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What is OCDRelated Symptoms & ConditionsCan OCD cause hallucinations? Here’s what experts say

Can OCD cause hallucinations? Here’s what experts say

7 min read
Grant Stoddard

By Grant Stoddard

Reviewed by Patrick McGrath, PhD

May 22, 2023

Random mental images, when they’re especially vivid, share similarities with hallucinations. They show up unannounced, squat in our minds without our consent, and may even leave us doubting our ability to distinguish what’s real from what’s not. 

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 various forms, including visual (seeing things that are not there), auditory (hearing voices or sounds that do not exist), olfactory (smelling odors that are not present), gustatory (tasting flavors without a source), or tactile (feeling sensations on the body without cause). Hallucinations are often vivid and difficult to distinguish from reality, leading people to fully 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 perception that is not completely convincing. Quasi-hallucinations may involve fleeting sensory impressions, such as faint visual distortions or whispers that are perceived as coming from within one’s 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

Affecting an estimated 1 in 40 people worldwide, OCD is a mental health condition characterized by recurrent, intrusive thoughts, images, or urges (obsessions) and repetitive behaviors (compulsions). It’s often used wrongly by people to describe fastidiousness or a desire for order or cleanliness, but it’s a very serious mental health condition that can interfere with all areas of life and be completely debilitating.

People who have been diagnosed with OCD—as opposed to people who simply happen to wash their hands often or like a neat workspace—find themselves caught in a vicious cycle of obsessions and compulsions

  1. Obsession: 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.
  2. Distress: Obsessions trigger intense anxiety, worry, shame, guilt, disgust, fear, etc. 
  3. Compulsion: People engage in compulsive behaviors or mental rituals to alleviate this distress or prevent an unwanted outcome. Examples include excessive hand washing, checking, counting, or seeking reassurance. These compulsions are often aimed at reducing anxiety or preventing perceived harm.
  4. Temporary relief. The compulsions provide short-lived relief, which reinforces the person’s belief that performing compulsive behaviors is necessary to prevent harm or stay safe. The cycle repeats, becoming stronger as people continue engaging in 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 someone’s 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 psychologist and Chief Clinical Officer for NOCD, Dr. Patrick 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—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,” he says. 

These intrusive sensations can significantly interfere with daily functioning, making it difficult to focus on tasks or engage in normal activities, and distorted sensory experiences can reinforce the fears associated with OCD. People with lower insight into their condition may believe that these sensations confirm the validity of their obsessions. 

Struggling to differentiate between actual experiences and the distorted sensations of quasi-hallucinations can create a lot of confusion and uncertainty, often reinforcing the OCD cycle. People may feel compelled to engage in rituals or behaviors to alleviate the distress caused by distorted sensory experiences. They may seek reassurance, repeatedly check their perceptions, or engage in other compulsive behaviors to feel certain about their experiences. This perpetuates 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 the interplay of several factors:

  • Hyperattention and sensory amplification: People with OCD often direct heightened attention and hyper-vigilance to their obsessions. This heightened focus can lead to increased sensory sensitivity and can even amplify bodily sensations or environmental cues, even contributing to quasi-hallucinations.
  • Anxiety and stress: Anxiety often plays a central role in OCD, and high anxiety and stress levels can exacerbate OCD symptoms. Elevated anxiety levels can also intensify the perception of bodily sensations, creating a heightened awareness of physical experiences, which can contribute to quasi-hallucinatory experiences, as people become acutely attuned to any sensations that align with their obsessions.
  • Cognitive biases: People with OCD often exhibit cognitive biases, such as selective attention and interpretation. These biases involve focusing on and attaching exaggerated importance to certain stimuli or information that aligns with their obsessions. In the case of quasi-hallucinations, people may interpret normal bodily sensations or sensory cues as confirmation of their obsessive fears or concerns, reinforcing the belief that their obsessions are valid.
  • Learned associations: The repetitive nature of the OCD cycle, where obsessions trigger anxiety and compulsions provide temporary relief, can lead to learned associations between triggers, obsessions, and sensory experiences. Over time, people may come to associate specific sensory cues with their 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 a person’s thoughts, emotions, and perception can combine to cause quasi-hallucinatory experiences in people with OCD. Thankfully, the right form of therapy can help people find relief from these symptoms and the distress they cause. 

Exposure and response prevention therapy (ERP) for OCD

ERP therapy is a form of therapy that was specifically designed for OCD. It involves gradually exposing people to anxiety-provoking situations or triggers (exposure) while refraining from engaging in compulsive behaviors or rituals (response prevention). By facing their fears and resisting the urge to perform compulsions, people learn to tolerate the distress that comes from their triggers and obsessions, without relying on compulsions that only make their symptoms worse.

ERP has been proven highly effective in managing the symptoms of OCD, including quasi-hallucinations. Treatment is structured and collaborative, with a trained therapist guiding you through exposure exercises. The therapist helps develop an individualized hierarchy of situations that trigger your obsessions, starting with those that induce mild anxiety and gradually progressing to more challenging ones. This gradual progression allows you to build resilience, develop coping strategies, and gain mastery of response prevention techniques.

“Whatever’s popping into your head that you’re believing might be true, we’re going to challenge in our sessions,” explains Dr. McGrath. “To do that, the therapist and the member can run a test together—a team approach to investigating this experience.”

“For example, you touch the bottom of your shoe, and now you really feel as if you can see germs on your hand, and feel them boring through your skin,” McGrath continues. “Now, I’m also going to touch the bottom of my shoe, and I see no germs in my hand and feel nothing boring into my skin. The difference might be that one of us has a diagnosis of OCD, and one does not. This doesn’t discount what you feel, because you absolutely do feel it. But it builds insight, proving to you that your visual, auditory, olfactory, tactile sensation is a product of your mind and, as such, it can be managed.”  

Getting the help you need

NOCD aims to reduce your OCD symptoms with live one-on-one video therapy. We’ll welcome you into our community and give you 24/7 access to personalized tools to manage your OCD symptoms—all built by world-renowned experts in OCD treatment. 

Schedule a phone call with a member of the NOCD Care team to learn more about how a licensed OCD therapist can help you get better. This consultation is free and doesn’t take very long—and it could be one of the most important calls you ever make. 

Learn more about ERP
Patrick McGrath, PhD

Dr. McGrath is a Licensed Clinical Psychologist and the Chief Clinical Officer at NOCD. He is a member of the Scientific and Clinical Advisory Boards of the International OCD Foundation, a Fellow of the Association for Cognitive and Behavioral Therapies, and the author of "The OCD Answer Book" and "Don't Try Harder, Try Different."