Hallucinations and Delusions: How to Recognize Psychosis and Help Someone
When Someone You Care About Is Experiencing a Different Reality
Watching someone you care about experience hallucinations, intense paranoia, or beliefs that don't match what you're seeing can be confusing and frightening.
Do you correct them? Reassure them? Agree with them? And how do you know when what you're witnessing has become a mental health emergency?
Hallucinations and delusions are common symptoms of psychosis, which affects how a person perceives and interprets reality. Psychosis can occur with schizophrenia, bipolar disorder, severe depression, substance use, certain medications, and some medical or neurological conditions.
Understanding what hallucinations and delusions look like—and knowing how to respond—can help you support someone without unintentionally increasing their fear or distress.
What Are Hallucinations?
Hallucinations are sensory experiences that other people don't perceive, but they can feel extremely real to the person experiencing them.
A person may:
Hear voices or sounds
See people, shadows, objects, or images
Feel sensations on or inside their body
Smell odors that others don't notice
Experience unusual tastes
Hearing voices is one of the most recognized forms of hallucination.
Someone may hear a voice talking directly to them, several voices having conversations, or voices criticizing, threatening, or giving them instructions.
For some people, hallucinations are relatively neutral. For others, they can be frightening and overwhelming.
What Are Delusions?
Delusions are strongly held beliefs that remain convincing to a person even when other people don't share the belief or available evidence doesn't support it.
One common example is a persecutory or paranoid delusion.
Someone might believe:
People are following or watching them
Someone is trying to harm or poison them
Their phone or home is being monitored
Family members are conspiring against them
Strangers are secretly communicating about them
Other delusions may involve believing that television programs or social media contain messages specifically for them, that they possess extraordinary abilities or importance, or that an outside force is controlling their thoughts or actions.
These beliefs can feel completely real.
Imagine genuinely believing that someone intends to hurt you while everyone around you insists that you're wrong. That can be terrifying—and it helps explain why arguing with someone experiencing a delusion often doesn't work.
What Are Signs Someone May Be Experiencing Psychosis?
Hallucinations and delusions aren't always the first noticeable signs.
Other changes may include:
Increasing paranoia or suspiciousness
Withdrawing from friends and family
Difficulty thinking or communicating clearly
Significant changes in sleep
Unusual or intensely held ideas
Difficulty distinguishing reality from imagination
Declining performance at work or school
Significant changes in behavior or self-care
Having one of these symptoms doesn't necessarily mean someone is experiencing psychosis.
However, new, worsening, or significant changes in someone's thinking, perceptions, or behavior should be taken seriously, particularly when they're interfering with everyday life.
How Should You Respond to Hallucinations or Delusions?
Your goal isn't to convince someone that you're right.
Instead, focus on calmness, safety, connection, and understanding what the person needs.
Stay Calm and Give Them Space
Speak calmly and avoid surrounding the person with multiple people or questions.
When possible, reduce environmental stimulation such as loud television, music, bright lights, or crowds.
Give the person comfortable physical space and pay attention to their body language. Someone who already feels threatened or watched may become more uncomfortable if another person stands too close.
Validate the Feeling Without Agreeing With the Belief
You can acknowledge someone's distress without confirming something you don't believe is happening.
If someone says:
"Someone is watching me through the walls."
Instead of agreeing or arguing, you might respond:
"That sounds really frightening. I can tell you're feeling unsafe right now."
You're validating the emotion, not the delusion.
Don't Argue About What's Real
Statements such as:
"That's ridiculous."
"You're imagining things."
or
"Nobody is following you. Stop saying that."
are unlikely to make the belief disappear and may increase distrust.
A better response might be:
"I understand that this feels very real to you. I'm not experiencing the same thing, but I can see that it's upsetting you."
This allows you to remain truthful while still showing empathy.
Ask About Safety
If someone is extremely distressed, hearing threatening voices, or behaving unusually, it's okay to ask direct questions.
You can ask:
"Are the voices telling you to hurt yourself?"
"Are you thinking about hurting yourself or someone else?"
"Do you feel like you have to do what the voices are telling you?"
Asking directly about safety can help determine whether the person needs immediate professional intervention.
When Are Hallucinations or Delusions an Emergency?
Not every hallucination or delusion automatically requires emergency care.
However, immediate assistance may be necessary if someone:
Is attempting or threatening suicide
Intends to seriously hurt another person
Is hearing commands to harm themselves or someone else and may act on them
Is severely confused or unable to care for themselves
Is behaving in a way that creates immediate physical danger
Suddenly develops hallucinations or severe confusion without a known explanation
Sudden hallucinations or confusion can sometimes have a medical or substance-related cause, which is another reason new symptoms shouldn't simply be assumed to be a psychiatric condition.
If someone's immediate safety cannot be maintained, seek emergency or crisis assistance.
Can Therapy Help With Psychosis?
Yes, but treatment for psychosis often involves more than psychotherapy alone.
Depending on the person's symptoms and their cause, treatment may involve:
Psychiatric evaluation
Medication
Family education and support
Substance use treatment when applicable
Medical evaluation
Coordinated treatment for first-episode psychosis
Therapy can help someone better understand their experiences, identify triggers and patterns, develop coping strategies, improve functioning, and reduce the distress associated with symptoms.
Family members can benefit from support as well.
Learning how to communicate with someone experiencing psychosis can reduce conflict and help families understand when to provide reassurance, when to establish boundaries, and when additional professional support is needed.
Mental Health Support in Riverside and the Inland Empire
Experiencing hallucinations, delusions, paranoia, or other significant changes in thinking can be frightening for individuals and their families.
At Lifepath Center in Riverside, California, our clinicians provide outpatient mental health services for individuals and families experiencing a wide range of mental health concerns.
We provide in-person therapy in Riverside and telehealth therapy throughout California, helping clients better understand their symptoms, develop coping strategies, strengthen relationships, and determine when additional psychiatric or medical care may be appropriate.
Some symptoms of psychosis require psychiatric treatment, specialized services, or a higher level of care. Part of responsible mental health treatment is helping determine what type of support is appropriate.
Ready to Talk With Someone?
Hallucinations and delusions can create two very different experiences of reality between someone experiencing psychosis and the people trying to support them.
Arguing usually doesn't bridge that gap.
Calm communication, empathy, safety, appropriate boundaries, and professional support can.
If you or someone you care about is experiencing concerning changes in thoughts, perceptions, emotions, or behavior, reaching out for professional support can be an important place to begin.
Contact Lifepath Center to learn more about therapy in Riverside or telehealth mental health services throughout California.
Frequently Asked Questions About Hallucinations and Delusions
What is the difference between a hallucination and a delusion?
A hallucination involves experiencing a sensation that others don't perceive, such as hearing a voice. A delusion is a strongly held belief that remains convincing despite evidence that doesn't support it.
Does having hallucinations mean someone has schizophrenia?
No. Hallucinations and psychosis can occur with several psychiatric conditions as well as substance use, medications, neurological conditions, medical illnesses, and other causes. A professional evaluation can help determine what may be contributing to the symptoms.
Should you agree with someone's delusion?
Generally, you should avoid both reinforcing the belief and aggressively arguing against it. Instead, acknowledge the person's emotions and distress while remaining truthful about what you are experiencing.
What should you say to someone who is hallucinating?
Keep your response calm and simple. You might say, "I can see that this is frightening for you. I'm here with you. What would help you feel safer right now?"
When should someone seek help for hallucinations or delusions?
Professional evaluation is appropriate when hallucinations, paranoia, delusions, confusion, or other changes in thinking or behavior are new, worsening, persistent, or interfering with everyday functioning. Immediate assistance is appropriate when there is a significant risk of harm or someone cannot remain safe.