According to the National Library of Medicine, recent data suggest that the presence of psychotic symptoms in patients suffering from posttraumatic stress disorder (PTSD) may represent an underrecognized and unique subtype of PTSD. Matthew Tull, Ph.D., at VeryWell, stated that post-traumatic stress disorder (PTSD) is a condition that can occur after someone has experienced a traumatic event. It involves four clusters of symptoms: re-experiencing symptoms, avoidance symptoms, negative changes in mood and brain function, and hyperarousal symptoms. However, sometimes PTSD can also occur with psychosis. Psychosis involves losing connection with reality, which can lead to symptoms such as delusions, hallucinations, and incoherent behavior. One study suggested that around 2.5% of people with PTSD also have psychosis.
The Connection between PTSD and Psychosis
Psychotic symptoms might be related to the severity of an individual’s PTSD symptoms. The more PTSD symptoms you’re experiencing, the greater the likelihood you will also have psychosis. It has been suggested that dissociation that occurs in PTSD may explain co-occurring psychosis. Frequent dissociation may increase a person’s risk of developing psychotic symptoms.
Traumatic events that increase the risk of develop PTSD with psychosis include:
• Being involved in a natural disaster
• Seeing someone injured or killed
• Experiencing shock as a result of a traumatic event that happened to a loved one
Other risk factors that can increase the likelihood of psychosis include schizophrenia, other mental disorders, physical illness, and substance use.
Complications of PTSD and Psychosis
When people have PTSD with psychosis, they can experience different types of psychotic symptoms alongside other symptoms of PTSD. This can include having positive and negative psychotic symptoms, flashbacks, and dissociation. This can complicate both the diagnosis and treatment process.
People with PTSD who experience psychotic symptoms, as compared to those with PTSD who do not, might be at greater risk for several mental health concerns, including suicidal thoughts, suicide attempts, and more significant overall distress. It’s essential for everyone with PTSD and their loved ones to know the risk factors and warning signs of suicide.
If you experience psychotic symptoms such as delusions, disorganized thinking, hallucinations, or flat affect, you should consult a medical professional immediately. You should also seek help immediately if you experience suicidal thoughts or behaviors.
Diagnosis of PTSD and Psychosis
To diagnose PTSD with psychosis, doctors will evaluate an individual’s symptoms, perform physical and lab tests to rule out other conditions, and review the individual’s medical history. This allows them to assess symptoms of PTSD and psychosis.
Flashbacks and dissociation commonly occur with PTSD. While they are not psychotic symptoms, they share some features with psychosis, including:
• During a flashback, you might temporarily lose connection with your present situation, being transported back in time to a traumatic event in your memory. If you have a severe flashback, you may see, hear, or smell things that others do not—which is consistent with a hallucination. Flashbacks often occur during periods of high stress and can be very frightening to the person experiencing them.
• Dissociation is when you feel disconnected from your body. You may have no memory of what was going on around you or what you were doing for some time. The experience of dissociating is similar to a daydream, but unlike a normal daydream, it’s very disruptive to your life.
To make a diagnosis, a doctor will also note the presence of psychotic symptoms. Psychotic symptoms can be divided into two groups: positive symptoms and negative symptoms. However, this doesn’t mean some psychotic symptoms are good and some are bad.
Positive psychotic symptoms are characterized by the presence of unusual feelings, thoughts, or behaviors. This includes experiences such as hallucinations or delusions.
• Hallucinations refer to sensations of something that isn’t really there. They can be auditory, visual, tactile, olfactory, and/or gustatory. Auditory hallucinations involve an experience of hearing voices or sounds that are not there. Visual hallucinations would involve seeing something that isn’t real. Tactile hallucinations occur when you feel something that isn’t there. Olfactory and gustatory hallucinations occur when you smell or taste something that is not present.
• Delusions are ideas that you believe are true despite the fact that they may be unlikely or odd. For example, you might believe that the CIA is spying on you or that aliens are controlling your behaviors or thoughts.
• Disorganized behaviors are also very common with psychosis. You may, for example, use made-up words, speak in unintelligible ways, or stand in an odd pose.
Negative psychotic symptoms are characterized by the absence of an experience. For example, you might not be emotionally expressive, you might have difficulty speaking or not speak for days on end (alogia), or be unable to accomplish simple tasks or activities, such as getting dressed in the morning.
In addition to PTSD, positive and negative psychotic symptoms can occur in other mental health conditions. It can sometimes be difficult to distinguish between them, as the symptoms can overlap. Mental health conditions that can have positive and negative psychotic symptoms include:
• Bipolar disorder
• Delusional disorder
• Major depressive disease with psychotic features
• Schizoaffective disorder
• Schizophreniform disorder
Some people have both schizophrenia and PTSD. Research has shown that traumatic experiences are more common among people with schizophrenia than in the general population. A 2018 study found a significant genetic overlap between schizophrenia and PTSD.
Treatment of PTSD and Psychosis
If you or a loved one who has PTSD is experiencing psychotic symptoms, it’s essential to seek out treatment. Treatment can not only improve functioning, but it can also reduce the risk of developing psychotic symptoms linked to untreated PTSD. Treatment options include:
• Psychotherapy: Research suggests that psychotherapy can be effective in treating PTSD with co-occurring psychosis. Addressing PTSD symptoms in treatment can also result in a reduction of psychotic symptoms.
• Medications: Positive psychotic symptoms can sometimes be effectively managed through medication. However, some researchers suggest that there is currently not enough evidence to recommend using second-generation antipsychotics (SGA) to treat PTSD with secondary psychotic features.
Treatment is also essential if a person has co-occurring PTSD and schizophrenia. However, having both disorders can complicate the treatment process. For example, exposure therapy for PTSD may not be the best treatment for someone with schizophrenia, as it could worsen their symptoms.
Coping with PTSD and Psychosis
For people who are experiencing symptoms of PTSD and/or psychosis, getting treatment is essential. In addition to seeking help from a qualified professional, people can also utilize strategies to cope:
• Get social support: Having support from loved ones can also help you better manage symptoms of PTSD with psychosis. Talk to trusted loved ones about your conditions and look for ways they can provide practical and emotional support.
• Practice self-care: Make sure that you care for yourself physically and mentally. Getting adequate sleep, eating a balanced diet, and engaging in regular activity can be helpful.
• Watch for triggers: Certain situations, people, or events can trigger symptoms of PTSD, which can exacerbate psychotic symptoms. Being aware of PTSD triggers and utilizing ways to manage them can help minimize the risk of experiencing flashbacks, dissociation, and other symptoms.
• Manage stress: Stress can trigger or worsen psychotic symptoms, so it is important to reduce stress levels and utilize effective relaxation techniques.
Some symptoms of PTSD share common features with psychosis, but it is also possible to experience psychosis along with PTSD. Experiencing symptoms of severe PTSD can elevate this risk. Possible complications of having both conditions include an increased risk of depression, self-harm, and suicidal behavior.
Treatment is essential and may involve psychotherapy, medication, or a combination. Caring for yourself, finding support, and being aware of PTSD triggers can be helpful when managing symptoms of both conditions.
Trauma can have profound and lasting effects, including the onset of post-traumatic stress disorder. While psychosis is not a typical symptom, it can occur in people with PTSD. If you are experiencing symptoms of PTSD, getting treatment may help reduce the risk of psychosis. Talk to your doctor for further evaluation and treatment recommendations.
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.