Perceptual Disturbances

There are two major types of perceptual disturbances: hallucinations and illusions. Hallucinations are defined as false sensory impressions or experiences. Illusions are defined as perceptual distortions, causing existing stimuli to appear quite different from what they are in reality.

Hallucinations may occur in any of the five major sensory modalities: visual, auditory, olfactory, gustatory, and tactile. Auditory hallucinations are most commonly reported. Clients who report hearing things (usually voices) that others do not hear usually suffer from either an affective disorder or schizophrenia. However, on occasion, such experiences may be produced by states of chemical intoxication or because of acute traumatic stress. In other instances, clients may report having especially good hearing or they may report listening to their own "inner voice." Although such reports are worth exploring, they are not in and of themselves signs of perceptual disturbance. In addition, people often report odd perceptual experiences, similar to hallucinations, that occur as they fall off to sleep or when they are just waking up. Such perceptual disturbances are normal—and occur during the hypnogogic or hypnopompic sleep states—and are a consistent part of many people's sleep patterns (Rosenthal, Zorick, & Merlotti, 1990). Therefore, when evaluating for hallucinations, interviewers should always determine when such experiences usually occur. If they occur exclusively when a client is in a stage of sleep, they are less diagnostically relevant.

Because of the psychotic nature of delusions and hallucinations and the bizarre nature of some obsessive-compulsive symptoms, interviewers should approach questioning in these areas with an especially gentle and explorative manner. The following sample interview dialogue illustrates how interviewers can help clients admit their unusual or bizarre experiences:

Interviewer: "I'm going to ask you some questions about experiences you may or may not have in your life. Some of the questions may seem odd or unusual, and others may fit some personal experiences you've had but haven't yet spoken about."

Client: "Okay."

Interviewer: "Sometimes radio broadcasts or television newscasts or programming can feel very personal, as if the people in them were speaking directly to you. Have you ever thought a particular program was talking about you or to you on a personal basis?"

Client: "That program the other night was about my life. It was about me and Cindy Crawford.

Interviewer: "You know Cindy Crawford?"

Interviewer: "And how did you meet her?"

Client: "We met when I was her director in about five or six movies she filmed." The next dialogue models an evaluation for auditory perceptual disturbances:

Interviewer: "I've noticed you seem to be a pretty sensitive person. Is your hearing especially good?"

Client: "Yes, as a matter of fact, I have better hearing than most people."

Interviewer: "Really? What kinds of things do you hear that most people can't hear?"

Client: "I can hear people talking through walls, in the next room."

Interviewer: "Right now?"

Client: "Yeah."

Interviewer: "What are the voices saying?"

Client: "They're talking about me and Cindy . . . about our sex life."

Interviewer: "How about your vision? Is it especially keen too? Can you see things that other people can't see?"

The next dialogue models an evaluation for obsessions:

Interviewer: "You know how sometimes people get a song or tune stuck in their head and they can't stop thinking about it? Have you ever had that kind of experience?"

Client: "Sure, doesn't everybody?"

Interviewer: "Yeah, that's true. I'm wondering if you ever have some particular thoughts, kind of like a musical tune, that you wish you could get rid of, but can't?"

Client: "Maybe sometimes, but it's no big deal."

Interviewer: "How about images? Do you have any images that seem to intrude into your mind and that you can't get rid of?"

Notice how the interviewer in these preceding examples normalizes each type of pathology by saying things like, "you seem sensitive" and "you know how sometimes people get a song or tune stuck in their head. . ." and then inquiring about the symptoms present.

Visual or tactile hallucinations are often linked to organic conditions. These conditions may include drug intoxication or withdrawal, brain trauma, or brain disease. Clients in acute delirious states may pick at their clothes or skin in an effort to remove objects or organisms (e.g., insects) they believe are producing their sensory experiences. Similarly, clients may reach out or call out for people or objects that do not exist. Obviously, when clients report such experiences or you observe clients as they experience such perceptual disturbances, the disorder is usually of a very serious nature. Immediate medical evaluation and intervention is warranted.

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  • karin
    How to ask about perceptual disturbances?
    2 years ago

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