Tactile Hallucinations: Symptoms, Causes & Treatment

What Are Tactile Hallucinations?

Tactile hallucinations are sensations of stimuli that are not actually present. Experiencing the feeling of your skin being touched, crawled on, or contacted in some other way can feel  unsettling and uncomfortable. Although tactile hallucinations refer specifically to faulty sensations, delusions, such as bugs laying eggs under the skin, can accompany the feeling.

There are many potential causes of tactile hallucinations beyond mental health disorders, including drugs (prescribed or otherwise), nutritional deficiencies, and other medical conditions. The intensity and duration of these sensations can vary greatly depending on the cause.

Symptoms of Tactile Hallucinations

Tactile hallucinations can take many forms and feel different depending on the person and the underlying condition causing them. Although no stimulus elicits the sensation, it can feel realistic and disturbing. The most common theme involves insects crawling on or under the skin, a feeling called formication.¹ Other tactile hallucinations may involve feeling wetness, electricity, or pressure, and although they can sometimes be pleasurable, they are usually described as uncomfortable and unsettling.

Symptoms of tactile (and related somatic) hallucinations may include:

• Something crawling on, biting, or stinging your skin; this is called formication.
• Wetness (e.g., urine running down leg)
• Being pricked by something sharp like a needle
• Burning or itching
• Feelings of being touched or kissed
• Pressure
• Mucus in one’s nose
• Stretching of body parts or skin
• Stickiness
• Breeze or coolness
• Vibration
• Electricity (e.g., electric shock or current)
• Penetration

What Causes Tactile Hallucinations?

Under normal conditions, when something touches your skin or other body parts, a signal is sent to specific areas of your brain (i.e., the parietal cortex) involved with the sensation of tactile stimuli. Certain culprits (e.g., drugs, medical conditions, etc.) can cause these brain areas to malfunction. As a result, a person experiences the sensation of being touched when you are not.

When the hallucination’s cause can be removed,  the hallucinatory experience may be short-lived. However, in the case of chronic medical or mental health conditions, the hallucinations may only subside with pharmaceutical or therapeutic treatment. It is important to note that sometimes it is normal for people to experience an isolated tactile hallucination at various points in their lives. For example, it’s common to feel itchy as you read the notice from school about someone in your child’s class having lice. However, persistent tactile hallucinations usually indicate something problematic.

Possible causes of tactile hallucination include:

Schizophrenia

Hallucinations are one of several psychotic symptoms that can accompany schizophrenia, a mental health disorder that occurs in less than 1% of the population. Approximately 70% of people with schizophrenia experience hallucinations. Auditory hallucinations are most common, followed by visual hallucinations.

Those with schizophrenia are less likely to experience tactile hallucinations, occurring in less than 9-19% of cases, and may co-occur with hallucinations in other modalities (e.g., feeling and seeing insects crawling on one’s skin).²

Schizophrenia is one of several schizophrenia spectrum disorders that may give rise to tactile hallucinations. Also included in this DSM-5 category are schizophreniform disorder, schizoaffective disorder, brief psychotic disorder, and schizotypal personality disorder.

Other Mental Illnesses

Psychotic symptoms, like hallucinations, are not exclusive to schizophrenia spectrum disorders.  From a formal diagnostic perspective in the DSM-5, “psychotic features” may be present in the bipolar and depressive spectrum of disorders. Hallucinations may also be observed in those with anxiety disorders — such as post-traumatic stress disorder, panic disorder, and obsessive-compulsive disorder. Somatic disorders — like illness anxiety disorder (i.e., “hypochondriac syndrome”), conversion disorder, and somatic symptom disorder are also linked to hallucinations.

Mental health conditions that may cause hallucinations include:

• Major depressive disorder (MDD) with psychotic features: Tactile hallucinations are rarely a symptom of MDD. MDD with psychotic features occurs in only .4% of the general population, with the majority of the hallucinations being auditory (96.7%).³
• Bipolar disorder: Hallucinations, in general, are less common in bipolar disorder compared to schizophrenia spectrum disorders, with tactile hallucinations occurring in about 8% of bipolar disorder cases.⁴
• Postpartum psychosis: Postpartum psychosis, characterized by psychotic symptoms (such as hallucinations) that onset shortly after childbirth is relatively rare. However, it’s particularly imperative to treat for the safety of the infant and mother.⁵ It is unclear why childbirth may trigger hallucinations, but a combination of genetic, hormonal, situational, and environmental factors (e.g., stress, and sleep deprivation) are suspected.
• Post-traumatic stress disorder (PTSD): Auditory hallucinations are the most common sensory modality in PTSD, though rarely tactile hallucinations may arise. One study found that out of 74 participants who had PTSD with psychotic symptoms, auditory hallucinations comprised 66.2% of those cases, followed by visual hallucinations (29.7%) and tactile hallucinations (8.1%), with tactile hallucination themes ranging from electric shock to being licked by a dog.⁶
• Delusional disorder: Although hallucinations are not the prominent symptom in this psychotic disorder, tactile hallucinations may arise in relation to the theme of the delusion (e.g., the sensation of crawling insects relating to the delusion of infestation).
• Brief psychotic disorder: As the name suggests, this psychotic state lasts at least one day but less than one month, and despite the interruption of life by psychotic symptoms (such as hallucinations), the individual returns to their pre-clinical state.
• Obsessive-compulsive disorder (OCD): Although not a prominent nor common symptom of OCD, hallucinations, including those of the tactile modality, have been reported.

Medications 

Certain prescribed and over-the-counter medications can cause the side effect of tactile hallucinations, such as medications used to treat Parkinson’s disease, medications for depression, ADHD medications, hypertension medication, and antiepileptic medications.¹

Although tactile hallucinations were not specifically noted, psychotic symptoms (including hallucinations)⁷ have also been reported as side effects for corticosteroids, decongestants, like pseudoephedrine, chemotherapeutics, ACE inhibitors, antimalarials, pain-relieving analgesics, muscle relaxants, and even certain antivirals and antibiotics.^{7,8,9,10,11,13,14}

Recreational Drugs

Certain recreational drugs can cause tactile hallucinations by affecting neurotransmitter levels in the brain, and altering sensory processes and perception. While several drugs can cause hallucinations (e.g., LSD, PCP, mescaline), amphetamines and cocaine most notably are associated with tactile hallucinations, often in the form of insects crawling on one’s skin. Tactile hallucinations can occur during acute intoxication, withdrawal, and even beyond withdrawal (as with substance-induced psychosis).

Though mechanisms of action may vary, depending on the drug, most hallucinations result from dopamine and glutamate changes in the prefrontal cortex and midbrain. An exception, however, is that psychedelics (e.g., LSD, psilocybin, MDMA/”ecstasy”) typically modulate serotonin (5-HT) in these regions to produce mind-altering effects.

Alcohol Misuse & Withdrawal

Alcohol is a central nervous system depressant affecting brain function, altering sensation and perception. When misused, as in the case of binge drinking or alcoholism, it can lead to psychotic symptoms including hallucinations. Though hallucinations are more often auditory or visual, they can be tactile. When resulting from excessive alcohol use over an extended time, it is called alcohol-related psychosis (a.k.a. alcohol-induced psychotic disorder, alcohol hallucinosis), but withdrawal from alcohol and delirium tremens can also give rise to hallucinations.¹⁵

Head Injury & Concussion:

Head injury can be accompanied by tactile hallucinations.  One study reported that close to one-third of injured motorcyclists who sustained whiplash in high-intensity accidents experience tactile hallucinations in the form of formication (i.e., the sensation of insects crawling on the skin).¹⁶

Sleep Disorders

The brain needs sleep to restore and maintain daily functioning. Sleep deprivation caused by insomnia, sleep apnea, situational life factors, or other sleep disorders can interfere with the brain’s ability to sense and perceive stimuli, either by detecting things that aren’t really there or not detecting things that are present.¹Anxiety and restlessness that often accompany insomnia (inability to fall asleep) can also contribute to tactile sensations especially involving the limbs (e.g., crawling insects, electric jolts).

There are also several sleep disorders in which the lines between waking and sleep (dreaming) mentation are blurred, leading to hypnagogic (in the process of falling asleep) hallucinations or hypnopompic (in the process of waking up) hallucinations. Examples include narcolepsy and sleep paralysis where the individual’s brain produces dream-like activity while the person is seemingly awake.

Phantom Limb Syndrome

When a limb is amputated, the areas of the brain that process sensation and movement of that limb are still intact and can activate either spontaneously or as part of a larger circuit in the brain. Such activation can give rise to the sensation and perception that the missing limb is being touched or moved; this condition is referred to as Phantom Limb Syndrome. Creative treatments exist for this condition using dummy props and mirrors to trick the brain into a change in sensation and perception, especially in cases that are painful.

Degenerative Diseases

Hallucinations can occur in diseases (e.g., Alzheimer’s, dementia, Parkinson’s) where deterioration of the brain tissue and/or change in neurotransmitter levels leads to faulty communication between brain regions. This leads to impairments in cognition, sensation, and perception. In the case of Parkinson’s disease, hallucinations can be caused both by a depletion of dopamine that characterizes the disease, as well as excessively high dopamine levels that can result from medication used to treat the illness.

Diagnosing Tactile Hallucinations

If you or someone you care about is experiencing tactile hallucinations, it is important to seek professional help to determine the cause and whether the symptoms indicate a more serious medical or mental health condition. A primary care physician, psychiatrist, hospital or clinic would be able to initiate the evaluation and if needed, direct you to a specialist depending on the suspected cause.

The diagnostic process for tactile hallucinations may include:

• Psychiatric evaluation: An evaluation usually consists of speaking with a psychiatrist or psychologist about what the individual is experiencing and engaging in neuropsychological testing (which is a series of brief activities and puzzles that are used diagnostically to assess brain function in a non-invasive way).
• Blood tests: Diagnostic blood tests can help assess the presence of psychosis-inducing substances, hormone levels, infection, medical conditions, and malnutrition.
• Urine and other relevant screens: Toxicology screens can help determine if drugs or other medical conditions may be underlying the hallucinations.
• Imaging scans: Neuroimaging (e.g., MRI, PET, CT) scans can help detect abnormal brain tumors or cysts that may be putting pressure on surrounding brain tissue and causing psychotic symptoms.

Tactile Hallucination Treatment

Tactile hallucinations can be distressing and indicative of various underlying conditions like substance use disorders, mental health disorders, and neurological conditions, as well as side effects of medication. A combination of treatment methods, including medication, psychotherapy, and detoxification/rehabilitation (if substance-related) is usually the most effective approach to managing tactile hallucinations. In addition to treating tactile hallucinations directly, particularly with antipsychotic medication, since hallucinations of all types tend to increase with heightened anxiety, any treatment — pharmacological, psychological, or behavioral — that reduces anxiety also tends to reduce the frequency of hallucinations. It is important to seek treatment as soon as possible to avoid any further negative impact on daily functioning and quality of life.

Medications

Medication can be helpful in treating tactile hallucinations by targeting the underlying condition that is causing them. For example, if hallucinations are a symptom of a psychiatric disorder like schizophrenia, antipsychotic medication can be prescribed to reduce the intensity and frequency of the hallucinations. If they are due to a neurological condition like Parkinson’s disease, different medications or adjustments to medication may be warranted. While if substance use is the cause of the hallucinations, medications to facilitate detoxification and stabilization may be given. Anti-anxiety and antidepressant medications may be used to reduce symptoms, such as anxiety, that can exacerbate psychotic symptoms.

Therapy

Psychotherapy can help treat tactile hallucinations by providing a safe and supportive environment for individuals to explore their experiences and develop coping strategies. Tactile hallucinations can be distressing and may be associated with underlying psychological conditions such as anxiety or trauma. Through psychotherapy, individuals can learn techniques such as mindfulness, relaxation, and cognitive restructuring to help manage their symptoms, as well as explore underlying psychological factors such as unresolved emotions or past traumas. There are several paths to finding the right therapist, such as asking your local physician, family, or friends for a recommendation or searching online therapy options.

Therapy options for tactile hallucinations include:

• Cognitive behavioral therapy for psychosis (CBTp): The goal of cognitive behavioral therapy for psychosis is to reduce distress from difficult symptoms like hallucinations, delusions, and negative symptoms by working with the patient to challenge these thought disturbances, form new thought patterns and establish effective coping strategies. This is a highly structured, time-limited, goal-based treatment that has been shown to reduce distress from psychotic symptoms in patients when use in conjunction with medication.
• Acceptance and commitment therapy (ACT): ACT can help treat hallucinations (in addition to other disorders such as depression, substance misuse, and anxiety disorders) by helping individuals observe and accept their experiences without judgment. As a relatively newer therapy, the goal is to develop psychological flexibility that can help with living a meaningful life despite the presence of distressing symptoms.
• Group therapy: By providing a supportive and validating environment where individuals can share their experiences and learn coping strategies from others with similar struggles, group therapy can be effective for those experiencing hallucinations, especially when combined with individual therapy and medication.
• Psychodynamic therapy: Psychodynamic therapy can sometimes be helpful with patients who have good insight to recognize how their psychotic symptoms may be related to past traumas, unconscious conflicts, and other psychological issues that haven’t been fully examined or acknowledged and how they might be maintained in the present by certain relationships and activities.
• Family therapy: Family therapy can be a very powerful and effective adjunct to individual therapy and medication as it helps family members create an environment of support and positivity that reduces anxiety, anger, and confusion that can arise with psychotic symptoms, such as hallucinations.
• Social skills training (SST): If hallucinations are part of a mental health syndrome that also involves cognitive and emotional dysfunction, such as schizophrenia, SST can be particularly useful, especially in conjunction with psychotherapy and medication, to help the individual develop coping mechanisms and skills that are deficient.¹⁸ This training may involve individual and/or group work.
• Breathing exercises: As noted above, since hallucinations of all types tend to increase with heightened anxiety, any intervention that reduces anxiety also tends to reduce the frequency of hallucinations. Such interventions need not be pharmacological or even psychotherapeutic but rather could include relaxation techniques, like various breathing exercises, including diaphragmatic breathing, and other methods, like the “deflated balloon” technique, which involves deep breaths and breathing out to deflate the belly.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate specific brain areas or pathways. In the case of tactile hallucinations, TMS works by targeting areas of the brain that process touch and potentially other areas that can dysfunctionally give rise to hallucinations. Although research has been mixed especially in establishing optimal parameters (target area, frequency, etc.), it may be a worthwhile consideration for those with very resistant psychotic symptoms, particularly auditory hallucinations, but tactile ones as well.¹⁹

How to Cope With Tactile Hallucinations

If tactile hallucinations interfere with your daily functioning, it is important to see a professional and establish a treatment plan. In addition to medical treatment (e.g., medication, therapy), several strategies may be helpful to cope with tactile hallucinations and allow you to lead a balanced and stable life despite intrusive symptoms.

Here are some ways to cope with tactile hallucinations:

• Practice meditation: Tactile hallucinations can be disruptive to daily functioning.  They may interfere with daily tasks (work or otherwise) or interfere with sleep, leading to fatigue during the day. Meditation techniques can be helpful in coping with these uncomfortable sensations as well as in reducing stress which in some cases can trigger or exacerbate hallucinations.
• Explore new hobbies: Engaging in a new interest or revisiting an old interest (e.g., journaling, painting/sketching, pickleball, playing an instrument, taking a cooking class, knitting, gardening, golf) can be helpful as a distraction. The act of engaging in an activity can provide a sense of control and accomplishment, reduce anxiety, promote relaxation, and, in some cases, increase social interaction.
• Embrace self-compassion: Self-compassion involves treating oneself with kindness, understanding, and acceptance, and in the case of hallucinations, this may involve reducing negative self-talk, giving yourself a pass for not being productive with work, and treating yourself with the same kindness and understanding that you would offer a friend who is struggling.
• Surround yourself with positive people: When dealing with challenging symptoms like hallucinations, it is important to surround yourself with positive and compassionate people who can help remind you to embrace self-compassion, distract you from your symptoms by engaging in activities with you, and be someone you can talk to when you are experiencing symptoms or feeling stressed.
• Family support: Having family members join for therapy appointments can make a big difference in the treatment outcome for individuals with a mental health disorder, especially one involving psychotic symptoms. Psychotic symptoms like hallucinations may leave gaps in what the individual shares with the clinician. Family members can provide additional information that may be key in determining treatment and support. Moreover, coping strategies work best when relatives are involved, educated about the illness, and equipped with coping strategies themselves.²⁰
• Stress management: Avoiding stressful situations is not always possible, and learning techniques to manage stress is important, such as recognizing stress before it becomes unmanageable, using relaxation and mindfulness techniques, and reframing one’s thoughts. Several mental health apps offer stress management techniques, as do a number of stress management books.
• Hygiene: Maintaining good hygiene, including regularly brushing teeth, bathing, and dressing properly is important to avoid other complicating health issues and to encourage positive social interactions.
• Attention to nutrition, diet, and exercise: Poor nutrition can be a stress factor rendering an individual who is already at risk for psychosis and/or drug misuse even more vulnerable. There is some evidence supporting the notion that foods with anti-inflammatory properties (such as omega-3 fatty acids, vitamins C and D) can be helpful in reducing psychotic symptoms in some cases.²¹ Regular exercise is important for mental health and can reduce anxiety which can exacerbate hallucinations.
• Avoid drugs and alcohol: Regardless of the cause of hallucinations (e.g., substance use, schizophrenia, etc.), drugs and alcohol can worsen them, increasing both their intensity and frequency. In the case of addiction, it is important to avoid places and people that might serve as a cue for relapse. Avoiding things that can worsen your symptoms may not only help you cope with the hallucinations but will improve your physical health, emotional regulation, clarity of mind, and overall ability to engage other coping strategies.
• Smart device apps: While nothing replaces face-to-face, in-person support, various useful CBT apps are available to help maintain routines, activity, emotional awareness, and a sense of overall well-being. Smart devices are also a great way to check in with friends and family if seeing them in person is not an option.

Final Thoughts

If you or someone you care about is experiencing tactile hallucinations, it is important to seek help. Hallucinations can be distressing and disruptive to daily living, but you do not have to suffer alone as there are professionals who can provide you with support and treatment. The first step to relief is reaching out to a trusted healthcare provider through an online therapist directory, a family member, or a friend who can start you on the path.