Bipolar disorder involves experiencing mood episodes like depression and mania. Some people, though, may also experience hallucinations. Here’s why.

Mania, hypomania, and depression are the formal symptoms of bipolar disorder. But, in some cases, people with bipolar disorder can also experience symptoms of psychosis, like hallucinations.

What are hallucinations?

Hallucinations are sensory experiences that don’t match a shared reality.

During a hallucination, you may see, hear, smell, taste, or sense things that others in the same situation do not.

For example, seeing a tiger walk around the bus you’re riding, when nobody else seems to see it, is an example of a visual hallucination.

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Not everyone living with bipolar disorder experiences hallucinations or other symptoms of psychosis.

But the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, revised text (DSM-5-TR), a handout that most U.S. mental health professionals use to diagnose, establishes that, in some cases, the condition may present “with psychotic features.”

Psychosis is a formal symptom of schizophrenia, but could also show up in other conditions.

In this case, though, bipolar disorder with hallucinations is still bipolar disorder. These hallucinations are more likely to occur during intense mood episodes.

Schizophrenia vs. bipolar disorder

Schizophrenia and bipolar disorder can both present with hallucinations and other features of psychosis.

The difference, according to the DSM-5-RT, is that in bipolar disorder, symptoms of psychosis are only present during episodes of major depression or mania.

Untreated schizophrenia, as a psychotic disorder, persistently features symptoms of psychosis at any time.

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What causes bipolar hallucinations?

Untreated bipolar disorder, which is associated with more recurrent mood episodes and more intense symptoms, may play a role in hallucinations.

Hallucinations in bipolar disorder are an understudied symptom. Current research points to changes in the brain as a possible contributing factor.

In 2016, a small study found that changes in the neurons in the areas of the brain responsible for assigning importance to experiences could result in symptoms like hallucinations.

Later, a 2018 study with a larger pool of participants and the use of magnetic resonance imaging (MRI), identified structural changes in the brain that may be linked to a history of auditory hallucinations in bipolar disorder. Auditory hallucinations refer to hearing things others can’t.

Hallucinations in bipolar disorder with psychotic features are most common during episodes of mania.

In fact, periods of hypomania — a milder form of mania — that manifest with hallucinations, are clinically reclassified as mania episodes.

What is psychosis?

Psychosis is a set of symptoms that indicate an inconsistency between what your brain perceives and the shared reality around you — what some people call “a break in reality.”

Symptoms of psychosis include:

  • hallucinations
  • delusions
  • disorganized thinking
  • negative symptoms (symptoms that show a loss of ability, like poverty of speech)
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Auditory hallucinations are the most common form of hallucinations experienced in psychosis, bipolar disorder, and other conditions.

However, a 2005 study found that, while auditory hallucinations were still the most common, visual hallucinations occurred more often in bipolar disorder than in disorders like schizophrenia or depression.

If you live with bipolar disorder with psychotic features, you may also experience other types of hallucinations such as:

  • olfactory (smell)
  • gustatory (taste)
  • tactile (touch)
  • somatic (internal, bodily sensations)

Your mood and hallucinations

When you experience a hallucination in bipolar disorder, the DSM-5-RT notes it will either be:

  • mood congruent
  • mood incongruent

Mood congruent hallucinations align with how you’re feeling.

If you’re feeling excessively confident, for example, you may have auditory hallucinations of people cheering for you.

Mood incongruent hallucinations go against your current mood.

You may experience visual hallucinations of dropping your award-winning cupcakes, for example, even though your mood has you feeling like an invincible baker.

Hallucinations in bipolar disorder are often directly treated with medications known as antipsychotics.

Antipsychotics can help you manage symptoms of psychosis, but they’re only one piece of the puzzle.

Treating bipolar disorder as a whole is often key to managing all of the symptoms.

Bipolar disorder treatment can involve:

If hallucinations are part of multiple psychosis symptoms, you may benefit from coordinated specialty care (CSC), which enlists multiple healthcare professionals in a team effort to create an individual plan for your specific needs.

CSC plans can involve all of the same programs as bipolar disorder treatment, but they may also include employment and social support to help you thrive in your everyday environment.

Hallucinations can be a symptom of bipolar disorder. When this happens, health professionals provide the diagnosis of bipolar disorder with psychotic features.

While auditory forms remain the most common type of hallucinations, visual hallucinations in bipolar disorder occur more frequently than in other conditions.

Bipolar disorder is considered a progressive condition. Receiving treatment early may help prevent your symptoms from getting worse and can lead to more positive long-term outcomes.