Could those elusive sounds you’re hearing actually be post-traumatic stress disorder (PTSD) hallucinations?
There are many anticipated symptoms that can accompany a post-traumatic stress disorder (PTSD) diagnosis. You might experience anything from flashbacks and avoidant behaviors to sleep disturbance.
What you might not expect to experience, however, are reality-altering changes like hallucinations.
While hallucinations are not typically considered one of the “classic” symptoms of PTSD, a growing body of research indicates these sensory experiences aren’t uncommon in trauma-spectrum disorders.
PTSD is a mental health condition that can occur when you’ve experienced or witnessed trauma, such as physical harm or threat.
PTSD can be an impairing disorder characterized by reexperiencing traumatic events and engaging in avoidance behaviors that can impact almost every aspect of daily functioning.
Not everyone who is exposed to a dangerous or traumatic experience will develop PTSD. For many people, the body’s natural reactions to trauma fade over time.
In a moment of danger, your heart rate and breathing may quicken, for example, and you might feel fear or other overwhelming negative emotions.
Afterward, you’re typically able to move on from the trauma. And while you may never forget it, you don’t necessarily experience the effects for a prolonged period of time.
But if you’re living with PTSD, you may still feel the effects. For someone with PTSD, some of those fight, flight, or freeze responses last long after the event, almost as if you’re stuck in perpetual survival mode.
PTSD occurs as the result of a traumatic experience. You may have played an active role in the event, or you might have witnessed a traumatic situation unfold.
Anyone, at any age, can develop PTSD.
Common causes of PTSD can include:
- physical danger
- near-death experience
- sexual or physical assault
- natural disaster
- death of a loved one
What causes PTSD in your brain?
While PTSD is caused by a traumatic experience, the reason why your brain remains in survival mode is less obvious.
These changes can create a unique dynamic where some regions of the brain might become hyperresponsive, while others may go into a state of reduced function.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) lists four categories of symptoms that appear in a PTSD diagnosis:
- Intrusive. Symptoms that cause reexperiencing, such as distressing dreams, flashbacks, unwelcome memories, and intrusive thoughts.
- Avoidant. Actively working to avoid people, places, and things that may remind you of the traumatic event. You may also attempt to avoid talking about it or thinking about it.
- Cognitive or mood. Experiencing changes in mood, an inability to recall events around the trauma, or developing distorted beliefs.
- Arousal or reactivity. Feeling irritable or participating in risky behaviors. You may be prone to outbursts, be easily startled, feel constantly on edge, or experience hypervigilance or feelings of “high alertness.” You may also experience sleep disturbance.
PTSD, and the traumatic experience it arises from, can be very personal. You may not have every symptom listed in the DSM-5.
For some people, you may even experience symptoms not considered criteria in the DSM-5 — like PTSD hallucinations.
Flashbacks vs. hallucinations
Experiencing flashbacks and hallucinations are not the same thing. And while flashbacks are often portrayed as a common symptom of PTSD in media and used for storytelling, they are not a usual feature of this condition.
Yes, you can experience hallucinations with PTSD.
While this symptom isn’t a part of the DSM-5 criteria for post-traumatic stress disorder, expanding research suggests hallucinations may be more common than originally thought among trauma-spectrum disorders.
In a 2020 study among women living with PTSD, researchers found that 46% reported clear auditory hallucinations in the form of voices.
Similar findings were reported in an earlier
Traditionally, hallucinations and delusions are classified as symptoms of psychosis. Psychosis is characterized by your brain’s inability to distinguish between what’s real and what isn’t.
However, psychotic-like experiences with PTSD are not necessarily considered classic psychosis.
The severity of a traumatic event was associated with the severity of symptoms experienced. When it came to PTSD hallucinations, they were most commonly associated with experiences of sexual abuse.
However, this research is far from conclusive. It’s important to note that this study was conducted on a sample of people with a preexisting psychotic disorder, and only half of all participants were living with PTSD.
Hallucinations are sensory experiences that can arise from an interruption in reality. They can involve any of your senses, meaning you can see, smell, hear, taste, or feel things that aren’t really there.
Clinically, sensory types of hallucinations are referred to as:
- auditory (hearing)
- olfactory (smell)
- tactile (external touch)
- gustatory (taste)
- visual (sight)
- somatic (internal sensation)
However, auditory hallucinations may be the most common among people with PTSD.
In general, hallucinations may be the result of:
- affective disorders (severe depression)
- postpartum psychosis
- psychoactive substances
- delirium tremens
- alcoholic hallucinosis
- brain injury
- Alzheimer’s disease
- Lewy body dementia
- Parkinson’s disease
- ear diseases
- eyes diseases
People with borderline personality disorder (BPD) may also experience hallucinations, though this might be less common. Only 29% of participants with BPD in a
Predictive coding in the brain
While this doesn’t explain the exact mechanism that creates PTSD hallucinations, like in schizophrenia, experts believe these altered perceptions of reality may come from skewed
Predictive coding is a theoretical concept suggesting that your brain is in a constant state of updating based on anticipated (or predicted) sensory inputs.
In other words, if your brain ignores the correct sensory input in favor of a trauma-informed response, you might experience a hallucination.
Hallucinations can be a symptom of underlying PTSD.
Treating PTSD hallucinations often means addressing your PTSD first. Long-term relief from PTSD often requires guidance from a mental health care professional.
If you have PTSD, there is an array of treatment options to help you manage symptoms.
Therapy is often a foundational method for treating PTSD. Medication is also sometimes prescribed to take the edge off of anxiety or hyperarousal from PTSD, but it is not considered as effective in treating other PTSD symptoms.
PTSD treatment may involve:
- prolonged exposure therapy (PE)
- cognitive behavioral therapy (CBT)
- cognitive processing therapy (CPT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- brief eclectic psychotherapy (BEP)
- narrative exposure therapy (NET)
- eclectic psychotherapy
Treating PTSD with hallucinations
You may also be prescribed an antipsychotic medication to help manage hallucinations during your PTSD treatment process.
For PTSD with hallucinations, you may also benefit from:
- transcranial magnetic stimulation (TMS)
- ABC analysis of voices
- depressive disorders, particularly major depressive disorder (MDD)
- anxiety disorders
- substance use disorders
Which one comes first is typically debatable and often depends on the individual.
Since PTSD is the result of trauma, it can be found as a precursor to substance use disorders, which may result from unhelpful coping strategies.
The cause-and-effect relationship goes both ways, however.
Living with an anxiety disorder or another mental health condition prior to a traumatic experience may increase your risk of experiencing PTSD.
Sometimes, the stress of living with a mental health condition may contribute to PTSD development.
After a traumatic event, living with PTSD can be a challenging reminder of your experience.
You may display symptoms of reexperiencing and avoidance, and you may also live with co-occurring mental health conditions, like anxiety and depression.
PTSD hallucinations can be an intimidating and unexpected addition to the other symptoms you may be dealing with. You may even feel reluctant to tell those closest to you, especially if you aren’t even sure yourself what’s happening.
But if you’re experiencing PTSD with hallucinations or psychosis, you can know that you aren’t alone.
You don’t have to live with PTSD or hallucinations forever. The right treatment can make PTSD manageable. And when PTSD is managed, PTSD hallucinations often go away as well.
Finding relief often begins with seeking help from a doctor or therapist to address the underlying PTSD. If you’re ready to get help but don’t know where to begin, you can check out Psych Central’s guide to finding mental health care.
Everyone’s trauma is unique. If you’re considering self-harm or suicide, it’s important to remember that you’re not alone and resources are available to you. If you need to talk with someone right away, you can:
- Call the National Suicide Prevention Lifeline, available 24 hours a day at 800-273-8255.
- Text “HOME” to the Crisis Text Line at 741741.
Not in the United States? You can find a helpline in your country with Befrienders Worldwide.