Differentiating Pseudohallucinations from True Hallucinations in Psychiatric Conditions

Core Distinguishing Features and Clinical Assessment

Patients with Charles Bonnet Syndrome have true visual hallucinations with preserved insight, as noted by the American Academy of Ophthalmology 1
True psychotic symptoms must be differentiated from psychotic-like phenomena due to developmental delays, trauma exposure, or overactive imagination in children and adolescents, according to the American Academy of Child and Adolescent Psychiatry 2

The American Academy of Child and Adolescent Psychiatry suggests that cultural, developmental, and intellectual factors may influence how patients describe their experiences, and should be considered when assessing pseudohallucinations 2
The American Academy of Ophthalmology notes that true hallucinations can occur with preserved insight, as seen in Charles Bonnet Syndrome, and should not be assumed to be pseudohallucinations based on insight alone 1

When evaluating patients with hallucinations, the American Academy of Child and Adolescent Psychiatry recommends considering the clinical context, including underlying conditions such as psychotic disorders, mood disorders, neurological conditions, and trauma 2
The American Academy of Ophthalmology and the American Academy of Child and Adolescent Psychiatry agree that ruling out organic causes, such as medical conditions, medications, substance use, and delirium, is crucial before finalizing classification of hallucinations 1, 2, 3