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Auditory Hallucinations

A number of illnesses can cause hallucinations, but many can be treated.
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Last updated April 26, 2021

Auditory hallucinations questionnaire

Use our free symptom checker to find out what's causing your auditory hallucinations.

Auditory hallucinations questionnaire

Use our free symptom checker to find out what's causing your auditory hallucinations.

Auditory hallucinations symptom checker

What are auditory hallucinations?

An auditory hallucination is when you hear a voice, music, or other noise that doesn’t exist and that other people do not hear. Sometimes a person is aware that the actual sound does not exist. And some people cannot tell the difference and believe the sound has occurred.

Command hallucinations

The most worrisome type of auditory hallucination is called a “command hallucination.” This is when someone hears a voice that is telling them (commanding) to do something. While sometimes these can be seemingly harmless commands, sometimes the voices tell people to harm others or themselves.

If someone has command hallucinations or thoughts of self-harm or suicide, they should talk to their doctor immediately or call 911.

Delusions vs hallucinations

Hallucinations are sometimes confused with delusions. A delusion is a set belief that does not line up with reality. It cannot be changed even when you’re given proof that the belief is false. Auditory hallucinations are hearing things that aren’t there.

Pro Tip

While it’s normal to feel afraid to discuss these problems with others, even our doctors, it is important to do so in order to get an accurate diagnosis and treatment plan made. Your doctor wants you to be well, and will help to arrange the next steps in your workup, even though some people feel embarrassed or “crazy” sharing this information. —Dr. Karen Hoerst

Causes of auditory hallucinations

Auditory hallucinations are caused by a number of psychiatric illnesses, most notably schizophrenia. They can also happen in bipolar disorder, post-traumatic stress disorder, and dementia. Understanding the underlying illness can guide how it’s treated.

1. Schizophrenia

Symptoms

  • Mood change
  • Change in behavior
  • Hallucinations (auditory, visual)
  • Substance abuse
  • Paranoia
  • Suicidal thoughts

Schizophrenia is the most common cause of auditory and visual hallucinations. They also may have delusions and disorganized thoughts and behaviors. Anxiety, mood changes, and thoughts of self-harm are also common.

Schizophrenia symptoms generally show up during teenage years and young adulthood.

Treatment for schizophrenia includes antipsychotic medications such as risperidone. Most treatment occurs in outpatient clinics, with a treatment team that includes a psychiatrist, social workers, and psychologists.

2. Bipolar disorder

Symptoms

  • Manic mood or behavior
  • Depressed mood or behavior
  • Hallucinations (auditory, visual)
  • Substance abuse
  • Suicidal thoughts

People with bipolar disorder have both manic episodes (a very elevated mood and intense energy) and depressive episodes (feeling very low, with little motivation). Hallucinations can occur during both types of episodes, but are more common during the manic state. There are several types of bipolar disorders, and they differ depending on the frequency and severity of the mood episodes.

Treatment may include talk therapy with a mental health professional, medication (such as mood stabilizers), and following a healthy sleep routine.

Auditory hallucinations questionnaire

Use our free symptom checker to find out what's causing your auditory hallucinations.

Auditory hallucinations symptom checker

3. Post-traumatic stress disorder (PTSD)

Symptoms

  • Anxiety and avoidant behavior
  • Flashbacks
  • Hallucinations (auditory, visual)
  • Substance abuse
  • Irritability and aggression
  • Sleep disturbances
  • Suicidal thoughts

Post-traumatic stress disorder (PTSD) causes a range of symptoms that are triggered by trauma. This trauma can be a single event or a repeated ongoing trauma. Common triggers for PTSD are sexual assault, combat, and physical illness.

Symptoms may include anxiety, insomnia, being irritable or aggressive, and psychosis, including hallucinations and flashbacks.

People with PTSD may also have other mental health conditions like depression, anxiety, or substance use.

Treatment for PTSD includes medications such as antidepressants and antipsychotics, along with counseling. Another treatment is called exposure therapy, where people are exposed (either in real life or through imagination) to their triggers in a controlled setting. This continues until the trigger no longer causes the same response.

4. Alzheimer’s disease

Symptoms

  • Memory problems
  • Change in behavior and the ability to function
  • Hallucinations (auditory, visual)
  • Tremors
  • Problems with self-care

Alzheimer’s disease affects the brain, causing problems with memory, functioning, and impaired judgement. Alzheimer’s disease causes abnormal plaques, a buildup of certain proteins, which block signaling between brain cells (neurons). Other neurons can also be damaged, leading to tangles—twisted strands of protein. The tangles block the neuron’s ability to function, causing the cells to die.

Alzheimer’s disease is the most common cause of dementia. The risk of Alzheimer’s increases with age and having a family history of the disease. As it progresses, hallucinations can occur.

Alzheimer’s disease is diagnosed with a combination of cognitive tests, a physical examination, and blood tests. You may also have brain imaging tests like a CT scan or MRI.

Alzheimer’s disease is not curable, but there are some medications that can slow its progression.

Dr. Rx

In general, when I am hearing about these hallucination symptoms, I am listening to how the symptoms developed. Did they start suddenly, or was it more gradual? Has this person ever had any other symptoms of mental health disease in the past? Are they experiencing any other neurological symptoms such as headaches or weakness? How old is the person? —Dr. Hoerst

5. Parkinson’s disease

Symptoms

  • Tremor
  • Rigid, stiff, or slow movements
  • Poor balance and falls
  • Memory problems
  • Change in behavior
  • Hallucinations (auditory, visual)

Parkinson’s disease causes movement problems including a tremor or shaking of the hands, stiff and slow movements, and balance problems that can lead to falls. These are caused by problems with the brain chemical, dopamine.

There are also psychological symptoms including dementia, depression, and psychosis, and hallucinations.

Parkinson’s is diagnosed based on a careful neurological exam. Blood tests and images of your brain such as an MRI may be needed.

Treatment includes medications that increase the amount of dopamine in the brain. Physical therapy is also recommended. Medications are also used to treat other symptoms such as depression.

In some situations, surgery (such as deep brain stimulation) is used to improve the physical symptoms.

6. Huntington’s disease

Symptoms

  • Chorea or abnormal movements
  • Eye movement problems
  • Balance problems
  • Mood disorders such as depression
  • Hallucinations (auditory, visual)

Huntington’s disease is a genetic disease that causes progressive movement problems called chorea. Chorea (from the Greek word that means “dance”) is an involuntary, irregular movement of a limb or your trunk. It’s caused by a spasm of a muscle. Often, other people will notice these movements before the person who is affected does.

Huntington’s disease also causes depression and psychosis, including hallucinations.

It is treated with medications such as tetrabenazine to treat chorea and antipsychotics to help with the psychiatric symptoms. Speech therapy and physical therapy may also be helpful.

7. Brain tumor

Symptoms

Brain tumors (both cancerous and benign) can cause auditory hallucinations, particularly if they affect certain parts of the brain. Hallucinations can occur if a tumor presses on a nerve that sends sound signals from the ear to the brain. Or if it’s in the part of the brain that processes this information.

If your doctor thinks you may have a brain tumor, you will have brain imaging tests, usually with an MRI.

Treatment depends on the type of tumor. Radiation, chemotherapy, or surgery may be needed, or a combination of all three.

Auditory hallucinations questionnaire

Use our free symptom checker to find out what's causing your auditory hallucinations.

Auditory hallucinations symptom checker

8. Drug use

Symptoms

  • Agitation or sedation
  • Behavioral changes
  • Hallucinations (auditory, visual)
  • Change in appearance of eyes (pupils)

Certain prescription medications, like amphetamines used to treat attention deficit hyperactivity disorder, some antibiotics, and steroids can cause hallucinations. Recreational drugs, such as cocaine, methamphetamine, psychedelic mushrooms, or LSD can cause hallucinations and other symptoms.

If hallucinations are worrisome, stop taking the recreational drug that's causing them. For prescription medications, talk to your doctor immediately. They may tell you to stop taking the medication or replace it with another drug. Do not make any changes before talking to your doctor.

Other possible causes

A number of conditions may also cause auditory hallucinations.

  • Migraine
  • Brain infection (encephalitis)
  • Deficiencies vitamin B12 or vitamin D
  • Stroke
  • Deafness
  • Dementia with Lewy bodies

When to call the doctor

  • Any new hallucinations should be discussed with your doctor, even if you are aware that the sounds are not real.
  • If you have had hallucinations before but they are worsening or changing, you should discuss this with your doctor.

Pro Tip

Sometimes the treatment approach rests not only on the diagnosis or cause of the symptoms but also on how bothersome they are to the person. For example, if a person with Alzheimer’s disease is hearing hallucinations involving music, or another pleasant sound, and it is not bothersome to them, treatment may not be necessary at all. —Dr. Hoerst

Should I go to the ER for auditory hallucinations?

Got to the ER if you have the following symptoms:

  • Any “command hallucinations” involving harm to self or others
  • Auditory hallucinations that occur with other harmful behavior such as increasing drug or alcohol use, unsafe physical behavior, or agitation

Treatments

At-home care

  • Get enough sleep.
  • Review medications and other recreational substance use.
  • Journal or log information about when your symptoms occur as this may help in the diagnosis.

Other treatment options

  • A combination of medications
  • Therapy
  • Surgery or radiation if it is caused by a structural problem in your brain.
Share your story
Dr. Hoerst is a board-certified Neurologist. She received her undergraduate degree in Neuroscience from the University of Scranton in 2005 and Jefferson Medical College (now Sidney Kimmel Medical College) in 2009. She completed an internal medicine internship, neurology residency and vascular neurology fellowship at Thomas Jefferson University Hospital in Philadelphia (2014). After completing her...
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