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Hallucinations: possible causes and when to get urgent help

Sultan AlmuhasinMedical review: Tatmeen team8 min read
دوائر وموجات وشرائط هندسية شفافة متداخلة بألوان زرقاء وصفراء وحمراء على خلفية فاتحة.
Article contents
  1. When is it an emergency?
  2. Can you wait if there is no obvious danger?
  3. Why do hallucinations not automatically mean schizophrenia?
  4. How can you describe the experience?
  5. How can you support someone whose experience you do not share?
  6. How are hallucinations different from “hysteria”?
  7. Frequently Asked Questions
  8. Sources and references
  9. Writer and reviewer

You might hear a voice in a room that no one else hears, or see something they cannot see. This alone does not mean schizophrenia. A hallucination feels real1 despite having no external source that explains it, and can involve hearing, sight, smell, taste or touch. Possible causes include mental and physical health conditions2, sensory problems, medicines and substances. Describing what happens to a clinician is the starting point for understanding the cause and getting appropriate help.

When is it an emergency?

Seek emergency medical care now if voices are telling someone to harm themselves or others1, they want to cause harm, there is immediate danger, or safety cannot be maintained. Hallucinations that worsen rapidly, severe agitation, or speech that has become incoherent also need emergency assessment. Do not wait for the person to agree that they are ill or accept a diagnostic label.

Sudden confusion is also a medical emergency: for example, suddenly not knowing where they are3, or developing new difficulty thinking or paying attention. Physical illness, medicines or substances may be involved. Do not postpone help until a psychiatric appointment.

In Saudi Arabia, call 997 for an ambulance4 when there is danger1 or you cannot reach emergency care safely. The person needing emergency care should not drive. A trusted person can accompany them and drive if travelling is safe. If you are helping and fear for your own safety, move to a safe place and call for help. Tell the medical service if no safe companion is available or the person refuses to travel; ask for guidance rather than trying to restrain or force them yourself.

Can you wait if there is no obvious danger?

New or unexplained hallucinations warrant urgent medical contact1, even when the person is calm. Contact their clinician or care team if they have an existing plan. Without an established service, seek medical assessment2. While safety is stable, you can call 937 for medical consultation and guidance5 in Saudi Arabia, available around the clock. If appropriate assessment cannot be obtained promptly, go to a hospital emergency department. Consultation must not delay emergency care when the warning signs above are present.

If the experience already has an established explanation and care plan, follow that plan and report changes in its intensity, nature or impact. A previous diagnosis does not necessarily explain every new experience; a change may need a fresh assessment.

Why do hallucinations not automatically mean schizophrenia?

Unusual sensory experiences can occur with different conditions, including schizophrenia or severe mood episodes6. They can also relate to medicines, alcohol or other substances, neurological illness1, infection or fever2. Assessment considers whether they began suddenly and what changed in physical health, sleep or attention.

Some experiences occur around falling asleep or waking. Some people with sight loss develop visual hallucinations associated with Charles Bonnet syndrome, which is not caused by mental illness or dementia7. These examples show why causes differ; they do not establish the explanation for your experience. Tell the clinician about sleep timing or changes in vision1 rather than treating them as proof of either mental illness or no need for assessment.

A person may recognise that others do not share what they hear or see, or may find that difficult to recognise. Conviction or duration alone cannot establish a diagnosis. The clinician needs the wider picture: symptoms and their course6, general health, medicines and substances2, and changes in everyday functioning.

How can you describe the experience?

Medical terminology is unnecessary. Use whichever observations you know2, without delaying care to complete a record:

What the clinician needs to know A useful description
The experience “I hear a voice speaking,” “I see shapes,” or “I smell an odor with no apparent source,” rather than only “hallucinations.”
Onset and context When did it start? Does it happen around sleep, after a new medicine, or alongside sight changes or physical illness?
Other changes Fever, confusion, changes in sleep or mood, or difficulty caring for yourself.
Medicines and substances Medicines, supplements, alcohol or other substances, and anything recently started or changed.
Impact and safety Does it disrupt eating, sleep or going out? Does it involve commands to cause harm? Who can help safely?

The clinician may perform an examination and request investigations according to the circumstances. Not everyone needs the same tests, and treatment depends on the cause2. Do not start a medicine because it helped someone else or change prescribed treatment without discussing it with your clinician.

How can you support someone whose experience you do not share?

Listen calmly and acknowledge their feelings10 without confirming that what they perceive is present or arguing to prove them wrong. You could say, “I do not hear that voice, but I can see it is upsetting you. Let us get help.” Reduce noise and crowds if possible, and allow time for them to describe their experience.

If they are confused, use short, simple sentences3 and stay with them if it is safe while arranging care. Avoid repeated questions or turning the conversation into a test. If they refuse help, you can seek professional advice yourself and describe your observations, including their refusal or difficulty taking part. You can seek help even if you do not agree on how to explain what they hear or see10.

How are hallucinations different from “hysteria”?

“Hysteria” is a broad historical term8 once applied to experiences now understood under different diagnoses. It is not a precise name for one condition to compare with hallucinations. In everyday speech it may describe intense emotion without explaining what is happening medically.

If someone means symptoms such as weakness, tremor or seizure-like episodes, a description and medical assessment are more useful than that label. Functional neurological symptoms are real and can occur even when some investigations are normal. A professional identifies them through the history, examination and relevant clinical signs9; a normal test alone does not establish the diagnosis, and the symptoms do not mean someone is pretending. New physical symptoms should not be assumed to be psychological before assessment.

Do not wait for a psychiatric assessment if one-sided weakness, facial drooping or speech difficulty starts suddenly; call 997, even if these signs stop. Also call an ambulance4 for a first seizure. For known seizures, follow the agreed care plan if you know it and have been trained to carry it out. Call an ambulance if a seizure lasts longer than usual12, exceeds five minutes when you do not know the usual duration, or is followed by incomplete recovery of consciousness, further seizures without regaining consciousness, serious injury or breathing difficulty. Do not explain these signs away as “hysteria” or assume that a previous functional diagnosis accounts for them.

Instead of asking, “Is this hallucination or hysteria?”, you might tell the clinician, “They see people I cannot see,” or “They developed trembling and weakness.” These describe experiences that need understanding rather than judging whether the person is truthful.

Frequently Asked Questions

What is a hallucination?

A hallucination feels real despite having no external source that explains it. You might hear a voice in a room that no one else hears, or see something they cannot see. It can involve hearing, sight, smell, taste or touch. Describing what happens to a clinician, such as “I hear a voice speaking” or “I see shapes,” is the starting point for understanding the cause and getting appropriate help.

Do hallucinations mean schizophrenia?

Not on their own. Unusual sensory experiences can occur with different conditions, including schizophrenia or severe mood episodes, but they can also relate to medicines, alcohol or other substances, neurological illness, infection or fever. Some occur around falling asleep or waking, and some people with sight loss develop visual hallucinations that are not caused by mental illness or dementia. That is why the cause needs assessment.

When are hallucinations an emergency?

Seek emergency medical care now if voices tell someone to harm themselves or others, they want to cause harm, there is immediate danger, or safety cannot be maintained. Hallucinations that worsen rapidly, severe agitation, incoherent speech and sudden confusion also need emergency assessment. Do not wait for them to accept they are ill, or for a psychiatric appointment.

In Saudi Arabia, call 997 for an ambulance when there is danger or you cannot reach emergency care safely. The person should not drive; a trusted companion can drive them if travel is safe. If you fear for your safety, move somewhere safe and call for help. If there is no safe companion or they refuse to travel, ask the medical service for guidance rather than restraining or forcing them yourself.

What should I do if hallucinations start but there is no obvious danger?

New or unexplained hallucinations warrant urgent medical contact, even when the person is calm. Contact their clinician or care team if they have an existing plan. Without an established service, seek medical assessment; while safety is stable, you can call 937 for medical consultation and guidance in Saudi Arabia. If appropriate assessment cannot be obtained promptly, go to a hospital emergency department. Consultation must not delay emergency care if emergency warning signs appear.

How can I help someone who hears voices I cannot hear?

Listen calmly and acknowledge their feelings without confirming that what they perceive is present or arguing to prove them wrong. You could say, “I do not hear that voice, but I can see it is upsetting you. Let us get help.” Reduce noise and crowds if possible, and allow time for them to describe their experience. If they refuse help, you can seek professional advice yourself.

Writing and article review

Sultan AlmuhasinWritten bySultan Almuhasin

Content writer and researcher at Tatmeen, working on Arabic and English articles across mental health and everyday life topics, including relationships, stress, work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

Every Tatmeen article is reviewed by care providers licensed by the Saudi Commission for Health Specialties, so what you read is accurate and trustworthy.

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