Psychosis Symptoms: What are Hallucinations and Delusions?
Hallucinations and delusions are the primary symptoms of psychosis. Hallucinations and delusions in relation to bipolar disorder explained in detail.
As mentioned before, hallucinations and delusions are the hallmark symptoms of psychosis. Bipolar hallucinations involve the senses; bipolar delusions are about unshakable feelings and beliefs. The following section gives you in-depth descriptions of each psychotic symptom, as well as some real-life examples of each. If you're wondering "Am I psychotic?", take our psychosis test.
Bipolar Hallucinations: Symptom of Psychosis
When I started to get psychotic, I looked out my window and saw a man's face. I also saw a child's face in the trunk of a car. I then saw a tiger in a tree. I was in the hospital the next day. They just seemed so real! I saw them with my own eyes, so how could I know they were fake?
I hear my name called over the loud speakers in stores. I hear it over-and-over again. It gets so bad I have to leave!
I see myself die a lot. If I'm standing on a street corner- I see myself get hit by a car- flipped in the air and then splat on the ground. I used to call them death images. Now I know what they really were! And I only got them when I was stressed!
I heard my mother screaming at me over and over again- but she lived in another state.
I heard a voice that told me I was the messiah and that I could save the world with my magnetic stare. That's really weird! Someone talked to me. I heard the voice and it wasn't my own. I looked around but there was no one in the room.
Hallucinations are about the senses. They are not thoughts or dreams or wishes. If you experience something involving seeing, hearing, tasting, smelling or touching as though it truly happened and yet it's hard to tell fact from fiction, it's more likely a hallucination.
Bipolar Delusions: Another Psychotic Symptom
There is a fine line between intense or even odd feelings and delusions. Bipolar delusions are not intuition. Delusions are false beliefs. They truly do not have a basis in reality. Here are a few examples.
When I got sick the last time- I was literally and totally positive my wife was having an affair with her ex-husband. I kept asking her over and over again, "Have you been sleeping with him? When did you sneak out to see him?" The fact that they had been divorced for eight years and they had no contact simply didn't register in my brain. I lost all touch with reality and the feelings took over my life. I believed she was cheating with every cell in my body. It was that real even though there was zero proof. I am amazed we survived this.
I thought my blood was full of snakes. I could feel them writhing and slipping around in there.
I constantly felt like someone was following me. When I got with a group of people, I could see them whispering about me. I felt that every step I took was a message to the people who were following me. I wanted to go to the police, but I was too scared. I'm so glad I didn't!
For almost three months, I believed I was the smartest person on the west coast and I believed the president knew about it and wanted me taken out of the picture.
People can have really odd feelings when they are not psychotic - the difference is that they can have a reasonable discussion about the feelings, especially when someone asks them questions based in reality. For example, a depressed person may fear they have cancer, but a doctor can say, "Is there any proof you have cancer?" and they reply, "No, but I am so miserable and so worried that I think I may have cancer."
In contrast, bipolar delusions are unshakable and immune to reality testing. There is no challenging the person and often the delusion is very bizarre such as, " I have cancer from a government experiment that no one knows about, but I know! They put the cancer in my drinking water." As a person starts to move out of psychosis, they are more able to have perspective and eventually they can see their feelings and beliefs as non-realistic, but while they are happening, they feel as real as reality!
Not all people with bipolar disorder have delusions. I once had a very strong delusion. As I was driving over a bridge, I saw a billboard advertising a local brand of beer. I had the immediate thought, "Is that sign giving me a message? Did I do something wrong involving that beer last night?" I had enough insight to understand this was a delusion and was able to talk myself out of the belief. Plus, I would never drink that brand of beer!
I want to stress again that it's really so important to distinguish between the psychosis in bipolar disorder and that in schizophrenia. What it comes down to is that though the two illnesses have the same psychotic symptoms, but people with bipolar disorder are more able to function at a higher level even when they are having hallucinations and delusions. They may still believe that the delusion is real and their reality testing can be very poor, but they can still get dressed, make breakfast and go to work. Their train of thought around the basics of life is not always disorganized. This is one reason people with bipolar psychosis can go for years without anyone knowing they are psychotic- this is not possible for people with schizophrenia as all of their behavior can become disorganized when they are psychotic.
Of course, when someone gets severely manic and psychotic, they can be very disorganized, but it's episodic and not chronic. I once believed that all of the evaluations I received after a speech were fake. It was such an intense delusion, even though there was no proof and in fact, faking the evaluations was literally impossible. But even though the delusion persisted for days and I asked people if it were possibly true, I just kept on going as if things were okay.
Last Updated: 27 March 2017
Reviewed by Harry Croft, MD