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Positive Symptoms of Schizophrenia: The Psychotic Dimension

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA

Positive Symptoms: The Psychotic Dimension

ear listening Hallucinations are sensations that only the person having them experiences. Whatever causes them happens within the person's brain, and not outside in the world. Hallucinations may involve sight, sound, taste, smell and touch. The most commonly reported form of hallucination involves hearing people's voices when those people are not there. These hallucinations happen when the person is fully awake. They appear to come from one or more third parties. They are not like the common odd sensations that many people experience during transitions from waking to sleep or when falling asleep. People with schizophrenia describe the voices as providing a running description of their behaviors and intentions in their heads. The voices might also be forceful and tell them to do or not do certain things. Frequently, the voices are very negative and critical in tone and attempt to humiliate the person.

Delusions are fixed, mistaken ideas that the person holds. These are often odd or incorrect ideas about themselves and the world around them. They may be based on hallucinations, or from faulty thinking about events that either happened or were believed to have happened but which are not real. Delusions vary widely in their themes. they may be persecutory (tormenting), referential (be about oneself, somatic (involving the body, focused on religious ideas, erotomanic (involving sexuality and relationships, or grandiose (larger than life).

Delusions can be:

  • A tormenting (persecutory) delusion involves the belief that the sufferer is being stalked, tricked, framed, or hunted in some way. A common delusion of this type that many patients share is that the FBI or other police or spy institutions are after them.
  • Referential delusions involve the belief that certain public communications contain specific hidden messages meant for the person alone. They may believe that a television host's gesture has personal meaning for them, for example, or that song lyrics contain a special personal message. When patients can demonstrate some insight that their referential delusions are possibly not true, the delusions can be called "ideas of reference". When they take on the force of delusions, they are termed "delusions of reference".
  • Somatic delusions involve the body. They typically are about people expressing 'knowledge' that they have a terrible illness (of a physical and possibly bizarre type and not schizophrenia. For example, they may complain that they have worms under their skin, that they have a tumor, or that they are being damaged by supernatural cosmic rays.
  • Religious delusions involve beliefs that they have a special relationship with God normally reserved for bible or mythic figures, or with the spiritual world. They may state that they are a religious figure who has been reborn in the current body. They may complain of demon possession, of being able to speak to God directly and hear replies, or to be in communication with a spirit from another world. They may believe that they are a god, or chosen messenger.
  • Erotomanic delusions are ones involving false ideas and feelings about relationships that may not actually exist. For example, people may believe that a famous actor or actress is in love with them. They may believe that their actual spouse or partner has cheated on them when this has not happened. They may also believe that people they don't want anything to do with desire to have sexual contact with them.
  • Grandiose delusions happen when people believe that they are a significant figure in the world, such as a movie star, political leader, or someone incredibly wealthy and powerful.

Many times, delusions will involve more than one of these categories at once. For instance, patients who think they are a religious god or leader, are expressing a delusion that is religious and grandiose at the same time. This sort of mixing is normal, although there is usually one theme that is stronger than the others. For example, the religious element may be more important and visible than grandiose elements.

Hallucinations and delusions generally can be described as being either possible or bizarre. Possible, or plausible, delusions are those that might be consistent with reality if reality were slightly different than it is. Bizarre delusions are completely outside of reality and highly unlikely to ever actually happen. For example, it is plausible for someone to think that their partner has cheated on them with another person. It is bizarre for them to think that their partner has cheated on them with the entire crew of an alien space craft. It would also be bizarre for someone to complain about their intestines spilling out of their body when simple observation by another person shows that this is not the case.

The combination of hallucinations and delusions often go together. For example, a delusion of persecution may be supported by 'evidence' that comes from hallucinated voices. A belief that one is an archangel may be supported by evidence from "God's" voice. The two symptoms interact with each other. This creates mental chaos and an atmosphere for the loss of reality.