Bipolar disorder, which some people may refer to as manic depression, is a mental health condition causing disordered mood, energy, activity levels, and concentration. Some people with this condition may experience bipolar hallucinations.

People with bipolar disorder experience shifts in mood. These can range from feeling elated, irritable, or energized, which doctors refer to as manic episodes, to feeling very sad, indifferent, or hopeless, which doctors refer to as depressive episodes.

If a person experiences a severe manic or depressive episode, they may also have symptoms of psychosis, which can include hallucinations.

This article explores the types of bipolar hallucinations a person may experience, as well as the causes and treatment.

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Estimates suggest that at least 1 in 4 people with bipolar disorder have, at some point, experienced auditory verbal hallucinations, which means hearing voices that are not there.

Other people with bipolar disorder may experience visual hallucinations, which means seeing things that are not there, or olfactory hallucinations, which means smelling things that are not there.

Learn more about bipolar disorder.

A person may experience hallucinations relating to their sense of hearing, sight, or smell. However, research suggests that they are more likely to hear things than see or smell things that are not there.

Auditory and visual hallucinations

For instance, a 20-year prospective study published in 2016 investigated auditory, visual, and olfactory hallucinations in 51 young people with schizophrenia, 25 with schizoaffective symptoms, 28 with bipolar disorder, and 79 with depression.

Schizoaffective means having symptoms of schizophrenia alongside a mood disorder like bipolar disorder or depression.

The researchers found that people with schizophrenia and schizoaffective symptoms were more likely to have auditory and visual hallucinations than people with bipolar disorder or depression.

Over the longer term, more people with schizophrenia experienced auditory and visual hallucinations than people with schizoaffective symptoms, bipolar disorder, or depression.

Olfactory hallucinations

Olfactory hallucinations were less common, but they still occurred. A few people with schizophrenia and very few people with bipolar disorder or schizoaffective symptoms had olfactory hallucinations.

Additionally, one study from 2023 explored the concept of pseudo-hallucinations. At first, the six study participants thought that they were experiencing true hallucinations. However, they realized after some time that the hallucinations were false.

The researchers said that these pseudo-hallucinations could be common in people with bipolar disorder.

Doctors have not identified a single cause of bipolar disorder hallucinations, but several factors may contribute.


If a child has a parent or a sibling with bipolar disorder, they have a higher chance of developing the disorder. However, a child can have a family history of bipolar disorder and not develop the condition. If one identical twin develops bipolar disorder, the other might not.


A person’s ability to handle stress may also affect whether they develop the disorder. Stressful life events, such as illness, death of a family member, divorce, or financial concerns, may trigger a manic or depressive period, although it is not a cause of bipolar disorder.

Brain structure and function

Researchers have found slight differences in average brain size and the activation of certain brain structures in people with bipolar disorder.

Childhood trauma

A study from 2019 found that people who experienced bipolar hallucinations had significantly higher levels of childhood maltreatment.

Hallucinations are a symptom of psychosis, and they may be more likely to happen during the manic phases of bipolar disorder.

A 2019 cross-sectional study involving 1,342 people with the most severe form of bipolar disorder found that 73.8% had a lifetime history of psychotic symptoms. This included 42.6% of people with hallucinations and 68.9% of people with delusions, which means beliefs with no basis in reality.

A systematic review from 2017 found a higher rate of psychotic symptoms during manic phases than depressive episodes of bipolar disorder. However, people commonly experience psychotic symptoms during both manic and depressive episodes.

The researchers also found a link between auditory verbal hallucinations and delusions.

To diagnose bipolar disorder, doctors first conduct an interview, order blood tests, and order body scans to rule out other illnesses.

Then, they check whether a person has experienced one or more episodes of mania or hypomania.

Hypomania means that a person has higher energy or activity levels than is typical for them, but they have not reached the level of mania.

Doctors will then assess a person’s symptoms and the severity of their manic and depressive episodes.

They use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the type of bipolar disorder a person may be experiencing.

Bipolar I disorder

A person has had one or more manic episodes. Most commonly, they will have had both manic and depressive episodes, but they do not need to have had an episode of depression to receive this diagnosis. Their manic episodes must have lasted for 7 days or longer or have resulted in hospitalization.

Learn more about bipolar I disorder.

Bipolar II disorder

A person has depressive episodes that switch back and forth with hypomanic episodes. They never experience a fully manic episode.

Learn more about bipolar II disorder.

Cyclothymic disorder or cyclothymia

A person has a long-term unstable mood condition, experiencing hypomania and mild depression for 2 years or more. They may have short periods of normal mood that last less than 8 weeks.

Learn more about cyclothymic disorder.

Bipolar disorder “other specified” and “unspecified”

A person’s condition does not fit the clinical definitions for the other types of bipolar disorder, but they have still had periods of clinically significant, abnormally elevated mood.

Bipolar disorder is typically a long-term condition. However, a combined medication and psychotherapy treatment plan can help a person manage their symptoms.

Doctors commonly prescribe mood stabilizers, such as lithium or valproate, along with atypical antipsychotic medication.

People with bipolar disorder often take antidepressants. Taking a mood stabilizer alongside these can help prevent a manic episode.

Additionally, psychotherapy may help a person identify and change their overwhelming emotions, thoughts, and behaviors. For instance, cognitive behavioral therapy (CBT) can help treat depression and insomnia and can be helpful in managing bipolar depression.

Other treatments healthcare professionals may prescribe for bipolar disorder include:

  • Electroconvulsive therapy (ECT): ECT is a brain stimulation technique for relieving severe bipolar disorder symptoms, especially when other treatments have not worked or if a person is unresponsive or at high risk of suicide.
  • Repetitive transcranial magnetic stimulation (rTMS): rTMS is a brain stimulation technique that uses magnetic waves to relieve depression. It does not require general anesthesia and has a low risk of negative effects on memory and thinking.

The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357) helps people find mental health treatment services in their area.

Alternatively, a person can visit the SAMHSA online treatment locator or text their zip code to 435748.

Research suggests that 1 in 4 people with bipolar disorder experience hallucinations, which are symptoms of psychosis.

Hallucinations can involve hearing, seeing, or, in a small number of cases, smelling things that are not there.

A person’s genes and brain structure can affect their likelihood of developing bipolar disorder. Stressful life events and childhood trauma may also be contributing factors.

Doctors typically prescribe medications and psychotherapy to treat bipolar disorder. Some people try brain stimulation techniques and light therapy.

A doctor can help you create the right treatment plan.