Random mental images, when they’re especially vivid, share similarities with hallucinations. They often show up unannounced, take over our minds without our consent, and may even leave us doubting our ability to distinguish what’s real from what’s not, says psychologist and Chief Clinical Officer for NOCD, Patrick McGrath, PhD.
Since obsessive-compulsive disorder (OCD) is characterized by intrusive, unwanted thoughts and images that can feel real and urgent, many people with the condition wonder if their experiences may actually be hallucinations. In this article, we’ll look at whether OCD can actually cause hallucinations, and, if so, how the gold standard treatment for the disorder can reduce their intensity, frequency, and duration.
Hallucinations and quasi-hallucinations
The terms “hallucination” and “quasi-hallucination” are often used to describe distinct but related experiences. Before we can get into their relation to OCD, we first need to understand what these terms really mean.
A hallucination refers to a sensory experience that occurs without any external stimuli. It’s something a person perceives even though nothing in their environment actually causes it.
Hallucinations can manifest in lots of different forms. They may be visual (such as seeing things that aren’t there), auditory (hearing voices or sounds that don’t exist), olfactory (smelling odors that aren’t there), gustatory (tasting flavors without a source), or tactile (feeling sensations without being touched). Hallucinations are often vivid and difficult to distinguish from reality, leading people to believe that they’re real.
A quasi-hallucination, on the other hand, refers to an experience that exists on the boundary between perception and imagination. It is characterized by a sense of unreality, or a feeling that is not completely convincing. Quasi-hallucinations may involve fleeting sensory impressions, such as faint visual distortions or whispers that you believe are coming from within your own mind. Unlike hallucinations, quasi-hallucinations are typically recognized as at least partially internal and distinct from reality, lacking the full sensory impact of true hallucinations.
What OCD looks like
OCD affects an estimated 1 in 40 people worldwide. It’s a mental health condition characterized by recurrent, intrusive thoughts, images, or urges (obsessions) and repetitive behaviors (compulsions) that are done in an effort to alleviate the uncomfortable obsessions. It’s often used wrongly by people to describe fastidiousness or a desire for order or cleanliness, but it’s a serious condition that can interfere with all areas of your life and may be debilitating.
People who have been diagnosed with OCD—as opposed to those who simply happen to wash their hands often, or like a neat workspace—find themselves caught in a vicious cycle of obsessions and compulsions. Here’s how it can play out:
- Obsession: This is an intrusive and persistent thought, image, or urge that creates significant distress. Obsessions are typically irrational, unwanted, and inconsistent with a person’s values or beliefs. Common obsessions include fears of contamination, doubts about safety, or concerns about harming oneself or others.
- Distress: Obsessions trigger intense anxiety, worry, shame, guilt, disgust, and fear.
- Compulsion: These obsessions cause you to engage in compulsive behaviors or mental rituals in an attempt to reduce your distress or prevent an unwanted outcome. Examples include excessive hand washing, checking, counting, or seeking reassurance from others.
- Temporary relief: While it’s true that acting on compulsions can provide short-lived relief, it only reinforces your belief that performing these behaviors is necessary to stave off harm or free yourself from stress—so the cycle repeats, becoming stronger as you continue to engage in your compulsions.
Quasi-hallucinations and OCD
While hallucinations feel like true sensory experiences that don’t have an external cause, quasi-hallucinations are a bit more ambiguous, where your ability to distinguish reality becomes a bit blurred. Some obsessions in OCD may actually be experienced as quasi-hallucinations, characterized by distorted perceptions of real sensory experiences.
“Can OCD seem real? Absolutely!” says Dr. McGrath. He explains that when people have a lower level of awareness of their OCD—called low-insight OCD—they are more likely to perceive visual, auditory, sensory, and olfactory sensations as if they are actually happening.
He adds that even when people have acknowledged that they have the condition and understand how it works—known as high-insight OCD—these disturbances can persist as quasi-hallucinations. “Sometimes people with Contamination OCD will talk about seeing germs on their skin, or feeling as though pathogens are boring into them, despite logically knowing that it’s not really happening,” says Dr. McGrath.
These intrusive sensations can significantly interfere with daily functioning, making it hard to focus on tasks or engage in normal daily activities. And the distorted sensory experiences you feel can reinforce fears associated with OCD.
Struggling to differentiate between actual experiences and the distorted sensations of quasi-hallucinations can also create a lot of confusion and uncertainty, often reinforcing the OCD cycle—making obsessions stronger and more distressing over time.
What causes quasi-hallucinations in people with OCD?
The exact causes of quasi-hallucinations in people with OCD are not fully understood, but they are believed to arise from several factors:
- Hyper-attention and sensory amplification: People with OCD are often hyper-aware and hyper-vigilant about their obsessions. And that can lead to increased sensory sensitivity and can even amplify bodily sensations or environmental cues that contribute to quasi-hallucinations.
- Anxiety and stress: Anxiety plays a central role in OCD, and high anxiety and stress levels can exacerbate OCD symptoms. They may also intensify the perception of bodily sensations, which can contribute to quasi-hallucinatory experiences, as you become acutely attuned to any feelings that align with your obsessions.
- Cognitive biases: People with OCD often exhibit cognitive biases, such as selective attention and interpretation, that involve focusing on and attaching exaggerated importance to certain stimuli or information that fit with your obsessions. In the case of quasi-hallucinations, for example, you may interpret normal bodily sensations as confirmation of your obsessive fears or concerns, reinforcing the belief that those obsessions are valid.
- Learned associations: The repetitive nature of the OCD cycle can lead to learned associations between triggers, obsessions, and sensory experiences. Over time, you may come to associate specific sensory cues with your obsessions, resulting in quasi-hallucinations when those cues are present. The distress caused by these experiences further reinforces the association and perpetuates the cycle.
All of these complex interactions between your thoughts, emotions, and perceptions can combine to cause quasi-hallucinatory experiences if you have OCD. Thankfully, the right form of therapy can help people find relief from these symptoms and the distress they cause.
How is OCD treated?
The most successful treatment for OCD is a form of behavioral therapy called exposure and response prevention (ERP). Unlike traditional talk therapy, which can backfire and make OCD worse, ERP — which was developed specifically to treat OCD — is clinically proven to be highly effective in the majority of people.
How does ERP work? A trained therapist who specializes in OCD will take the time to understand your symptoms and create a custom ERP therapy plan specifically for you. Starting with something least likely to elicit anxiety — for example, your therapist may simply show you a photo of things out of order, if you have an obsession with symmetry — you’ll have the support and encouragement you need to resist a compulsive response. You’ll be given tools to engage in “self-talk” that eventually quiets the irrational thoughts going through your mind — such as the fear that something bad will happen if everything around you isn’t arranged in perfect symmetry — until your anxiety level declines. Only when you’re comfortable with the initial experiment will your therapy progress so you can conquer bigger fears.
Ultimately, ERP with a trained therapist will help you live the life you would choose to live if OCD did not exist. You won’t be riddled with distress from intrusive thoughts. And the things that matter the most to you won’t be at risk of slipping away. For instance, instead of constantly obsessing over whether your partner is going to leave you, you’ll be able to live your life free from these thoughts and have the relationship you deserve.
By beginning ERP on your own without a therapist, you risk starting on an exposure exercise that you’re not ready for, which is like lifting weights that are too heavy for you instead of starting with the right load for you. With an ERP therapist guiding you the whole time, you’ll practice confronting your fears in very small doses and in the controlled setting of therapy. When you’re ready, you’ll then bring these lessons that you work on with your therapist back into your everyday life. The result is that something amazing happens: Your fearful thoughts lose their power over you and your need to engage in compulsions goes away.
Working with an OCD specialist in the areas that cause you distress is more accessible than ever thanks to virtual ERP therapy — which is as effective as in-person therapy. In fact, peer reviewed studies have suggested ERP delivered in live teletherapy sessions can bring results in under half the time of outpatient ERP therapy. One of the biggest hurdles to getting started is finding a therapist who is an expert in treating OCD. But we’ve made it easy, with our network of expertly-trained ERP specialists. Help is available, and you can reach out for it today.