For some people with OCD, hallucinations can accompany their obsessions and compulsions. There are treatments to help you manage this.
Some people who have obsessive-compulsive disorder (OCD) experience hallucinations.
Obsessive-compulsive disorder includes two major symptoms: obsessions — which are persistent, upsetting thoughts or images — and compulsions, actions you take to stop those obsessive thoughts.
Sometimes, it can be accompanied by hallucinations. These hallucinations can be auditory, visual, sensory, or otherwise in nature.
Many people with OCD also experience quasi-hallucinations. With a quasi-hallucination, you know it’s not real, but the feeling is still strong. For example, you might feel dirt on your skin and have a compulsion to wash it off, even though you know there isn’t really dirt on your skin.
It’s also possible for someone with OCD to have a separate disorder, such as schizophrenia, which can also cause hallucinations.
As 2014 research notes, many of us experience mental images from time to time — you might think of a loved one and remember a specific memory very strongly, or even smell their perfume or feel the sensation of being hugged by them.
When these mental images are involuntary, we call them intrusions.
Constant intrusions can be a symptom of several mental health conditions, including:
Sometimes, intrusive mental images can fit the criteria of hallucinations, especially when they’re particularly vivid.
There are different types of hallucinations possible with OCD.
Auditory hallucinations involve hearing things that aren’t there — voices, bangs, music, or other noises.
One survey-based study dating back to 2009 found that many non-schizophrenic people with OCD have auditory hallucinations, although they’re often distinguishable from “real” sounds or voices.
As the name suggests, visual hallucinations involve seeing things that aren’t there.
If you have obsessions around car accidents, for example, you might have a strong mental image of the events leading up to the accident, the crash itself, and the aftermath.
Tactile hallucinations (touch hallucinations)
Tactile hallucinations involve sensing the feeling of something on your skin. For example, you might “feel” dirt or germs on your skin if you have contamination OCD, compelling you to wash your skin.
Olfactory hallucinations (smell hallucinations)
It’s possible to have the sensation of smelling something that isn’t there.
For example, a common OCD obsession is the idea that you didn’t turn off the gas before leaving the house. This might be accompanied by the smell of gas.
A compulsion that may follow could include checking that you’ve turned it off several times before leaving the house.
Somatic hallucinations (bodily hallucinations)
Bodily, or somatic, hallucinations can involve feeling like things are happening to your body. You might feel the sensation of being hurt or falling, for example.
One study notes that 3 in 4 people with OCD report experiencing sensations along with their symptoms. These could be hallucinations or quasi-hallucinations.
There’s a lack of rigorous studies on the prevalence of OCD with hallucinations. However, one 2014 study, which looked at people with OCD and depressive symptoms, found that it’s fairly common among both groups.
Interviews with 26 people with OCD found that 73% experienced hallucinations or quasi-hallucinations. In total:
- 54% reported having somatic mental intrusions
- 46% reported having visual mental intrusions
- 35% reported having tactile intrusions
- 12% reported having auditory/acoustic intrusions
However, this is a small sample size, and it relies on self-reported information — in other words, these percentages might not accurately represent everyone with OCD.
In a word, no.
Auditory hallucinations and intrusive thoughts may seem similar, but they are not.
Intrusive thoughts can happen to anyone, and most people have them. Maybe you’ve finished a big exam and thought, “I’m pretty smart” or “I totally aced that.” Or, these thoughts can be negative: “I can’t believe I failed that test.”
These types of thoughts are not uncommon. They typically involve distinctive thoughts that you “hear” in your own voice, the same as you would any other thought.
Auditory hallucinations, on the other hand, involve hearing the voice of someone else.
People with OCD may appear to be in psychosis but are not. For example, they may repeatedly check and recheck the front door several times before leaving the house. They may do this fearing a break-in and feeling it was their responsibility for ensuring the doors were locked.
This is not psychosis. Why not?
A distinctive feature of OCD is the person may be aware that these intrusive thoughts and behaviors are irrational or not real but aren’t able to control them.
On the other hand, a person in psychosis may not be aware that their thoughts aren’t real.
A person with OCD may, however, also have schizophrenia. Psychosis can occur in schizophrenia.
OCD with hallucinations can be treated so that the symptom can become more manageable.
Talk therapy, also called psychotherapy, is a good place to start. OCD is most commonly treated by exposure and response prevention (ERP), which is a type of cognitive behavioral therapy (CBT). Research has found that ERP is an effective therapy for treating OCD.
Some research, such as this 2014 study, has suggested that imagery rescripting might help treat OCD with hallucinations.
Imagery rescripting might involve acknowledging the sensation, reconsidering it, and then changing it so that it feels different. Imagery rescripting can be a part of CBT or another kind of therapy.
Some people with OCD benefit from medications prescribed by a doctor. Selective serotonin reuptake inhibitors (SSRIs), which are often prescribed for depression and anxiety, might help people with OCD.
There’s no current research to suggest that medications may help with hallucinations.
Although self-care strategies can’t replace therapy or medication, they can help manage symptoms of OCD.
Common self-care strategies for OCD include:
- healthy lifestyle choices, like eating a balanced diet and getting enough sleep, both of which can affect your mood
- exercise and meditation, which can help you manage stress
- creative hobbies to help you process your emotions
Having OCD with hallucinations can feel isolating. It might be a good idea to find support groups for people with OCD. You could try the IOCDF OCD support groups list for local meet-up groups and the IOCDF online or telephone support groups for remote groups.
Some people with OCD do experience hallucinations or quasi-hallucinations. This can be a result of OCD or it could be a symptom of another mental health condition.
Remember, OCD can be treated effectively. Talk therapy is a good place to start if you’d like to get help. You can start by finding a therapist experienced in treating OCD.