Psychotic Symptoms in Bipolar Disorder: Hallucinations

When someone is experiencing an acute manic episode, they can sometimes have:

  • delusions – fixed, false, irrational or illogical beliefs
  • hallucinations – hearing, seeing, or sensing things that are not real.

When these psychotic symptoms occur with other manic symptoms it indicates that the person has a bipolar I disorder.

Psychotic symptoms are not seen in hypomania which is the key defining mood state of bipolar II disorder.

The presence of psychotic symptoms needs to be taken seriously

Psychotic symptoms indicate a serious episode and the person may need to be admitted into hospital for close monitoring and urgent treatment.

If there is a lot of support available from family and/or a community mental health team this can sometimes be avoided. However, a person experiencing these symptoms needs a quiet, calm and controlled environment to keep them safe and this can be hard to achieve in the home environment.

The risk is that the person acts on a delusional belief (e.g. they may believe they have the ability to fly and then try to jump out of a window) which puts them or others in danger.

Delusional beliefs are by definition fixed and held absolutely, so that even repeated and persuasive attempts by others to prove that the belief is false, fail.



Hallucinations are also seen in mania and can occur in any sensory organ (i.e. hearing, taste, sight, sensation).

The most common hallucinations occurring in mania are auditory (hearing things).

Sometimes the experience of having hallucinations can propel the person to seek an explanation for their presence and this can fuel the development of a delusional belief.

Auditory hallucinations

Auditory hallucinations consist of hearing things. These things can be:

  • sounds of footsteps
  • a single voice or several voices, male or female, familiar or unfamiliar
  • voice(s) that call the person’s name, tell them to do things, comment on what the person is doing, or if more than one voice can talk to each other about the person
  • perceived as coming from outside the person’s head but occasionally people hear them inside the head (similar to the person’s own thoughts).

Visual hallucinations

Visual hallucinations consist of seeing things that aren’t really there (e.g. seeing people or shadows).

Visual hallucinations can become quite complex with people seeing whole scenes but they are uncommon in ‘pure’ mania and are more commonly associated with some underlying physical or organic problem.

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