Illusions or Delusions: Anxiety-Induced Visual Disturbances

Is it a visual hallucination or an illusion?

Hello Doctor, I am a patient with health anxiety.
I started medication in April of last year because I was experiencing persistent dizziness and was afraid it was a brain tumor.
However, after a CT scan, the results were normal.
Later in April, feeling uneasy, I underwent an MRI, which also came back normal.
Despite this, I continued to feel anxious and sought help from a psychiatrist.
Since then, I have started to worry about various cancers and serious illnesses, with my condition fluctuating.
Earlier this year, my situation improved, but during the Lunar New Year, I left my medication at school and didn't bring it home.
About five days after stopping the medication, I experienced what I believe was my first hallucination (though I'm not entirely sure), where I felt that objects around me sometimes moved or there were flashes of light.
I was very anxious at that time, but after resuming my medication, I noticed improvement.
At the end of February, my doctor suggested reducing my medication.
A week after the reduction, I seemed to see something flashing again.
I later had a fundus examination to confirm that my eyes were fine, but the situation persisted.
I have observed that when I am tense and anxious, the symptoms tend to reappear, whereas when I exercise or play video games, the symptoms are almost nonexistent.
In simple terms, the frequency of symptoms increases significantly when I am focused on them.
Recently, I have been considering whether to undergo another CT or MRI scan because I read online that brain issues could cause such symptoms, and I have been thinking about more serious illnesses.
I would like to hear your thoughts and whether you recommend another brain examination.
Thank you.

Hsuān, 20~29 year old female. Ask Date: 2024/03/05

Dr. Li Guanying reply Psychiatry

From your letter, it is clear that you are experiencing distress due to your concerns about anxiety disorder (hypochondriasis).

1.
Facing an uncertain future, anxiety disorder (hypochondriasis) is a common condition in modern society.
It is a chronic illness that requires long-term treatment for recovery.

2.
Anxiety disorder (hypochondriasis) is characterized by episodes of exacerbation, remission, recovery, and relapse.
More than half of patients may experience a recurrence of symptoms even after they have improved.
Due to individual differences in constitution, the definition of delusions should be evaluated by a healthcare professional, and suitable treatment options will need to be discussed.

3.
Regarding pharmacological treatment alone, each primary medication requires 4 to 6 weeks to assess its effectiveness.
It is advisable to keep track of the duration and frequency of any discomfort you experience.

4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment that does not require anesthesia, has a high safety profile, and does not necessitate hospitalization.
It can help improve issues related to anxiety and depression.

For the psychiatric symptoms, I encourage you to discuss them thoroughly with your physician.
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
I recommend considering a visit to have your symptoms assessed in person by a physician, so that together you can make the best decision for your care.

Wishing you mental and physical well-being.

Reply Date: 2024/03/05

More Info

It sounds like you are experiencing a complex interplay between anxiety and visual disturbances, which can be quite distressing. Your symptoms, including the perception of movement or flashes of light, especially during times of heightened anxiety, suggest that your visual experiences may be influenced by your mental state.
Anxiety can manifest in various ways, including physical symptoms such as dizziness, visual disturbances, and even sensations that may feel like hallucinations. These experiences can be exacerbated by stress and anxiety, leading to a cycle where the anxiety itself can amplify the perception of visual disturbances. This phenomenon is not uncommon among individuals with anxiety disorders, particularly those who may also have health anxiety or hypochondriasis, where there is a persistent fear of having a serious illness despite medical reassurance.

Given that you have undergone thorough medical evaluations, including CT and MRI scans, which returned normal results, it is essential to consider that your symptoms may not be due to a neurological issue but rather a manifestation of your anxiety. The fact that your symptoms improve when you are engaged in activities such as exercise or gaming suggests that distraction and physical activity can help alleviate your anxiety and, consequently, the visual disturbances.

It is understandable to have concerns about your health, especially when experiencing unusual symptoms. However, it is crucial to focus on managing your anxiety effectively. Here are some recommendations:
1. Continue Medication as Prescribed: If your doctor has prescribed medication for your anxiety, it is important to take it consistently. Abruptly stopping or reducing medication can lead to a resurgence of symptoms, including anxiety and visual disturbances.

2. Therapeutic Support: Consider seeking therapy, particularly cognitive-behavioral therapy (CBT), which is effective for treating anxiety disorders. A therapist can help you develop coping strategies, challenge irrational thoughts, and reduce health-related anxiety.

3. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help reduce anxiety levels and improve your overall well-being. These techniques can also help you manage the physical symptoms of anxiety, including visual disturbances.

4. Limit Health-Related Research: While it is natural to seek information about your symptoms, excessive research can lead to increased anxiety. Try to limit your time spent searching for health information online, as this can often lead to unnecessary worry.

5. Regular Follow-ups: Continue to have regular check-ups with your healthcare provider. If you feel that your symptoms are worsening or if new symptoms arise, do not hesitate to reach out for further evaluation. However, it may not be necessary to undergo additional imaging studies unless there are significant changes in your symptoms.

6. Engage in Physical Activity: As you noted, engaging in physical activities can help alleviate your symptoms. Regular exercise is known to reduce anxiety and improve mood, so try to incorporate it into your daily routine.

In summary, while your concerns about potential underlying health issues are valid, it is essential to recognize the significant role that anxiety plays in your experiences. By focusing on managing your anxiety through medication, therapy, and lifestyle changes, you may find relief from the visual disturbances and improve your overall quality of life. If you have ongoing concerns, discussing them with your healthcare provider can help you find the best path forward.

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