Can Bipolar Disorder Cause Hallucinations?

If you’ve been diagnosed with bipolar disorder and experienced seeing, hearing, or feeling things you might be dealing with bipolar hallucinations. Read on to learn about the causes and treatments.

Bipolar disorder, which is a mood disorder known for its dramatic shifts in mood, ranging from intense highs to deep lows, has various lesser-known symptoms, including hallucinations. These hallucinations can occur in bipolar I disorder or bipolar II disorder and might indicate the presence of bipolar psychosis. Here is a breakdown of how hallucinations present in bipolar disorder, their causes, and how to treat them for better mental health maintenance.

When and why hallucinations happen in bipolar disorder

Hallucinations are false sensory perceptions that appear real but are created by the brain without any external stimulus and can involve any of the senses — hearing, touch, taste, or smell.  Bipolar hallucinations are considered a type of psychotic symptom due to their indication of a loss of contact with reality.

In bipolar disorder, hallucinations often accompany severe mood episodes, such as intense depression or mania. Bipolar disorder is classified into two primary subtypes: bipolar I disorder and bipolar II disorder. The former is defined by the occurrence of at least one full manic episode lasting a week, but people with this condition also typically experience bipolar depression. Hallucinations are more often seen in this bipolar disorder experience, particularly during episodes of mania.

Bipolar II disorder is expressed by episodes of hypomania (a less intense form of mania) and major depression. Unlike bipolar I, hallucinations in bipolar II are more likely to be linked with severe depressive episodes as opposed to mania.

Types of hallucinations in bipolar disorder

Here’s an overview of the types of hallucinations that people with bipolar hallucinations might experience. 

1. Auditory hallucinations

Auditory hallucinations are the most common type experienced in bipolar disorder, ranging from hearing indistinct sounds or whispers to fully formed voices. An auditory hallucination is often mood-congruent, meaning it is reflective of the emotional state of the person, such as hearing harsh and self-critical voices during a depressive episode or voices encouraging risky situations, or a grandiose delusion during a manic phase. 

Furthermore, hearing such negative commentary or commands from a hallucinated voice can become highly distressing and contribute to feelings of fear or paranoia in the person experiencing the hallucination.

2. Visual hallucinations

Although less common, visual hallucinations can also occur during severe manic or depressive episodes. While experiencing a visual hallucination, people can see things ranging from fleeting shadows or flashes of light to detailed, complex images such as people, animals, or scenes that appear entirely real. People may see figures, shapes, or even elaborate scenes that are not present in reality. These sights are often unsettling and may intensify fear or confusion, especially when they align with the mood state, such as seeing dark, ominous figures during a depressive episode or seeing bright lights or images that feel euphoric during a manic episode. 

Additionally, visual hallucinations in bipolar disorder may indicate the presence of psychotic features within a mood episode or even another psychiatric disorder. 

3.  Tactile hallucinations

The rarest form of bipolar hallucinations, tactile hallucinations, involve a strong physical sensation that feels very real despite having no external cause. People might experience feelings of being touched, pinched, or even a sensation of heat or cold, often exacerbating discomfort or paranoia. In some cases, people can display more severe manic symptoms, like interpreting these sensations as a part of a grandiose or supernatural experience, adding to their confusion.

While they are less common than auditory or visual hallucinations, tactile hallucinations are a more serious sign of psychosis in bipolar disorder and may require immediate medical attention. 

What causes bipolar hallucinations?

While the causes of hallucinations in bipolar disorder are not fully understood, several factors are believed to contribute to their presence. 

1. Chemical imbalance

Bipolar disorder involves disruptions in neurotransmitters like dopamine and serotonin, which are important for mood regulation. Imbalances in these chemicals may lead to hallucinations by disrupting the brain’s communication pathways, contributing to distorted sensory experiences. High dopamine levels, as seen during manic episodes, amplify the brain’s response to stimuli, increasing the likelihood of hallucinations, while low serotonin levels, seen during depressive episodes, may be linked to negative auditory hallucinations.

2. Sleep deprivation

Sleep disturbances are common during manic episodes, where people often need very little sleep, sometimes going days with minimal rest. This lack of sleep can impair cognitive function, making the brain more susceptible to misinterpreting sensory information, which may lead to hallucinations. Prolonged sleep deprivation can worsen mania and trigger psychotic symptoms, including disorganized thinking and a loss of touch with reality.

3. Stress and trauma

Chronic stress or a history of trauma can sensitize the brain’s stress response system, making it more reactive and vulnerable during mood episodes. For those with bipolar disorder, intense stress can act as a catalyst, escalating symptoms of mania or depression, as the heightened emotional state combined with existing neurotransmitter imbalances can lead to altered perceptions and the onset of hallucinations. 

In cases where trauma is a factor, hallucinations may even reflect aspects of past traumatic experiences, making them particularly distressing and harder to differentiate from reality.

The impact of bipolar hallucinations 

Hallucinations can be distressing and may significantly disrupt a person’s daily functioning in various ways. Here are three of them. 

1. Increased anxiety

Experiencing hallucinations in bipolar disorder can lead to heightened anxiety, as a person may struggle to understand whether what they are hearing or seeing is real. The distress of not being able to trust their own senses can lead a person to exhibit increased bipolar disorder symptoms, such as increased paranoia or panic, especially if the hallucinations are negative or threatening in nature. As anxiety builds, it may even further intensify hallucinations, creating a vicious cycle that exacerbates bipolar symptoms. 

2. Impaired reality 

Bipolar hallucinations can blur the line between reality and perception, potentially resulting in impaired judgment, as a person may act on false beliefs or respond to things that aren’t actually there. Ongoing uncertainty about what’s real and what’s not can erode a person’s confidence in their own thoughts and experiences, making everyday decision-making and interactions confusing and overwhelming. 

This disconnect from reality often deepens the emotional turmoil that bipolar disorder brings, increasing the likelihood of isolation and further complicating the management of the mood disorder.

3. Social isolation

The fear of being judged or labeled as “crazy” by others may lead people to withdraw from social interactions and hide their experiences, increasing their sense of isolation and potentially worsening their mental health. The reluctance to share their symptoms can delay a person from seeking help for their bipolar disorder, allowing the hallucinations and overall mental health to worsen over time. 

Additionally, the growing sense of isolation can deepen feelings of loneliness and hopelessness, forming a repetitive cycle of depressive symptoms. Without support, a person may feel trapped in their own distressing reality, making it harder to break free of their hallucinations and mood instability.

Treatment options for bipolar hallucinations

Common treatment options for bipolar hallucinations are as follows:

1. Medication

The most common medications used to treat bipolar disorder are mood stabilizers, which help regulate aggressive mood swings and can, in turn, reduce the risk of hallucinations during manic or depressive episodes. Antipsychotics may also be prescribed for the management of more severe psychotic symptoms, including hallucinations and delusions. 

Antidepressants may also be prescribed for intense depressive episodes or even co-occurring mental health conditions like depression. However, treatment with antidepressants must be monitored closely, as they can sometimes trigger mania or worsen mood episodes

2. Therapy

Psychotherapy is often the most common approach when it comes to therapy for bipolar disorder. Cognitive behavioral therapy (CBT) is often the most utilized, as it can be beneficial in helping people process their experiences, challenge distorted thoughts, and develop strategies to manage bipolar hallucinations. This can also help people, as well as their loved ones, recognize early signs of mood episodes, cope with distressing hallucinations, and reduce the risk of mania. 

3. Hospitalization

In cases of a severe psychotic episode, hospitalization may be necessary to provide intensive care and ensure the safety of a person with bipolar disorder. During hospitalization, a person can receive close monitoring, medication adjustments, and a structured environment to help stabilize symptoms. Inpatient treatment also provides immediate access to a multidisciplinary team of psychiatrists, nurses, and therapists who can collaborate to create a treatment plan for each person to prepare them for a safe transition back into outpatient care. 

Living with bipolar disorder and hallucinations

Here are some tips on how to maintain mood stability and reduce the risk of worsening bipolar disorder symptoms in everyday life. 

1. Regular monitoring

It is important for a person to monitor their bipolar disorder to help track events that trigger mood responses and changes in symptoms and identify early warning signs of a psychotic episode. One good practice in particular is keeping a mood diary, which allows people to document daily shifts in mood, sleep patterns, stress levels, and any unusual sensory experiences like hallucinations. 

Over time, a mood diary can also serve as a valuable tool for self-awareness and communication, helping patients articulate their experiences more clearly during therapy or psychiatric appointments. 

2. Medication adherence

Adherence to medication as prescribed helps maintain stable levels of neurotransmitters, reducing the likelihood of hallucinations and psychotic symptoms. Taking prescribed medications consistently is key to preventing severe mood episodes and hallucinations. Skipping doses or stopping medication abruptly can lead to a rapid return of symptoms, often more intense than before, even when a person might feel better. 

3. Support networks

Support networks, such as community groups or support groups, offer a safe space where people can share their experiences without judgment, learn from others facing similar challenges, and gain valuable insights into managing symptoms. Hearing from peers who have successfully navigated similar struggles can provide encouragement and practical advice that complements professional treatment. 

Additionally, family members and loved ones can also benefit from attending support groups, as they offer education and strategies for better supporting their loved ones with bipolar disorder. 

How Charlie Health can help

If you or a loved one are struggling with bipolar disorder, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions, including bipolar disorder. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing your mental health is possible. Fill out the form below or give us a call to start healing today.