Can Post-Traumatic Stress Disorder Cause Hallucinations?

Post-traumatic stress disorder (PTSD) hallucinations are an often overlooked, but important, PTSD symptom.

Post-traumatic stress disorder (PTSD) is a complex mental health condition triggered by exposure to traumatic events such as combat, abuse, natural disasters, or accidents. While commonly associated with symptoms like flashbacks, nightmares, and hypervigilance, PTSD can also manifest in less familiar ways, including psychotic symptoms such as hallucinations. These symptoms, including auditory hallucinations, tactile hallucinations, and olfactory hallucinations, highlight the intricate relationship between PTSD and psychotic features. Below, we explore the connection between PTSD and hallucination, shedding light on underlying causes of this psychotic symptom, related conditions like depression with psychotic features and schizoaffective disorder, and approaches to PTSD treatment.

The link between PTSD and psychotic features

Hallucinations are not a core diagnostic criterion for PTSD or complex PTSD, but they can develop in severe cases. These psychotic features are often tied to trauma-related memories, making the experience deeply personal and distressing. For instance, auditory hallucinations in PTSD often involve voices linked to the traumatic event, such as the commands of a combat officer or the threats of an abuser. Tactile hallucinations, such as feeling the touch of a traumatic assailant, and olfactory hallucinations, like the smell of smoke or blood, are also reported in some cases.

Distinguishing PTSD-related hallucinations from symptoms of psychotic disorders, such as schizophrenia or schizoaffective disorder, is crucial. Hallucinations in psychotic disorders are often persistent and detached from specific triggers, whereas PTSD-related hallucinations are typically episodic and trauma-related. Psychosis-related PTSD may also present with negative psychotic symptoms (e.g., flattened affect, social withdrawal, lack of motivation, or reduced speech), complicating diagnosis. A comprehensive evaluation is essential to rule out other causes of psychosis symptoms, such as substance use or neurological conditions.

What causes PTSD-induced hallucinations?

The development of hallucinations in PTSD involves a combination of neurobiological and psychological factors. Neurobiologically, PTSD disrupts the stress response system. Overactivation of the amygdala, which governs fear responses, coupled with prefrontal cortex dysfunction, impairs rational thought and reality testing. This heightened state of arousal can cause hallucinations.

Psychologically, intrusive memories and flashbacks are key contributors. PTSD often makes it difficult to distinguish between past trauma and present experiences, and this overlap can cause hallucinations that feel vividly real. For example, auditory hallucinations or olfactory hallucinations in PTSD may be direct sensory recreations of a traumatic event.

Psychosis caused by PTSD is also influenced by certain risk factors. Individuals with comorbid conditions, such as dissociative disorders or depression with psychotic features, are more likely to experience hallucinations. Negative symptoms, such as emotional blunting or social withdrawal, may also complicate the presentation. Furthermore, disrupted sleep—a common issue in PTSD—can heighten susceptibility to hallucinations and psychosis symptoms by impairing the brain’s ability to process memories and regulate emotions.

Treatment approaches for PTSD with psychotic features

Addressing hallucinations in PTSD or complex PTSD requires a tailored PTSD treatment plan. Here are some key treatment approaches: 

1. Therapy

Trauma-focused psychotherapies, such as eye movement desensitization and reprocessing (EMDR) and cognitive behavioral therapy (CBT), are highly effective in addressing core symptoms. These approaches help individuals process traumatic memories, reduce flashbacks, and manage psychotic symptoms such as auditory hallucinations or tactile hallucinations. Grounding techniques, which focus on anchoring an individual in the present moment, can help reduce the intensity of hallucinations.

2. Medication

Medications also play an important role in PTSD treatment, especially for individuals with severe psychotic features. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to address PTSD symptoms, while antipsychotics may be prescribed to manage psychotic symptoms like hallucinations. Concurrently addressing comorbid conditions such as insomnia or substance use can significantly improve outcomes.

3. Self-care and support

Recovery from PTSD with psychotic features requires both professional intervention and a supportive environment. Therapy and medication provide the foundation, but self-care strategies such as mindfulness, establishing routines, and seeking support from friends, family, or support groups are invaluable. Creating a sense of stability and empowerment is crucial for managing symptoms like hallucinations.

How Charlie Health can help

If auditory or visual hallucinations are affecting your mental health, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides mental health treatment for people dealing with serious mental health conditions, including post-traumatic stress disorder, schizophrenia, borderline personality disorder, and more. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With this kind of holistic online therapy, managing your mental health is possible. Fill out the form below or give us a call to start healing today.