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Positive Symptoms of Schizophrenia: The Psychotic Dimension

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA Updated: Mar 20th 2017

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.


Reader Comments
Discuss this issue below or in our forums.

You don't need doctors - Chris - Sep 13th 2013

I would find a pastor. that believes you. and get him to bless the house.

Wondering if Im having delusions - Deb - Sep 4th 2013

I am 53 i was a nurse until 06 I had to quit due to medical problems. I have chronic pain from several surgeries. I have to take two different pain meds and several meds for depression and anxiety. Ive been on numerous different types of pain meds thru the past ten years and i now have a dr that has me on a stable med plan. The problem is about two years ago i was lying in my bed awake but my eyes closed and i heard someone come into my room and get into bed with me. No one was at home but me. I looked and there was no one there but i could hear them breathing moving around in bed etc. Since that day i have had this I will call my room mate. It is a male and i do dream that he talks to me and treats me well. That is until the past six months or so. I finally caught what i thought was him breathing on my audio so I come to the conclusion that he was real. I am a Christain so i begin to think it could only be a demon because he tries to have sex with me. I could write a book on all the crazy thin gs ive been thru with this over the past years. When i decided that he had to go everything really went bizzare. Ive been to pastors and they seem to jump right at the crazy thing or my meds causing it. The only thing was catching something on audio and ive been getting these awful sores in my mouth that will not heal that only started after i begin to try to banish this thing. Any thoughts im trying to get an appt.with a Dr now to see if im mentally ill.

;) - George - Jul 30th 2013

Hi I haschizoaffective bipolar religiously themed. It's awesome. I wouldn't trade it for all the pills in the world. there are many aspects to reality and there are many in the... anyway I think we can help, any one have questions or comments email me at 

My heart goes out to all of you. - jena ema - Jan 15th 2013

My adoptive mother was diagnosed as bi-polar and schizophrenic.  She abused me mentally, emotionally, physically and sexually.  I didn't know that other people would have labeled it as abuse until I was 13.

Her schizophrenia is religion/persecution based. 

I stumbled onto this site accidently doing some research.  I've never talked to anyone about it really. So, this is a happy accident for me.

My brother - Cheyenne - May 14th 2012

I'm 14 and I have an older brother who was diagnosed with schizophrenia. My family is having a hard time dealing with it and my mom has tried many times to get him to go get help, but he won't go on his own acord. What do you think we should do????

My Schizophrenic sexual hallucinations experience - Kimberly - Nov 13th 2010

I am 33.  My first experience with auditory/visual experiences, occurred in September of this year (2010).  I had felt (beings) either disembodied spirits ( I thought to be either previously deceased or astral traveling)or aliens, were physically touching me and having sexual relations with me.  I blamed myself, told my husband that I was an abomination and considered myself to be a whore (even though I was only physically having a relationship with my husband).  The hallucinatory sexual relationships felt so real.  For the first time in my life I had orgasms which the experience was both positive and negative.  Negative because my mind was the gateway to my experiences and now that I am taking Dr. prescribed medications my sexual life is back to it's dead self.  Is it wrong to desire pleasurable experiences even if it's all stemming from my hallucinatory (imagination)?  I have never experienced something so liberating in my life.  And now that I am taking my meds, I feel violated in that I won't ever experience those sensations again.

iam shizophrenia - Patricia - Oct 21st 2010

I am constantly asking people if they are okay.  i hate having to take medication, and i have put on a lot of weight. i am constantly telling myself thaT IM NO GOOD. I JUST FIND IT HARD TELLING MYSELF THAT THAT I AM a GOOD PERSON. I BELIEVE MY MOM TOLD ME I WAS STUPID All the time.  aFTER BEING TOLD THAT SO MANY TIMES I BELIEVED IT UNTIL i met my husband. he thought i could  do no wrong. i finaLLY Had my self confidence baCK.  BUT THEN HE DIED. NO ONE UNDERSTANDS HOW YOU FEEL.

Health Professional Srudent - - Feb 23rd 2009

The person diagnosed with ocd,

You may want to get a second opinion concerning your diagnosis. maybe from a pychiatric doctor/ I can't say that your diagnosis is incorrect, but i can say your discribing highs and lows that could reflect a different diagnosis.

- lila - Apr 15th 2008


well, I've been diagnosed with a schizoaffective disorder for a year now, but positive symptoms began 11 years ago. I was 12 and felt I was being observed, watched.

By age 19 I could swear that tv (films, shows) were talking to me and by that time I also believed I could control  birds flight with my mind, and also make children appear on the street by my wish.

 I would hear voices telling me I was no good, and see dark spirits.

 Nowadays (23) I hear relatives and friends, sometimes stranger's voices chatting all day long,in my mind.  Although I cannot recall what the conversations are, it is by no meaning threatful or insulting.

 I have to ask everyone who suffers or knows someone who does to *please* take your medication. It will get daarker before it gets brighter if you don't. Go to your family doctor and make sure you get help. I get my medication at no cost, as I cannot afford it.

Please take care of yourseves.


please help am i just jelous - burk - Jul 22nd 2007
i have been to a bunch of dr's some said i have sever depression i have fybro chronic fatigue and pain 24/7  i have 3 kids all grown in there mid 20s i have been married for almost 30 yrs never a seperation but my wife had relations before we met she was i month from being 15 at first this did not bother me but over the years it fill like she cheated on me i know that is not true she has never cheated on me to my knwledge in 2 yrs dating and 29 yrs marrage yet i ask her about it jow many time how many guys and it has caused here terrible greif  that i keep asking why she did it so young she sayes she is sorry that it happened but does not have an answer she says it happened be for we where married and it does not have no bearing i agree with that but it bothers me more and more. i'm sorry to make her and my life misarble we have 3 very good kids and 5 grand kids and are retired at age 48 can anyone please offer and suggestion thanks k

suffering in tennessee - Amanda - Jul 16th 2007

I am reading these symptoms of delusion for the first time.  I was diagnosed with ocd maic depressive  fear of abandoment, and post tramatic stress disorder, in 2001. I did not have a wonderful childhood as you can tell.  I am very concerenced about my diagnosis because to me the symptoms sound more like phscisophranic.  I hear voices. I think people are constantly watching me. I talk to people who arent their. I cannot talk to people for a long period of time without having the urge to leave and just end the conversation .  I have committed suicide 3 times since 2001.  I am constantly thiniking about death and wanting to die.  My husband laughs and says I have a death wish.  But I don't think it's funny at all.  I have major problems with paying bills and saving money.  I also cry allot and I am constantly agitated and pissed off at him.  I do love him I just can't get passed myself to show it.  I also have an eating disorder. I will binge one day then eat little to nothing the next.  I feel that I have been wrongfully diagnosed.  I am writting this to let people know that you are not crazy.  I use to think I was now I know that i have a very bad disease.  I hope this helps someone who is suffering from any type of mental disorder. To me this is the worlst type of sickness their is.  Huggs and kisses to everyone suffering.


Amanda in Tennessee

I think this is very interesting, and this coming from a kids who is only 12 - tiffany pautin - Feb 8th 2007
I think this is very interesting, and this is coming from a kid who is only 12.

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