Bipolar disorder is a type of mental health condition that causes extreme shifts in mood ranging from depression to mania. Bipolar disorder is not a rare condition and millions of people all over the world have been diagnosed with this condition. In the past, the condition used to be referred to as manic depression or bipolar disease. The mood changes associated with bipolar disorder depend on many different factors, vary in length and severity, and there can even be changes in the symptoms over a period of time. One surprising fact that many people don’t realize about the mood episodes of bipolar disorder is that they can also involve hallucinations. Read on to find out everything about whether bipolar disorder can cause hallucinations.
Can Bipolar Disorder Cause Hallucinations?
Bipolar disorder is a mental health condition characterized by extreme shifts in mood ranging from mania to depression. It is estimated that nearly three percent of all adults in the United States alone, or five million people, have been diagnosed with bipolar disorder. (1,2,3) While depression, mania, and hypomania are the most commonly observed symptoms of bipolar disorder, in some cases, people sometimes also experience symptoms of psychosis, including hallucinations.
Hallucinations are a type of sensory experience that does not match what is actually happening in reality. When a person experiences hallucinations, they may hear, see, smell, taste, or even sense things that other people who are in the same situation are not able to. For example, a person having a hallucination may see a giraffe walking on the street when nobody else is able to see it. This is a type of visual hallucination.(4,5) Most hallucinations are usually fleeting, but they can be long and very detailed, such as hearing voices or having a conversation with someone who is not there. In severe cases, hallucinations may even take over any of a person’s senses, but usually only one sense at a time.
Of course, hallucinations can also take place as a symptom of psychosis or a disconnect from reality. It is possible for a person to have more than one mental health condition at the same time. Some of the other signs and symptoms of psychosis may include:
- Disorganized thoughts or speech
- Feelings of confusion or suspiciousness
- Self-isolation or withdrawal from society
Psychosis is a symptom and not a mental health condition by itself. However, it is quite commonly observed in people with bipolar disorder.
In fact, a study from 2005 showed that an estimated 50 to 75 percent of people who have been diagnosed with bipolar disorder also experience the symptoms of psychosis during their mood episodes. These symptoms usually are sufficient to provide a diagnosis of bipolar disorder with psychotic features. So while some people live with bipolar disorder with the symptoms of psychosis such as hallucinations and others, it is also possible to have hallucinations with bipolar disorder but not have any other symptoms of psychosis.(6,7)
It is important to note, though, that not everyone who has been diagnosed with bipolar disorder experiences hallucinations or any other symptoms of psychosis.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, revised text (DSM-5-TR), some patients of bipolar disorder may present with psychotic symptoms such as hallucinations. The DSM-5-TR is the standard handout that most mental health professionals in the US use for diagnosing and establishing mental health conditions.(8) According to experts, hallucinations are more frequently seen with the manic episodes of bipolar disorder than during the depressive ones, but they can sometimes also occur during the depressive episodes.
Another point to be noted here is that hallucinations also help doctors separate hypomania from mania in bipolar disorder. If a patient has hallucinations during an episode of what would otherwise be termed as hypomania, the episode is automatically taken as meeting the criteria for mania. There is no doubt that hallucinations can make an already confusing disorder feel even worse. For a bipolar disorder patient, hallucinations can feel even more confusing, and even terrifying, especially when they have no idea what is causing them. Nevertheless, hallucinations in bipolar disorder are actually more common than what most people would think.(9,10)
What Causes Hallucinations in Bipolar Disorder?
Untreated cases of bipolar disorder are more commonly associated with frequently recurring mood episodes and more severe symptoms. This is believed to play a role in the occurrence of hallucinations.(11)
The issue that arises is that hallucinations that occur in bipolar disorder have not been studied much as a symptom. The current research that is available indicates that certain changes in the brain could be responsible for causing the hallucinations. In 2016, a small-scale study discovered that changes happening in the neurons present in certain parts of the brain that are responsible for giving importance to experiences are the likely cause of causing symptoms like hallucinations.(12) Another study carried out in 2018 with a larger group of participants as well as the use of magnetic resonance imaging (MRI) found that certain structural changes occurring in the brain might be associated with a history of having auditory hallucinations in patients of bipolar disorder. Auditory hallucinations happen when an individual hears things that others do not.(13)
Studies have also shown that hallucinations in bipolar disorder with psychotic features are most commonly observed during the mania episodes. During the periods of hypomania, which is a milder form of mania, hallucinations are at their peak. Due to this, periods of hypomania that occur with hallucinations are often reclassified as being mania episodes.(14)
Types of Hallucinations Observed in Bipolar Disorder
Auditory hallucinations are the most common type of hallucinations observed in patients with bipolar disorder.(15) Auditory hallucinations are also the most common type of hallucination experienced by people having psychosis or other types of mental health conditions. However, a study in 2005 found that even though auditory hallucinations are the most common type of hallucinations in bipolar disorder, visual hallucinations tend to also occur equally commonly in bipolar disorder as compared to other disorders like depression or schizophrenia.(16)
If you have been diagnosed with bipolar disorder with psychotic features, it is possible that you also experience other types of hallucinations, including:
- Tactile (taste)
- Somatic (bodily or internal sensations)
- Olfactory (smell)
- Gustatory (taste)
When you experience a hallucination in bipolar disorder, it is usually either mood congruent or mood incongruent. Mood congruent hallucinations are ones that match or align with your mood or how you are feeling at that moment. For example, if you are feeling very confident at that moment, you may experience auditory or visual hallucinations of people cheering or clapping for you. On the other hand, mood incongruent hallucinations do not match with your current mood. For example, you may be feeling like you are a great cook, but your hallucinations may see you burning the food or dropping the awards that you won for your cooking.(17, 18)
Can Bipolar Disorder Hallucinations Be Treated?
It is possible to treat hallucinations in bipolar disorder with direct medications that are known as antipsychotics. Antipsychotics are a class of drugs that are prescribed for managing the symptoms of psychosis. However, using antipsychotics is just one part of the treatment.(19,20)
The treatment of bipolar disorder as a whole is also critical when it comes to managing all the symptoms of a patient, including hallucinations.
The overall treatment for bipolar disorder involves many things like:
- Stress management strategies
- Lifestyle changes
- Family and self-education about the disease
If you are experiencing hallucinations which are diagnosed as being part of multiple psychosis symptoms, you might greatly benefit from a therapy known as coordinated specialty care or CSC. CSC involves various healthcare professionals working together in a team to come up with an individually tailored treatment plan for your specific needs. SCS plans usually involve most of the same therapy programs that are a part of bipolar disorder treatment, but the difference is that they may also include social and employment support to help the patient thrive in their daily environment and situations.(21,22)
Hallucinations can very much be a symptom of bipolar disorder. In such cases, doctors will provide a diagnosis of bipolar disorder, but with psychotic features. Auditory hallucinations are the most common form of hallucinations experienced by people having bipolar disorder, but visual hallucinations also tend to occur more frequently in bipolar disorder as compared to other mental health conditions. Since bipolar disorder is known to be a progressive condition that gets worse with time if left untreated, seeking early treatment can help manage and even prevent your symptoms from getting worse. Proper timely treatment can also help achieve a more positive outcome in the long run.
- Grande, I., Berk, M., Birmaher, B. and Vieta, E., 2016. Bipolar disorder. The Lancet, 387(10027), pp.1561-1572.
- Müller-Oerlinghausen, B., Berghöfer, A. and Bauer, M., 2002. Bipolar disorder. The Lancet, 359(9302), pp.241-247.
- Bipolar disorder (no date) National Institute of Mental Health. U.S. Department of Health and Human Services. Available at: https://www.nimh.nih.gov/health/statistics/bipolar-disorder (Accessed: February 24, 2023).
- Manford, M. and Andermann, F., 1998. Complex visual hallucinations. Clinical and neurobiological insights. Brain: a journal of neurology, 121(10), pp.1819-1840.
- Mocellin, R., Walterfang, M. and Velakoulis, D., 2006. Neuropsychiatry of complex visual hallucinations. Australian & New Zealand Journal of Psychiatry, 40(9), pp.742-751.
- Olincy, A. and Martin, L., 2005. Diminished suppression of the P50 auditory evoked potential in bipolar disorder subjects with a history of psychosis. American Journal of Psychiatry, 162(1), pp.43-49.
- McDonald, C., Bullmore, E.D., Sham, P., Chitnis, X., Suckling, J., MacCabe, J., Walshe, M. and Murray, R.M., 2005. Regional volume deviations of brain structure in schizophrenia and psychotic bipolar disorder: computational morphometry study. The British Journal of Psychiatry, 186(5), pp.369-377.
- Rowe, S. (2022) What’s the DSM-5?, Psych Central. Psych Central. Available at: https://psychcentral.com/lib/dsm-5/ (Accessed: February 24, 2023).
- Asaad, G. and Shapiro, B., 1986. Hallucinations: theoretical and clinical overview. The American journal of psychiatry.
- Siegel, R.K., 1977. Hallucinations. Scientific American, 237(4), pp.132-141.
- Post, R.M., 2020. How to prevent the malignant progression of bipolar disorder. Brazilian Journal of Psychiatry, 42, pp.552-557.
- Neves, M.D.C., Duarte, D.G., Albuquerque, M.R., Nicolato, R., Neves, F.S., Souza-Duran, F.L.D., Busatto, G. and Corrêa, H., 2016. Neural correlates of hallucinations in bipolar disorder. Brazilian Journal of Psychiatry, 38, pp.1-5.
- Mørch‐Johnsen, L., Nerland, S., Jørgensen, K.N., Osnes, K., Hartberg, C.B., Andreassen, O.A., Melle, I., Nesvåg, R. and Agartz, I., 2018. Cortical thickness abnormalities in bipolar disorder patients with a lifetime history of auditory hallucinations. Bipolar disorders, 20(7), pp.647-657.
- Badcock, J.C., Mahfouda, S. and Maybery, M.T., 2015. Hallucinations and inhibitory functioning in healthy young adults with high and low levels of hypomanic personality traits. Cognitive neuropsychiatry, 20(3), pp.254-269.
- Thakur, T. and Gupta, V., 2020. Auditory Hallucinations.
- Baethge, C., Baldessarini, R.J., Freudenthal, K., Streeruwitz, A., Bauer, M. and Bschor, T., 2005. Hallucinations in bipolar disorder: characteristics and comparison to unipolar depression and schizophrenia. Bipolar disorders, 7(2), pp.136-145.
- Winokur, G., Scharfetter, C. and Angst, J., 1985. The diagnostic value in assessing mood congruence in delusions and hallucinations and their relationship to the affective state. European archives of psychiatry and neurological sciences, 234, pp.299-302.
- Fennig, S., Bromet, E.J., Karant, M.T., Ram, R. and Jandorf, L., 1996. Mood-congruent versus mood-incongruent psychotic symptoms in first-admission patients with affective disorder. Journal of Affective Disorders, 37(1), pp.23-29.
- Slotema, C.W., Blom, J.D., Niemantsverdriet, M.B. and Sommer, I.E., 2018. Auditory verbal hallucinations in borderline personality disorder and the efficacy of antipsychotics: a systematic review. Frontiers in psychiatry, 9, p.347.
- González-Rodríguez, A., Molina-Andreu, O., Penadés, R., Bernardo, M. and Catalán, R., 2014. Effectiveness of long-acting injectable antipsychotics in delusional disorders with nonprominent hallucinations and without hallucinations. International clinical psychopharmacology, 29(3), pp.177-180.
- Dixon, L.B., Goldman, H.H., Bennett, M.E., Wang, Y., McNamara, K.A., Mendon, S.J., Goldstein, A.B., Choi, C.W.J., Lee, R.J., Lieberman, J.A. and Essock, S.M., 2015. Implementing coordinated specialty care for early psychosis: the RAISE Connection Program. Psychiatric Services, 66(7), pp.691-698.
- Tanzer, J.R., Redding, C.A., Mikhalyuk, I., Bennett, B., Lamoureux, B., Achin, D., Bassett, S., Martin, R. and Stein, L.A.R., 2021. Implementing Coordinated Specialty Care in CMHC Youth and Young Adults with Severe Mental Illness: Preliminary Outcome Assessment. Community Mental Health Journal, pp.1-12.
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