My 17-year-old son has been having visual and auditory hallucinations with no other symptoms. He’s outgoing, heavily involved in athletics and gets good grades. He denies nor shows any signs of depression, bi-polar disorder, anxiety or schizophrenia. He has no medical diagnoses and takes no medication. He doesn’t use drugs and has been screened several times. The hallucinations began two years ago and were minor, like seeing things out of the corner of his eye. They’ve slowly progressed, and are now vivid and disturbing. They are much more vivid in bright light or daylight. He is fully aware that the strange things he sees and the voices he hears aren’t real. He hasn’t been sleeping well for the past couple months, and has kept the hallucinations to himself until one week ago, when he told me he needed help. He was embarrassed, and felt he could deal with them, however they’re starting to wear on him. I’m a terrified mom right now, and can’t understand how this could happen for two years with no other signs or symptoms. We have a close relationship and I have never noticed anything out of the ordinary. We have an appointment with a psychologist next week. Is this rare to have vivid hallucinations and multiple voices in your head with no other symptoms?

A. You asked about whether it is rare to have only hallucinations and voices in the absence of other symptoms. Remember that he is also having sleep difficulties which I would characterize as a symptom, in the context of his hallucinations and voices. His symptoms may be indicative of a psychotic disorder but only a psychiatric evaluation could make that determination.

It’s possible that he is experiencing other symptoms and doesn’t yet recognize them as being symptoms. For instance, perhaps he is experiencing a lack of motivation or increased agitation but does not perceive these as being symptoms. If that were true, a mental health professional would consider them symptoms, especially in light of his other symptoms. It is very good that he’s being seen by a mental health professional in the near future. The psychologist can identify all of his symptoms and provide more information about what might be happening.

The psychologist might also recommend that your son undergo a medical evaluation to rule out a physical cause. Oliver Sacks, a famous professor of neurology who has studied hallucinations extensively, says that they can be caused by a number of physiological conditions including illnesses, fever, sleep deprivation, drug use, extended grief, trauma and severe exhaustion. He explored the nature of hallucinations in his new book appropriately entitled “Hallucinations.”

Thankfully, your son has finally asked for help. The sooner he receives treatment, the better the prognosis. Please take care.

Dr. Kristina Randle
Mental Health & Criminal Justice