What You Need to Know about Hallucinations in Schizophrenia

Hearing voices in schizophrenia

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In this series of articles you will find information about what the experience of schizophrenia looks like from the patient’s point of view. The first article in the series focuses on what is commonly referred as voices or auditory hallucinations.

While the auditory hallucinations are the most frequent type of unusual perceptual abnormalities reported in schizophrenia, people with schizophrenia also report other types of hallucinatory experiences, which are discussed in this article.

Abnormal visual perceptions range from the illusion of things changing sizes or shapes, such as houses getting bigger or shrinking, wavy walls, changing patterns of color, to vague hallucinations such as shadows or poorly defined things from the corner of the eye, to  - rarely – full fledged humanoid figures who follow the vision seer around.  Strange sensations on the skin range from tickling or pricking sensations to more complex feelings such as that of insects crawling on or under the skin. Somatic hallucinations refer to hallucinations based on the soma or body. Feeling as if your brain is leaking out, or an alien creature is ripping your insides, or a transmitter is pulsating inside your brain, or demons are moving your body organs around, or rats are eating your brain are extremely frightening experiences. In extreme, such experiences can lead to action that might appear puzzling and  “crazy” to an outsider, but makes sense from the point of view of “attacking the attacker” such as stabbing oneself to kill the possessing entity or banging of the head with the intent of hemorrhaging profusely so that the possessing entity will be drowned in blood.

Finally, unpleasant to full fledged foul odors, smells or tastes, such as the smell or taste of rotting or putrid flesh or feces can be experienced. Such olfactory (related to the sense of smell) or gustatory (related to the sense of taste) hallucinations can occur on their own or as part of complex hallucinations, meaning a perception where auditory, visual and other types of hallucinations appear together.

For example, you can sense a demonic presence who appears as a vague shadow, have a distinct, irritant, sulfurous odor and engages you in a dialogue [1].

Simple or complex

The hallucinations can occur alone but most times are a part of a delusional system of thought and beliefs.  When that is the case the hallucinatory experiences might be taken as evidence for the delusions validity. For example, the voices confirm that CIA is out to get you. Alternatively, the delusional beliefs might explain why the hallucinations are present. For example, the CIA might have implanted an Web 4.0 particle transmitter that “voices” your CIA handler commands.

Personal and cultural factors

Undergoing hallucinations is not a “one size fits all” type of experience. It turns out that the hallucinations are tied into past personal experiences (such as a history of abuse) or even the cultural background. People from a Western background are more prone to experience malign commands, such as orders to harm themselves or others.

A non-Western background on the other hand seems to be associated with more benign commands such orders to doing clean the house, do the dishes, or take a walk.


[1]. While people with schizophrenia can have non-auditory hallucinations, such hallucinations are frequently a sign of sudden brain injury. Infections, drugs, acute hormonal dysfunction, kidney or liver failure, seizures, brain tumors or brain traumatic injury need to be considered.

A comprehensive medical work up is routinely done as part of diagnosing schizophrenia. This standard work up will likely be supplemented by specific neurological investigations, including brain imaging and EEG studies for people experiencing visual, somatic, tactile , gustatory or olfactory hallucinations.

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