Visual hallucinations in psychiatric conditions: appraisals and their relationship to distress.

OBJECTIVES: Visual hallucinations (visions) associated with psychiatric conditions are poorly understood. This study tested the hypothesis that appraisals of visions would predict distress associated with visions. It also aimed to describe typical appraisals of visions.
DESIGN: A cross-sectional interview study of people with visual hallucinations.
METHOD: Participants (N = 20) who had experienced visions caused by their psychiatric condition (i.e. not by additional pathology such as epilepsy or substance abuse) completed a semi-structured interview and the Beck Depression Inventory (BDI). Possible associations between appraisals of visions (e.g. of controllability or outcome) and distress were examined. Novel categories of appraisal were generated in an attempt to reflect individuals' experiences as closely as possible.
RESULTS: Appraisals of negative outcome, but not control, predicted distress. Thus, if individuals believed that the persistence of their visions would result in unpleasant consequences, they experienced more distress. Neither the form nor content of the visions predicted distress, nor was current mood predictive. Five categories of appraisal were generated, and independent raters could assign these reliably. Preliminary analyses showed that where individuals appraised a vision as indicating a special task, gifts or powers, they experienced less distress.
CONCLUSIONS: Appraisals of visions predicted the distress associated with visions. 'Objective' characteristics of visions were poorer predictors of distress, and appraisals did not simply follow from the content of the vision. However, current mood may partially determine appraisals. The novel categories of distress require replication but may help to guide clinical practice. Therapeutic interventions aimed at altering appraisals may reduce distress.