If you have any familiarity with bipolar disorder, you likely know it as a mental health condition defined by “high” and “low” mood states — episodes of mania, hypomania, or depression, to be precise.
How you experience these mood episodes can depend on different factors. Episodes might vary in length and severity, and you could even notice changes in mood symptoms over time.
Yet many people don’t realize one important fact about mood episodes: They can also involve hallucinations.
Hallucinations tend to happen more frequently with the manic episodes that characterize bipolar I, though they can also appear during depressive episodes.
Hallucinations also separate hypomania from mania. If you hallucinate during what otherwise feels like hypomania, the episode automatically meets criteria for mania, notes the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Hallucinations can feel confusing, even terrifying — especially when you don’t know what causes them. But they’re more common than you think.
Below, we’ll explore bipolar hallucinations in depth, plus offer some guidance on getting support.
Hallucinations do often happen as a symptom of psychosis, or a disconnect from reality. Other main symptoms of psychosis include:
- self-isolation or withdrawal
- disorganized speech and thoughts
- feelings of suspiciousness and confusion
Psychosis is a symptom, not a mental health condition in and of itself, and it’s somewhat common with bipolar disorder.
In fact, older
Two different types of psychosis can happen with bipolar disorder:
- Mood congruent psychosis. The symptoms you experience align with the mood episode. You might hear people laughing and talking or cheering you on during an episode of mania, for example. This type is more common.
- Mood incongruent psychosis. These symptoms conflict with your mood state. In a state of depression, for example, you might believe you’re actually someone famous, or hear a voice telling you that you’re invincible.
Although some people living with bipolar disorder do experience psychosis, it’s possible to hallucinate with bipolar disorder without ever having any other symptoms of psychosis.
In short, hallucinating doesn’t always mean you’re dealing with psychosis.
Hallucinations can involve any of your senses, though usually just one at a time.
Three types of hallucinations appear most commonly with bipolar disorder:
- auditory, or hearing things no one else can hear
- somatic, or feeling something you can’t see or hear
- visual, or seeing something no one else can see
It’s also possible to hallucinate tastes or smells, but
Often, hallucinations are fleeting: You might briefly see flashing lights, feel someone touch your hand, or hear music playing.
They can also be longer and more detailed: You could hear voices having a conversation, or see a long-departed loved one walking past your house.
Experts don’t fully understand why some people with bipolar disorder experience hallucinations and others don’t.
They do know hallucinations can happen for plenty of different reasons, including chronic medical conditions, head injuries, and seizures, just to name a few.
As for hallucinations that happen with bipolar disorder? Well, potential causes can still vary pretty widely. A few recognized triggers include:
Any kind of stress can have an impact on mental and physical well-being. This includes both ordinary life stress and the added strain that can happen as a result of living with a mental health condition.
Common sources of stress include:
- traumatic experiences
- relationship conflict or breakup
- family problems
- health concerns
- workplace or financial issues
You might be more likely to hallucinate when under a lot of daily stress, or feeling overwhelmed and anxious about something in particular.
In some cases, stress can also serve as a trigger for mood episodes.
Lack of sleep
During manic episodes, you might feel as if you need less sleep — after just 2 or 3 hours, you wake up feeling rested and ready to go. Of course, you still actually need that sleep you’re missing out on.
Sleep deprivation is a key cause of hallucinations, so regularly getting fewer than 6 or 7 hours of sleep each night could increase your chances of hallucinating and make some mood symptoms worse.
Not getting enough rest can also prompt manic episodes, not to mention contribute to anxiety, depression, and plenty of other health concerns. Most adults need between 7 and 9 hours of sleep each night for optimal health.
Medication side effects
Hallucinations may happen as a side effect of certain medications, including some antidepressants and antipsychotics used to treat bipolar disorder:
- selective serotonin reuptake inhibitors (SSRIs)
- tricyclic antidepressants
- olanzapine (Zyprexa)
If you hallucinate while taking antidepressants or any other medication that lists hallucinations as a potential side effect, let your prescriber know right away. They can help you monitor your symptoms and switch your medication or adjust the dose, if needed.
Alcohol and other substances
Hallucinations can happen as a result of:
It’s not uncommon to use alcohol and substances to cope with emotional turmoil and distress, especially when living with a lifelong condition like bipolar disorder. Mood episodes can feel overwhelming, even unbearable, and it’s not always easy to manage them without wanting to numb that pain.
Keep in mind, though, that these substances only provide temporary relief and may even worsen mental health symptoms. Working with a therapist can help you explore more long-lasting methods of relief.
Some people experience hallucinations and other symptoms of psychosis after childbirth.
Postpartum psychosis is rare, but it’s more common in people with a history of bipolar disorder — and it always represents a medical emergency.
Connect with your care team right away if you’ve recently given birth and experience hallucinations, along with:
- a general sense of confusion or disorientation
- sudden shifts in mood
- thoughts of violence or self-harm
- fears that someone wants to hurt your baby, or you do
It’s always safest to let your doctor know about hallucinations after childbirth, even if you don’t notice other signs of psychosis. They can help you watch for other symptoms and offer support with getting the right treatment.
Other potential causes
Medical causes of hallucinations include:
It’s also possible to hallucinate:
- during periods of isolation
- as part of a spiritual or religious experience
Since hallucinations can happen for so many reasons, it may take some time to narrow down what’s causing yours.
Telling your therapist or other healthcare professional everything you can about not just the hallucination, but how you felt beforehand and any other symptoms you noticed, can make it easier for them to arrive at the right diagnosis:
- Maybe you only notice hallucinations when you haven’t slept well for several days, or when your mood is very low.
- If you also report head pain or other physical symptoms, your therapist may encourage you to connect with a healthcare provider to rule out underlying health conditions.
You know your symptoms best, so if the suggested diagnosis doesn’t feel right, it’s important to let them know.
Distinct mood episodes nearly always suggest bipolar disorder, especially when you don’t experience any other symptoms of psychosis or experience any “break” from reality. The specific pattern, type, and length of your mood episodes will help your healthcare professional determine the most likely subtype.
Keep in mind it’s entirely possible to have more than one mental health condition at the same time. Anxiety, for example, commonly occurs with bipolar disorder — and many people living with anxiety do
When you have other symptoms of psychosis
Your symptoms could meet criteria for bipolar disorder with psychotic features, but they could better fit a diagnosis of schizoaffective disorder.
This mental health condition involves mixed symptoms of bipolar disorder and schizophrenia. But with schizoaffective disorder, you’ll also experience psychosis when you aren’t having a mood episode.
To diagnose this condition, a mental health professional will help you track when psychosis appears and note whether it’s present during just your mood episodes, or at other times, too.
Typically, bipolar disorder requires professional treatment, though treatment may require different approaches:
- during mood episodes
- during a manic episode versus a depressive episode
- once mood symptoms start to improve
- when you aren’t experiencing any symptoms
After a mood episode, treatment generally aims to reduce future mood episodes and help you maintain a euthymic (symptom-free) mood state.
To achieve this goal, you might work with your treatment team to:
- find medication dosages that work well, with few side effects
- learn helpful ways to manage stress
- address hallucinations, and any other concerning symptoms, in therapy
- explore lifestyle changes and self-care habits to improve sleep, physical health, and emotional well-being
- discuss complementary treatments, like light therapy, acupuncture, or mindfulness practices like meditation and yoga
These strategies can go a long way toward improving all symptoms of bipolar disorder — including hallucinations that happen with psychosis and those that relate to sleep loss or stress.
Without treatment, though, symptoms often get worse. You could have more frequent mood episodes, and you might also notice more hallucinations.
If you live with bipolar disorder, it’s always a good idea to work with a therapist who has experience treating the condition. Therapists trained to recognize the often complex presentation of mood episodes can identify the correct diagnosis and help you find the most effective treatment.
When treatment doesn’t seem to help
Perhaps your current medication hasn’t done much for your symptoms. Or maybe you think it’s causing your hallucinations.
You’ll want to mention this to your psychiatrist or doctor right away, but it’s best to keep taking the medication unless they tell you otherwise. Abruptly stopping a medication can lead to serious side effects.
It’s also important to continue taking any prescribed medications, even when you have no mood symptoms at all. Stopping the medication could trigger a mood episode.
Concerned about side effects? Ask your care team about reducing your dose or trying another medication.
Mood episodes remain the defining feature of bipolar disorder, but the condition can involve hallucinations, too.
Sure, they might feel less frightening when you recognize them as hallucinations and never lose touch with reality. But it’s entirely natural to feel unsettled, confused, or even stressed, which could make bipolar symptoms worse.
A therapist can offer more insight on potential causes and help you take steps to find the most effective treatment.
Crystal Raypole writes for Healthline and Psych Central. Her fields of interest include Japanese translation, cooking, natural sciences, sex positivity, and mental health, along with books, books, and more books. In particular, she’s committed to helping decrease stigma around mental health issues. She lives in Washington with her son and a lovably recalcitrant cat.