Visual Language Models (VLMs) are known to produce hallucinated predictions that are not grounded in visual evidence, yet existing approaches lack a principled understanding of how robust such predictions are under counterfactual perturbations. In this work, we study the sample complexity of counterfactual robustness for hallucinated outputs in VLMs. We define a causal influence metric based on log-probability differences between factual, counterfactual, and activation-patched runs, and use it to characterize the stability of hallucinated predictions. By leveraging circuit discovery techniques (CD-T), we identify model components responsible for these predictions and track their activation differences across counterfactual samples. We then derive empirical bounds on the minimum number of counterfactual samples m required to reliably detect instability in hallucinated outputs, using concentration inequalities and variance estimates of the causal influence distribution.
Vision-Language Models (VLMs) excel at multimodal reasoning, yet it remains unclear whether their answers are grounded in visual evidence or driven by learned language and world priors. Counting provides a precise testbed: when visual evidence conflicts with canonical object knowledge, a model must rely on the image rather than a prototypical count. We introduce CounterCount, a diagnostic framework for counterfactual counting in VLMs, consisting of paired factual and counterfactual images with edited count-relevant attributes, verified answers, and localized evidence annotations. Evaluating recent VLMs, we find strong performance on factual images but consistent degradation under counterfactual attribute changes, indicating reliance on object-level priors even when contradictory visual evidence is present. Using localized annotations, we show that these failures are not solely due to missing or ambiguous visual evidence, but to models underweighting attention to count-relevant visual tokens. We introduce a unified inference-time attention modulation strategy that reweights selected visual tokens, improving counterfactual counting accuracy by up to 8% across multiple VLMs. Overall, CounterCount exposes prior-driven counting failures and provides diagnostic insights for designing future VLMs.
Reem Alzahrani, Hassan Alshanqiti, Bushra Bin Hemid +3
Large vision--language models (LVLMs) demonstrate strong multimodal reasoning capabilities but remain prone to hallucination, where model predictions are not grounded in visual evidence. Existing black-box hallucination detection methods estimate uncertainty through a single consistency metric, implicitly assuming that model uncertainty can be adequately characterized by a single measure. However, hallucinations exhibit diverse manifestations of uncertainty across different behavioral probes, making a single measure insufficient to characterize their underlying behavior. We propose \emph{Unique Hallucination Pattern (UHP) Detection}, a fully black-box framework that models hallucination as a structured uncertainty pattern defined by two axes: perturbation modality (image vs.\ text) and logical polarity (a statement vs.\ its negation). Their intersection produces four complementary consistency groups that capture distinct manifestations of model uncertainty, from which both within-group and between-group features are extracted to train a lightweight classifier. Through comprehensive experiments on AMBER and PhD across three LVLMs, UHP Detection consistently outperforms prior black-box and white-box baselines, with improvements of up to +18.72% AUC-ROC and +20.07% AUC-PR over the strongest black-box methods. Extensive ablation studies demonstrate that each consistency group contributes complementary information and that their combination forms a structured hallucination pattern. Furthermore, cross-dataset evaluation shows that this learned pattern generalizes across benchmarks, indicating that hallucination behavior reflects a model-specific consistency pattern. \textbf{Code is publicly available at} https://github.com/amirezzati/uhpdet.
Amir Mohammad Ezzati, Kiyan Rezaee, Bardiya Kariminia +4
Large vision-language models (LVLMs) are increasingly used for clinical image understanding, yet they remain vulnerable to \emph{hallucinations}--producing textual findings or attributes not supported by the image. We present a vision-traceable hallucination detection framework that audits arbitrary LVLM responses via visual evidence grounding, requiring neither modification nor internal access to the hidden states of LVLMs. Given an LVLM response, we extract visually verifiable entities and use a medical-domain-adapted Qwen-VL grounding verifier to localize each entity on the input image. To enhance the robustness of our detection method, we introduce a counterfactual entity perturbation method and estimate visual evidence uncertainty by contrasting factual and counterfactual grounding results. Specifically, we compute an entity-level uncertainty score from the positive confidence, counterfactual confidence, and their grounding overlap for binary hallucination decision-making. Experiments on multiple medical imaging modalities and LVLM backbones demonstrate that our method consistently improves hallucination detection performance over recent baselines, while providing interpretable localization evidence and strong cross-model transferability. Code and dataset are available at https://github.com/Agentic-CliniAI/CounterVHD.