Black, Donald W.

Background Pseudohallucinations (PHs), defined as perceptual experiences recognized by the individual as unreal, have historically been distinguished from “true” hallucinations. However, their conceptual validity and clinical utility remain debated, with definitions and applications varying widely. Methods A narrative review of historical and contemporary literature on PHs was conducted. Articles were identified through PubMed using the terms “pseudohallucination,” “hallucination,” “dissociation,” and “trauma,” and through reviewing reference lists of key publications. Results Historical accounts emphasized features such as insight and localization, but empirical findings challenge these distinctions and demonstrate significant overlap with hallucinations and intrusive imagery across diagnoses. PHs are observed in psychotic, trauma-related, and personality disorders, suggesting they may reflect a spectrum of perceptual experiences rather than a discrete entity. Conclusions Moving beyond binary classifications and exploring the use of specifiers to describe hallucinations may offer a more nuanced framework for understanding these experiences across diagnostic categories. Rather than seeking rigid distinctions, this approach encourages descriptions that reflect individual phenomenology and context. Such a shift may help reduce stigma, foster more compassionate clinical engagement, and preserve the perceived relevance of the PH concept while aligning it with contemporary dimensional models of psychopathology.