Pseudohallucination: Divergent Conceptual Foundations and Their Consequences for Psychopathology

The concept of pseudohallucination remains a deeply problematic construct in Psychopathology, with persistent controversy undermining both clinical utility and research validity. This review identifies, through analysis of historical and contemporary literature, three primary definitions that underlie this conceptual fragmentation. These are categorized as the Insight-Based (prioritizing insight), Descriptive-Structural (emphasizing precise phenomenological description), and Pathognomonic-Psychotic (linking the phenomenon to chronic psychosis) definitions. The adequacy of these categorical frameworks is then evaluated through synthesis of modern research, which reveals insight as multidimensional and evolutive rather than binary, and hallucinatory experiences as existing on a phenomenological continuum that challenges a classification based on rigid divisions. Our analysis demonstrates that the incompatibility of these definitions, as well as the failure of reconciliation attempts, stems not from mere semantic differences but from a fundamental epistemological divide concerning the very method and aims of Psychopathology. Confronting this impasse, we propose a paradigm shift toward a dimensional and descriptive framework that moves beyond the hallucination/pseudohallucination dichotomy. This approach maps subjective experiences across multiple characteristics including perceptual qualities, insight, behavioral impact, sense of ownership and their evolution over time. Grounded in pragmatic synthesis, this reframing prioritizes precise description of lived experience over contested categorization, offering a coherent path to enhance clinical communication, diagnostic precision, and the scientific rigor of Psychopathology.