitter systems are believed to play a significant part in this process. Dopamine is a chemical messenger in the brain that is heavily implicated in psychosis. An imbalance in the dopamine system can disrupt how the brain processes information and distinguishes between internal thoughts and external reality, contributing to false visual perceptions.
Brain imaging shows that complex hallucinations are associated with activity in higher-order visual processing areas of the brain. The primary visual cortex, which first receives signals from the eyes, may not be active during these hallucinations. This suggests a disconnect where higher-level brain regions generate images independently of direct sensory input.
Approaches to Management and Support
Effective management begins with a medical evaluation to identify the root cause. Since these visions are a symptom, treatment focuses on the underlying condition. A healthcare professional can conduct the necessary assessments to arrive at a diagnosis and create a management plan.
Medication is a primary treatment method. Antipsychotic medications are prescribed to rebalance brain chemistry, particularly the dopamine system, which can reduce or eliminate hallucinations. The specific medication and dosage are tailored to the individual’s diagnosis and health profile.
Alongside medication, psychotherapy offers valuable support for individuals learning to cope with visual hallucinations. Cognitive Behavioral Therapy for psychosis (CBTp) is a specialized approach that helps people develop strategies to manage their experiences. This therapy can assist individuals in changing how they interpret and respond to their visions, reducing associated distress.
A strong support system is another component of managing psychosis. The involvement of family, friends, and support groups can provide encouragement and understanding. If visions are distressing or involve commands to cause harm, seek immediate medical help to ensure safety.