PTSD and Psychosis

PTSD with psychosis is a rare but real type of PTSD. Learn who’s vulnerable to this form of PTSD and how symptoms differ from other types of psychosis.

Often caused by exposure to a traumatic event, post-traumatic stress disorder affects a sizable portion of the population. According to the National Center for PTSD, approximately 6% of the population will have PTSD at some point in their lives. Symptoms of PTSD are distressing and often include flashbacks, emotional numbness, detachment and distressing memories. In some instances, people suffering from this condition experience PTSD with psychosis, in which they also experience psychotic symptoms such as delusions and hallucinations. This is known as PTSD psychosis.

Understanding PTSD and Its Core Symptoms

PTSD is a serious psychiatric illness that develops after people experience or see a traumatic event. These are usually events that directly affect the individual and may involve sudden death, injury or violence. Examples include:

• Military veterans who experience violent warfare or have been wounded in action
• Victims of sexual or violent assault or abuse
• Rape victims
• Individuals experiencing the sudden death of someone close

Not everyone who experiences trauma develops PTSD, but for those who do, the condition is debilitating. Core symptoms of PTSD include:

• Intrusive memories. Distressing memories and flashbacks of the event and emotional distress
• Avoidance behavior. Not talking about the event and suppressing memories and places associated with the trauma
• Negative thinking and moods. Feelings of fear, shame, guilt or anger, negative thoughts about themselves and emotional numbness
• Extreme emotional and physical reactions. Being easily frightened and constantly on guard against danger, together with physical reactions such as rapid breathing, racing heartbeat, shaking and sweating

Can PTSD Cause Psychosis? Exploring the Connection

When someone experiences severe or ongoing trauma, particularly during early life, they have an increased probability of developing psychotic symptoms along with PTSD. It’s thought that the mental arousal and stress associated with PTSD cause changes in the brain. These changes contribute to the development of secondary psychotic symptoms. As many as 40% of PTSD sufferers may develop psychotic symptoms.

A person with psychosis loses touch with reality. They may see and hear things that don’t physically exist. Psychotic symptoms include:

• Hallucinations. A perception of images, sounds and smells that appear real but aren’t
• Delusions. A firm conviction that something bad will happen despite evidence to the contrary
• Disorganized thinking. Thought patterns and speech that are confused and not logical
• Disconnection from reality. A feeling that people and objects around them aren’t real

This condition is referred to as PTSD with secondary psychotic features.

Trauma-Related Psychotic Symptoms vs. Other Disorders

Although the presented symptoms are often similar, trauma-induced psychosis is distinctly different from other forms of psychosis, particularly schizophrenia. The main characteristic of the symptoms of PTSD with psychosis is that they’re related to the trauma that caused the PTSD. Also, PTSD patients are generally aware that the intrusive hallucinations and delusions are related to memories of the trauma and aren’t a current reality.

With schizophrenia, the hallucinations and delusions experienced by sufferers are perceived as real and in the present. The same can be said for psychosis that occurs from other conditions, such as bipolar disorders, delusional disorders and psychotic disorders caused by medical conditions or drugs.

Treatments and prognoses also differ. The symptoms experienced by people with PTSD-related psychosis usually improve with therapy and over time. Conversely, individuals affected by other forms of psychosis generally require ongoing medication to control their symptoms.

Risk Factors and Who May Be Most Vulnerable

The mechanism that causes some PTSD sufferers to develop psychosis isn’t clear, although certain risk factors for post-traumatic psychosis have been identified. Empirical evidence suggests that vulnerable populations at risk of developing psychosis, together with PTSD, include:

• Those exposed to ongoing trauma. People who experience continuous and ongoing traumatic events, such as war or abuse, appear to be more susceptible, particularly if the trauma occurs when they’re children.
• Children who have inadequate support structures. They receive little or no emotional support from those around them because of a lack of understanding or compassion.
• People with concurrent mental health conditions. Preexisting mental health conditions, such as anxiety, severe depression and bipolar disorders, appear to increase the risk.
• Individuals are abusing stimulants and hallucinogenic drugs . The abuse of mind-altering drugs increases the risk of psychosis.

Treatment Approaches for PTSD With Psychosis

Treatment of PTSD sufferers who also have psychosis usually involves psychotherapy in conjunction with medications to help relieve the symptoms of PTSD and psychosis. Treatment options include residential inpatient or intensive outpatient therapy.

Therapies

Talk therapy is an extremely effective way of helping people with PTSD process their trauma and manage the symptoms of PTSD and psychosis. Common therapies used for treating psychosis and PTSD include:

• Cognitive behavioral therapy (CBT). With CBT, therapists help patients identify negative thought patterns associated with their trauma. Therapists teach techniques to help improve thought patterns and reshape thinking in more positive directions.
• Exposure therapy. Therapists use exposure therapy to help PTSD patients confront their fears and psychoses in a safe and secure environment. This helps them face up to the thoughts, situations or images that trigger negative thinking and avoidance behavior constructively and positively.
• Eye movement desensitization and reprocessing  (EMDR) therapy. EMDR helps patients process traumatic memories and flashbacks through bilateral stimulation. It helps the brain reprocess these images and releases trapped emotions.

Medications

Medications can reduce the debilitating symptoms of PTSD and psychosis. Under the guidance of experienced medical professionals, treatment may include the use of antidepressants to minimize PTSD symptoms and antipsychotic drugs to reduce the psychotic symptoms.

Supporting Someone Experiencing Both Conditions

It’s important for someone with both conditions to feel safe and secure. You can help them by staying calm and responding gently to their behavior. It’s best to avoid confrontation or doing anything that may trigger an emotional response. Remember, your loved one is ill because of the trauma they faced.

Listen to them actively and empathetically. The feelings they describe are genuine and rooted in past experiences. Any out-of-the-ordinary event may provoke a negative response, so establish normal routines that help them feel safe and secure.

Learn as much as possible about their condition and encourage them to seek help. Respect their boundaries, and let them talk when they’re ready. Above all, look after yourself and if possible, create opportunities where you can have some time out.

Finding Treatment for PTSD With Psychosis

There’s hope for you or a loved one struggling with PTSD and psychosis. FHE Health offers a comprehensive selection of therapies specifically targeting trauma and mental health issues. Someone is available 24-7 to talk to you about mental health treatments for PTSD and psychosis. Don’t delay; contact us now for an appointment and a confidential health assessment.