Schizophrenia Basics: Delusions, Hallucinations & Onset
One of the most obvious kinds of impairment caused by schizophrenia involves how a person thinks. The individual can lose much of the ability to rationally evaluate his or her surroundings and interactions with others. They often believe things that are untrue, and may have difficulty accepting what they see as “true” reality.
Schizophrenia most often includes hallucinations and/or delusions, which reflect distortions in the perception and interpretation of reality. The resulting behaviors may seem bizarre to the casual observer, even though they may be consistent with the schizophrenic’s abnormal perceptions and beliefs.
The Differences Between a Delusion & a Hallucination
Delusions are an unshakable theory or belief in something false and impossible, despite evidence to the contrary. Examples of some of the most common types of delusions are:
- Delusions of persecution or paranoia – Belief that others — often a vague “they” — are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Russians are trying to poison me with radioactive particles delivered through my tap water”). Click here to learn more about paranoid delusions, or here to learn more about persecutory delusions.
- Delusions of reference – A neutral event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a celebrity is sending a message meant specifically for them. Click here to learn more about delusions of reference.
- Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly). Click here to learn more about delusions of grandeur.
- Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”). Click here to learn more about delusions of control.
A hallucination is a sensation or sensory perception that a person experiences in the absence of a relevant external stimulus. That is, a person experiences something that doesn’t really exist (except in their mind). A hallucination can occur in any sensory modality — visual, auditory, olfactory, gustatory, tactile, etc.
Auditory hallucinations (e.g. hearing voices or some other sound) are most common type of hallucination in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Hallucinations can often be meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
More Schizophrenia Basics
Someone with schizophrenia may act in an extremely paranoid manner — purchasing multiple locks for their doors, always checking behind them as they walk in public, refusing to talk on the phone. Without context, these behaviors may seem irrational or illogical. But to someone with schizophrenia, these behaviors may reflect a reasonable reaction their false beliefs that others are out to get them or lock them up.
Nearly one-third of those diagnosed with schizophrenia will attempt suicide. About 10 percent of those with the diagnosis will commit suicide within 20 years of the beginning of the disorder.
Patients with schizophrenia are not likely to share their suicidal intentions with others, making life-saving interventions more difficult. The risk of depression needs special mention due to the high rate of suicide in these patients.
The most significant risk of suicide in schizophrenia is among males under 30 who have some symptoms of depression and a relatively recent hospital discharge. Other risks include imagined voices directing the patient toward self-harm (auditory command hallucinations) and intense false beliefs (delusions).
The relationship of schizophrenia to substance abuse is significant. Due to impairments in insight and judgment, people with schizophrenia may be less able to judge and control the temptations and resulting difficulties associated with drug or alcohol abuse.
In addition, it is not uncommon for people suffering from this disorder to try to “self-medicate” their otherwise debilitating symptoms with mind-altering drugs. The abuse of such substances, most commonly nicotine, alcohol, cocaine and marijuana, impedes treatment and recovery.
The Onset of Schizophrenia
The onset of schizophrenia in most people is a gradual deterioration that occurs in early adulthood — usually in a person’s early 20s. Loved ones and friends may spot early warning signs long before the primary symptoms of schizophrenia occur. During this initial pre-onset phase, a person may seem without goals in their life, becoming increasingly eccentric and unmotivated. They may isolate themselves and remove themselves from family situations and friends. They may stop engaging in other activities that they also used to enjoy, such as hobbies or volunteering.
Warning signs that may indicate someone is heading toward an episode of schizophrenia include:
- Social isolation and withdrawal
- Irrational, bizarre or odd statements or beliefs
- Increased paranoia or questioning others’ motivations
- Becoming more emotionless
- Hostility or acting with extreme suspicion for no reason
- Increasing reliance on drugs or alcohol (in an attempt to self-medicate)
- Lack of motivation
- Speaking in a strange manner unlike themselves
- Inappropriate laughter
- Insomnia or oversleeping
- Deterioration in their personal appearance and hygiene
While there is no guarantee that one or more of these symptoms will lead to schizophrenia, a number of them occurring together should be cause for concern, especially if it appears that the individual is getting worse over time. This is the ideal time to act to help the person (even if it turns out not to be schizophrenia).
Continue reading: Schizophrenia Symptoms
Grohol, J. (2019). Schizophrenia Basics: Delusions, Hallucinations & Onset. Psych Central. Retrieved on March 31, 2020, from https://psychcentral.com/lib/schizophrenia-basics-delusions-hallucinations-onset/