3 Types of Hallucinations You've Probably Never Heard Of

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Psychosis is popularly portrayed as visual hallucinations and paranoid delusions (e.g., "A Beautiful Mind," "Shutter Island"). Psychotic conditions, like schizophrenia-spectrum disorders, actually encompass a wide set of symptoms. Disorganized activity/thoughts, catatonia, and unusual expressions are just some of the other common symptoms. Readers are encouraged to review the post "4 Categories of Psychotic Symptoms" for extensive details.

While hallucinations and delusions are indeed psychosis hallmarks, they also span a palette of manifestations that can influence one another. Even seasoned providers may find it surprising just how far perceptual disturbances can go.

More Than Visions and Voices

People who hallucinate have sensorial experiences sans actual stimuli. Thus, hallucinations are internally-generated sensory experiences. Auditory and visual hallucinations are the most common type in psychogenic psychosis (e.g., schizophrenia and affective psychoses).

Waters et al. (2010) noted that about 75 percent of schizophrenia sufferers and 20-50 percent of depression and bipolar disorder-related psychosis experience auditory hallucinations, the most persistent type. Visual hallucinations have been noted in about 72 percent of schizophrenia sufferers, while tactile, gustatory (taste), and olfactory are very rare in psychogenic psychosis (Ohayon, 2010). In fact, the latter three, and visual, are common in general medical conditions spurring psychotic symptoms and should generally encourage a physical evaluation, especially if they develop abruptly.

Despite the common belief we have only five senses, there are many more. Three of these are proprioception, the “sixth" sense of visceral awareness of unseen presence, and somatosensory experiences, and figure into hallucinatory experiences. Though perhaps even rarer than tactile, olfactory, and gustatory in terms of psychogenic disorder symptoms, clinicians would do well to remain aware of them, as they can present safety, cultural, and medical considerations. Here's what they look like:

Proprioceptive Hallucinations

There is scant material regarding proprioceptive hallucinations in psychogenic conditions (Blom & Sommer, 2011; Lim et al., 2016; Michael & Park, 2016). Though it may sound fancy, a proprioceptive hallucination just means the sensing of motion, whether the entire body or body parts. This can range from feeling one is levitating/flying to feeling a body part is growing or in motion. In 20-plus years, I’ve encountered only one case of a suspected proprioceptive hallucination related to mental illness:

Bobby (name disguised) was placed in the jail’s protective custody setting, given increasingly acute mania. He was housed on the second tier of the cellblock. Upon approaching his door, Bobby informed me, in classic manic excitement, of his superior status. This revolved around superpowers, including flying capability. At first, it seemed it was all delusional grandiosity, not atypical of his manic episodes. However, Bobby continued that he’d been feeling aloft and thus practicing flight, and when let out, would launch from the tier and meet me in the office I used. He was carefully escorted to the jail's inpatient unit and stabilized.

Extracampine Hallucinations

Extracampine means “beyond the possible sensory field.” Like olfactory, tactile, and gustatory hallucinations, extracampine hallucinations are fairly rare in psychogenic psychosis. They tend to be symptomatic of Parkinson’s disease (Wood et al., 2015) or related to seizures (Anzelotti et al., 2011).

These hallucinations are often experienced as a viscerally-felt form of the “sixth sense” knowledge that someone else, unseen, is present. It can also be more complex, involving confusing feelings of where the real self is, called autoscopy, which varies in presentation. This is perhaps best illustrated by the Anzelotti et al. (2011) explanation of “he-autoscopy”:

The he-autoscopy is rare but probably more frequent than pure autoscopic hallucinations. The term "Heautoskopie" was proposed by Menninger-Lerchenthal to denote the experience of seeing one's self and to designate the classical doppelgänger experience described in literary accounts. The double usually appears colorless ('foggy,' 'pale,' or 'as through a veil'), can behave autonomously, may or may not mirror the person's appearance and maintains sidedness. The expression heautoscopic 'echopraxia' means imitation of bodily movements by the double, giving rise to the illusion that the doppelgänger contains the real mind.

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While never encountering anything as dramatic as he-autoscopy, an account of the viscerally-felt unseen presence type comes to mind:

Omar (name disguised), a 30-ish Muslim male, did not exit his cell for breakfast. Instead, he was observed by correctional staff as being "paranoid" and "fighting something off" while lying on his bed. Upon meeting with Omar, he explained that it was the "jinns," or malevolent spirits of Muslim culture. He continued that he could feel the presence of the jinn but not see it. What the officer witnessed was his trying to fight the powerlessness he felt as Jinn cursed him to suffocate. Omar shared that such jinn encounters occurred periodically throughout his life. He denied any history of mental health care and said jinn encounters are not unusual to Muslims.

Omar was soon released, and I did not get to know him, so I was unable to learn if it may have been entirely culture-bound or a Muslim culturally-influenced symptom of a psychotic disorder (Larøiet al., 2014; Lim & Blom, 2021). After some research, I learned that Omar’s experience was in excess of many Muslim people’s accounts of jinns, and he thus could have been silently suffering from psychosis influenced by cultural/religious ideas. If he returned, it would be worth monitoring him, as it may have been a mere glimpse into a bigger concern, or at least referring him to the Muslim imam that visited the jail.

Somatic Hallucinations

Somatic hallucinations are sometimes viewed as splitting hairs with tactile, but there is a difference. Tactile relates to touch, an exteroceptive experience, whereas somatic implies an interoceptive, or visceral, sensory experience (Kathirval et al., 2013), including pain. Also frequently associated with neurodegenerative disorders or substance abuse, these may be more common in schizophrenia, especially in certain cultures, than realized (Lim & Blom, 2021). Further, as noted by McKenna (1997), somatic hallucinations:

...are not usually reported simply, but are invariably combined with a degree of delusional elaboration–the relative contributions of delusions and hallucination to the bizarre bodily complaints of schizophrenic patients are often impossible to disentangle.

Somatic hallucinations were involved in two of the more complex cases I’ve worked with. One of these involved Jessica (name disguised), whose paranoia knew no boundary:

Jessica was convinced her mother, with whom she lived, was always conspiring to secretly bring her down, but she was also dependent on her. Jessica also suffered a medical complication that required frequent testing and treatment. After a particular test, she arrived in my office to say it was a ruse to insert "the chip," and she now knew the medical providers were hired by her mother to monitor her. Jessica explained she knew when the monitors were on when she felt the chip buzz in her bloodstream. This then led to a headache that would incapacitate her so that she would lay still for "the examination."

Such a sci-fi belief, coupled with her paranoid nature, left little room for doubt she was indeed hallucinating the internal “buzzing chip” that led to headaches. Regardless, any somatic complaint that clearly causes distress warrants a medical evaluation to rule out a physical complication that could be misinterpreted through the delusion. Provided her paranoia and that her uncle and myself were the only two she would trust at this point, it took careful coordination to get her to agree to go to the hospital.

It was with the understanding this hospital was not associated with her “co-conspirator” doctors, and they could report back to me, a trusted figure if the chip could be removed. She had been medically cleared and was immediately psychiatrically hospitalized, and the chief psychiatrist alerted me if her complicated paranoia and array of hallucinations continued.

Clinical Implications

Given we’re most familiar with “the five senses,” when someone describes strange/unlikely sensory experiences, like in the above cases, it might be easy to ascribe it to a complex, bizarre delusion. Clearly, delusions can influence hallucinations and vice versa. In such cases, it’s important to realize they’re describing a sensory experience, and assuming a curious position about them is a clinical necessity. If, like Bobby, they’re actually experiencing a sensation of levitation and thus are convinced they can fly, it adds another layer of risk.

Learning about one’s somatic complaints, as unlikely as they may be, it is never safe to assume it’s completely psychogenic. Real, organic experiences could influence a patient’s psychiatric narrative. Further, while someone’s extrasensory experiences might seem part of a psychogenic hallucinatory experience, it is also a good idea to have them medically evaluated, especially if it is a newer experience to them, as we know these tend to be correlated to certain neurodegenerative complications.

Disclaimer: The material provided in this post is for informational purposes only and is not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care or intervention from an individual’s provider or formal supervision if you’re a practitioner or student.

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