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It's rather hard to see sometimes, but if you're paying attention, you can be ready for it. However, there is a spawn animation for the Horrific Figment, which can give you some notice when it's about to happen. The reason it's so dangerous is because it can put you into combat when you're not expecting it, preventing you from putting down a Sanity Orb and potentially making you Sanity out. It doesn't have much health (~200k) and killing it can actually proc Gift of the Titans, which is useful on long boss encounters.
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This Horrific Figment will automatically aggro onto you, no matter your current location and will run towards you Aggroing any mobs along the way. When you're below 50% sanity, you'll randomly spawn a Horrific Figment add periodically. This Mask is something that can cause you to fail your Horrific Vision run if you're not paying attention. While below 50% sanity, occasionally an enemy of the void will spawn and attack you.