pseudohallucinations

Pseudohallucinations are perceptual experiences that resemble hallucinations but are recognized by the person as not real or externally generated. They are vivid and convincingly concrete sensations, yet the individual retains awareness that the perception originates in the mind rather than from the external environment.

Key feature distinguishing pseudohallucinations from true hallucinations is insight. In pseudohallucinations the person reports the sensation as unmistakably internal or imagined and acknowledges that it is not real. True hallucinations, by contrast, involve perception without external stimuli and are experienced as real by the person.

Modalities and contexts: Pseudohallucinations can occur in any sensory modality, most often auditory or visual, but also olfactory or tactile. They are described across psychiatric conditions, such as schizophrenia spectrum and mood disorders with psychotic features, and in neurologic conditions including temporal lobe epilepsy, migraines, or neurodegenerative diseases. They may also appear in Charles Bonnet syndrome in visually impaired individuals, and in sleep-related states such as hypnagogic or hypnopompic experiences, though those are sometimes categorized separately.

Diagnosis and management: Pseudohallucinations are clinical phenomena defined by the presence of insight; they are distinguished from delusions or true hallucinations through careful history and examination. Management focuses on the underlying cause, with treatment addressing the psychiatric, neurologic, or medication-related factors. In some cases, low-dose antipsychotic medication or psychotherapy may be considered; however, prognosis varies and many individuals lead functional lives if the underlying condition is managed and insight remains intact.