Understanding PTSD with psychosis (2023)

post traumatic stress disorder(PTSD) is a condition that can occur after someone has been through a traumatic event. It includes four groups of symptoms:Renaissancesymptoms, avoidance symptoms, negative changes in mood and brain function, andsymptoms of hyperarousal.

However, sometimes PTSD can accompany psychosis.PsychosisIt's about losing connection with reality, which can lead to symptoms such as delusions, hallucinations, and incoherent behavior. One study suggested that about 2.5% of people with PTSD also have psychosis.

This article discusses the connection between PTSD and psychosis and how both conditions can affect diagnosis and treatment.

The link between PTSD and psychosis

Psychotic symptoms may be related to the severity of a person's PTSD symptoms. The more PTSD symptoms you have, the more likely it is that you also have psychosis.

It has been suggested that the dissociation that occurs in PTSD could explain the coexistence of psychosis. Frequent dissociation can increase a person's risk of developing psychotic symptoms.

Although PTSD and psychosis are separate conditions, research suggests that there is evidence that PTSD with Secondary Psychotic Features (SP-PTSD) may be a distinct form of PTSD.

traumatic eventsthat increase the risk of developing PTSD with psychosis are:

  • Being involved in a natural disaster
  • See someone hurt or killed
  • Shock as a result of a traumatic event that happened to a loved one

Other risk factors that may increase the likelihood of psychosis include schizophrenia, other mental disorders, physical illness, and substance use.

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Flashbacks and dissociation in PTSD

Complications of PTSD and psychosis

When people have PTSD with psychosis, they may experience different types of psychotic symptoms along with other PTSD symptoms. This can include positive and negative psychotic symptoms, flashbacks, and dissociation. This can complicate the diagnosis and treatment process.

Psychosis-Related PTSD

Research has also shown that experiencing psychosis is traumatic, which can lead to psychosis-related post-traumatic stress disorder. A systematic review found that 14% to 47% of people with psychosis develop this type of PTSD.

People with PTSD who have psychotic symptoms may be at increased risk of a variety of mental health problems compared to people with PTSD who do not, includingsuicidal thoughts, suicide attempts and greater general malaise. It is important that all people with PTSD and their loved ones know this.Suicide risk factors and warning signs.

If you experience psychotic symptoms such as delusions, disorganized thinking, hallucinations, or numbed affect, seek immediate medical attention. You should also seek help immediately if you have suicidal thoughts or behavior.

If you are having suicidal thoughts, contact yourNational Suicide Prevention HotlineNO988for the support and assistance of a trained counselor. If you or a loved one is in immediate danger, call 911.

(Video) Trauma, PTSD, Psychosis and the Link Between Them - Simplest Explanation Ever

Diagnosis of PTSD and psychosis

To diagnose PTSD with psychosis, doctors evaluate a person's symptoms, perform physical and laboratory tests to rule out other disorders, and review the person's medical history. This allows them to assess for PTSD symptoms and psychosis.

Flashbacks and dissociation are common with PTSD. Although they are not psychotic symptoms, they share some features with psychosis, including:

  • during oneretrospective scene, you may temporarily lose touch with your current situation and flash back to the memory of a traumatic event. When you have a severe flashback, you can see, hear, or smell things that others don't, which is a hallucination. Flashbacks often occur at times of high stress and can be very frightening for the person affected.
  • dissociation It is when you feel disconnected from your body.You may not remember what was going on around you or what you were doing for a while. The dissociation experience is similar to a dream, but unlike a normal dream, it is very disruptive to your life.

symptoms of psychosis

To make a diagnosis, the doctor will also look for psychotic symptoms.psychotic symptomsThey can be divided into two groups: positive symptoms and negative symptoms. However, this does not mean that some psychotic symptoms are good and others are bad.

Positive symptoms are related to an experience such as hallucinations, while negative symptoms are related to an inability to show emotions, apathy, language difficulties, and withdrawal from social situations and relationships.

positive psychotic symptomsThey are characterized by the presence of unusual feelings, thoughts, or behaviors.This includes experiences likehallucinationsohallucinations.

  • hallucinationsthey refer to sensations of something that is not really there. They can be auditory, visual, tactile, olfactory and/or gustatory.auditory hallucinationsIt involves the experience of hearing voices or sounds that do not exist.visual hallucinationswould imply seeing something that is not real.tactile hallucinationsThey happen when you feel something that doesn't exist.Hallucinations of smell and taste.they happen when you smell or taste something that isn't there.
  • hallucinationsthey are ideas that you believe to be true even though they are unlikely or outlandish. For example, you may believe that the CIA is spying on you or that aliens are controlling your behavior or thoughts.
  • disorganized behaviorthey are also very common in psychoses. For example, they may use made-up words, speak in an unintelligible manner, or strike an awkward pose.

negative psychotic symptomsThey are characterized by a lack of experience. For example, he may not be emotionally expressive, have difficulty speaking or not speak for days (alogia), or be unable to perform simple tasks or activities, such as getting dressed in the morning.

Related conditions

In addition to PTSD, both positive and negative psychotic symptoms can occur with other mental illnesses. Sometimes it can be difficult to tell them apart, as the symptoms can overlap.

Mental illnesses that can have both positive and negative psychotic symptoms include:

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  • Bipolar disorder
  • delusional disorder
  • Major depressive illness with psychotic features
  • schizoaffective disorder
  • schizophrenia
  • schizophreniform disorder

Some peoplehave schizophrenia and PTSD. Research shows that traumatic experiences are more common in people withschizophreniathan in the general population. A 2018 study found significant genetic overlap between schizophrenia and PTSD.


PTSD and psychosis have overlapping symptoms that can make diagnosis difficult. Doctors will assess symptoms, including flashbacks, dissociation, and psychosis, to make a diagnosis. Other disorders with psychotic symptoms must also be ruled out. Some people may suffer from PTSD and other conditions such as schizophrenia.

Treatment of PTSD and psychosis

If you or a loved one with PTSD are experiencing psychotic symptoms, it's important to seek treatment. In addition to improving functioning, treatment can reduce the risk of developing psychotic symptoms associated with untreated PTSD.Treatment options include:

  • psychotherapy: Research suggests that psychotherapy may be effective in the treatment of PTSD with comorbid psychosis. Treatment of PTSD symptomsunder treatment can also lead to a reduction in psychotic symptoms.
  • medicine: Positive psychotic symptoms can sometimes be effectively treated with medication. However, some researchers suggest that there is currently insufficient evidence to recommend the use of second generation antipsychotics (SGA) to treat PTSD with secondary psychotic features.

Treatment is also essential when a person suffers from PTSD and schizophrenia at the same time. However, both disorders can complicate the treatment process. For example,Exposure Therapy for PTSDIt may not be the best treatment for someone with schizophrenia, as it can make their symptoms worse.

Studies have shown that well-designed treatment can reduce the symptoms of PTSD. It is important for people with PTSD and schizophrenia to find a psychologist who is familiar with treating both conditions.

Dealing with PTSD and psychosis

Treatment is essential for people with symptoms of PTSD and/or psychosis. In addition to seeking help from a qualified professional, people can also use coping strategies:

  • get social support: Support from loved ones can also help you better manage the symptoms of PTSD with psychosis. Talk to loved ones about your illness and find ways to provide practical and emotional support.
  • practice self care: Make sure you take care of yourself physically and mentally. Getting enough sleep, a balanced diet, and regular activity can help.
  • look at the triggers: Certain situations, people, or events can trigger PTSD symptoms that can make psychotic symptoms worse. Be awarePTSD triggersand using ways to manage them can help minimize the risk of flashbacks, dissociation, and other symptoms.
  • manage stress: Stress can trigger or worsen psychotic symptoms, so it is important to reduce stress levels and use effective relaxation techniques.

Experiencing psychotic symptoms can give insight into how severe a person's PTSD is and how they are coping. If symptoms are severe or get worse, it's important to talk to your doctor.

(Video) Complex PTSD affects the brain long-term and can affect your closest relationships


Some PTSD symptoms share characteristics with psychosis, but it is also possible to experience psychosis along with PTSD. Experiencing severe PTSD symptoms can increase this risk. Potential complications of both disorders include an increased risk of depression, self-harm, and suicidal behavior.

Treatment is essential and may include psychotherapy, medication, or a combination. Taking care of yourself, finding support, and being aware of PTSD triggers can be helpful in managing symptoms of both conditions.

A word from Verywell

Trauma can have profound and long-lasting effects, including the onset of post-traumatic stress disorder. Although psychosis is not a typical symptom, it can occur in people with PTSD. If you have symptoms of PTSD, treatment can help reduce your risk of developing psychosis. Talk to your doctor for further evaluation and treatment recommendations.

If you or a loved one is struggling with post-traumatic stress disorder or psychosis, contact theSubstance Abuse and Mental Health Administration (SAMHSA) National Hotline.NO1-800-662-4357Information on support and treatment centers in your area.

For more mental health resources, visit ourNational Database of Support Lines.


How can you tell the difference between PTSD and psychosis? ›

In PTSD, the interpretation of intrusive symptoms such as flashbacks is seen as central to the maintenance of the disorder. In psychosis, hallucinations and delusional beliefs are interpretations of intrusions [9].

What kind of trauma causes psychosis? ›

Possible pathways from childhood abuse to psychosis

A few studies have indicated that, childhood trauma (particularly childhood sexual abuse) may result in even higher rates of psychosis or psychotic symptoms when it, occurs together with cannabis use.

What are the coping skills for psychosis? ›

understand what triggers your psychosis or makes it worse.
For example, it can help to:
  • Try to get enough sleep. Sleep can help give you the energy to cope with difficult feelings and experiences. ...
  • Think about your diet. ...
  • Try to do some physical activity. ...
  • Spend time outside. ...
  • Avoid drugs and alcohol.

Do people with psychosis know they have psychosis? ›

People who have psychotic episodes are often totally unaware their behaviour is in any way strange or that their delusions or hallucinations are not real. They may recognise delusional or bizarre behaviour in others, but lack the self-awareness to recognise it in themselves.

Can PTSD look like psychosis? ›

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. Among combat veterans with PTSD, 30% to 40% report auditory or visual hallucinations and/or delusions.

What are the most common psychotic symptoms in PTSD? ›

Despite these limitations, hallucinations, especially auditory hallucinations, and delusions are the most common psychotic symptoms in refugees with PTSD (Nygaard et al., 2017; Soosay et al., 2012).

What medication is used for PTSD psychosis? ›

These medications can include antidepressants like nefazodone (Serzone), imipramine (Tofranil), and phenelzine (Nardil). Atypical antipsychotics, like quetiapine (Seroquel), risperidone (Risperdal), and olanzapine (Zyprexa), have also been studied.

What is the most common mental illness causing psychosis? ›

The following conditions have been known to trigger psychotic episodes in some people: schizophrenia – a mental health condition that causes hallucinations and delusions. bipolar disorder – a person with bipolar disorder can have episodes of low mood (depression) and highs or elated mood (mania) severe stress or ...

What is the number one cause of psychosis? ›

What causes psychosis? There is no one specific cause of psychosis. Psychosis may be a symptom of a mental illness, such as schizophrenia or bipolar disorder. However, a person may experience psychosis and never be diagnosed with schizophrenia or any other mental disorder.

Will I ever be the same after psychosis? ›

In fact, many medical experts today believe there is potential for all individuals to recover from psychosis, to some extent. Experiencing psychosis may feel like a nightmare, but being told your life is over after having your first episode is just as scary.

How do therapists treat psychosis? ›

An effective treatment for psychosis is CBTp, which is cognitive behavioral therapy adapted for psychosis. Through CBTp, people with psychosis can learn to change their thinking or behaviors to make psychosis less distressing.

Can music help psychosis? ›

Dr Luo: Music interventions may improve clinical symptoms in schizophrenia, especially for positive symptoms. Although these normalized effects were no longer sustained after 6 months, this represents a good option to improve the symptoms of schizophrenia, in addition to a stable drug treatment strategy.

What are the two common signs in psychosis? ›

But in general, 3 main symptoms are associated with a psychotic episode:
  • hallucinations.
  • delusions.
  • confused and disturbed thoughts.

How does a person with psychosis feel? ›

Psychosis is when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions).

What does a psychotic break look like? ›

Typically, a psychotic break indicates the first onset of psychotic symptoms for a person or the sudden onset of psychotic symptoms after a period of remission. Symptoms may include delusional thoughts and beliefs, auditory and visual hallucinations, and paranoia.

Is PTSD neurotic or psychotic? ›

Clinical findings: When a PTSD becomes established at a subject to the personality of neurotic structure, the intensity of the PTSD's symptoms lead to a psychotic expression which constitutes a factor of seriousness. Besides, PTSD often induces a risk of substance use disorder supplying psychotic symptoms.

Can PTSD cause voices in your head? ›

Rare cases of PTSD may involve auditory hallucinations and paranoid ideation. Individuals who experience auditory hallucinations may experience tinnitus, a constant ringing in one's ears, or they may hear a voice or set of voices that are not physically present.

Can psychosis traumatize you? ›

Psychosis can be a sufficiently traumatic event to lead to post-traumatic stress disorder (PTSD).

Can PTSD induce psychosis? ›

PTSD can also trigger psychotic symptoms. Not everyone with the condition will experience them, but studies with veterans indicate that between 30 and 40 percent have hallucinations, delusions, or both. Some experts advocate for a sub-type of PTSD, known as PTSD-SP, or PTSD with secondary psychotic features.

What are the symptoms of extreme PTSD? ›

Common symptoms of PTSD
  • vivid flashbacks (feeling like the trauma is happening right now)
  • intrusive thoughts or images.
  • nightmares.
  • intense distress at real or symbolic reminders of the trauma.
  • physical sensations such as pain, sweating, nausea or trembling.

Can PTSD look like schizophrenia? ›

Symptoms such as hallucinations have been shown to be clinically indistinguishable in adolescents with PTSD or a psychotic disorder. Patients with PTSD also exhibit the chronic debilitating social withdrawal, which is characteristic of schizophrenia.

What is the best mood stabilizer for PTSD? ›

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), might be used to help reduce symptoms of depression or anxiety in people with PTSD.
Other medications used for PTSD
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
Feb 22, 2022

What is the best antipsychotic for psychosis? ›

Fluphenazine (Prolixin): This drug treats schizophrenia and psychotic symptoms such as hallucinations, delusions, and hostility. Haloperidol (Haldol): Doctors prescribe this drug to treat psychotic disorders, tics associated with Tourette's syndrome, and severe behavioral problems in children.

What do they prescribe to calm PTSD? ›

There are 4 medications recommended to treat PTSD symptoms. These medications are also used to treat depression.
There are 4 SSRIs/SNRIs that are recommended for PTSD:
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Venlafaxine (Effexor)
Nov 9, 2022

Is psychosis damaging to the brain? ›

An untreated episode of psychosis can result in structural brain damage due to neurotoxicity.

What happens in the brain during psychosis? ›

“What we do know is that during an episode of psychosis, the brain is basically in a state of stress overload,” says Garrett. Stress can be caused by anything, including poor physical health, loss, trauma or other major life changes. When stress becomes frequent, it can affect your body, both physically and mentally.

Can you reason with someone in psychosis? ›

You should not dismiss, minimize, or argue with the person about their delusions or hallucinations. Similarly, do not act alarmed, horrified, or embarrassed by such delusions or hallucinations. You should not laugh at the person's symptoms of psychosis.

Do people remember psychosis? ›

When a person is in a full-blown manic and psychotic episode, memory is greatly affected. In fact, it is rare for someone who is in a deep episode to remember all that happened. This is why it's called a blackout. The average person in this situation remembers maybe 50 percent, in my experience.

When does psychosis become permanent? ›

Psychosis may not be permanent. However, if someone isn't treated for psychosis, they could be at greater risk for developing schizophrenia or another psychotic disorder. Schizophrenia is rare, but people who have it are at increased risk for premature death and suicide.

What does a psychiatrist do for psychosis? ›

Your psychiatrist will carry out a full assessment to help identify and diagnose any underlying mental health condition that could be causing your symptoms. This will help when planning your treatment for psychosis.

Which vitamin deficiency causes psychosis? ›

Vitamin B12 deficiency may present with a psychosis which is curable if treated promptly. Although this fact is not new and is described in various textbooks,9,10 it seems that it is often forgotten, which results in prolonged suffering from irreversible brain damage.

What is alternative treatment for psychosis? ›

Some studies suggest that glycine, sarcosine, NAC, several Chinese and ayurvedic herbs, ginkgo biloba, estradiol, and vitamin B6 may be effective for psychotic symptoms when added to antipsychotics (glycine not when added to clozapine).

Can you hear voices with psychosis? ›

Hearing voices (i.e. auditory verbal hallucinations) is mainly known as part of schizophrenia and other psychotic disorders. However, hearing voices is a symptom that can occur in many psychiatric, neurological and general medical conditions.

What helps people with voices in psychosis? ›

Coping with hearing voices
  • Understand your voices.
  • Communicate with your voices.
  • Distract yourself from your voices.
  • Talk to other people who hear voices.
  • Look after yourself.
  • Find spiritual help.

Can the brain heal from psychosis? ›

Evidence suggests that early treatment—and a shorter DUP—promotes better symptom improvement and overall functioning in everyday life. There is yet inadequate proof to say conclusively that psychosis causes permanent brain damage.

What are the 5 key symptoms of a psychotic disorder? ›

  • delusions.
  • hallucinations.
  • disorganized speech (e.g., frequent derailment or incoherence)
  • grossly disorganized or catatonic behavior.
  • negative symptoms (i.e., affective flattening, alogia, or avolition)

What is psychosis personality? ›

Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations.

Is psychosis terrifying? ›

Psychosis can be very scary and confusing, and it can significantly disrupt your life. Psychosis is a syndrome or group of symptoms. Psychosis itself isn't a disease or disorder—it's usually a sign of a health problem. Before an episode of psychosis begins, you will likely experience early warning signs.

Do crazy people know they are crazy? ›

When someone is developing a serious mental illness with psychosis, such as schizophrenia, they usually don't know it. “Part of 'crazy' is getting away from reality,” Goodman says. Marty Livingston, PhD, a New York psychologist and author, agrees.

Does psychosis turn into schizophrenia? ›

Many people with substance-induced psychoses will later transition to a diagnosis of schizophrenia, but estimates vary widely between early psychosis services and population-based registers.

How do you know if you are experiencing psychosis? ›

Symptoms of psychosis

hallucinations – where a person hears, sees and, in some cases, feels, smells or tastes things that do not exist outside their mind but can feel very real to the person affected by them; a common hallucination is hearing voices.

How do you know if someone is developing psychosis? ›

Confused and disturbed thoughts

Signs of this include: rapid and constant speech. disturbed speech – for example, they may switch from one topic to another mid-sentence. a sudden loss in their train of thought, resulting in an abrupt pause in conversation or activity.

Can schizophrenia be confused with PTSD? ›

Schizophrenia and post-traumatic stress disorder (PTSD) are related in specific ways. A 2016 study indicates that PTSD and schizophrenia commonly co-occur and present similar symptoms. But Dimitriu notes that “the relationship varies quite significantly between various studies, with correlations ranging from 0 to 57%.”

What can be confused with PTSD? ›

PTSD can be misdiagnosed as the symptoms or behaviors of other mental health conditions. Conditions such as anxiety, depression, acute stress disorder, and more, have similarities to PTSD. It is important to note that not everyone who experiences a traumatic event has PTSD.

How do people act during psychosis? ›

Symptoms of psychosis include delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). Other symptoms include incoherent or nonsense speech and behavior that is inappropriate for the situation.

How do you explain what psychosis feels like? ›

Psychosis is characterized as disruptions to a person's thoughts and perceptions that make it difficult for them to recognize what is real and what isn't. These disruptions are often experienced as seeing, hearing and believing things that aren't real or having strange, persistent thoughts, behaviors and emotions.

How does a person with psychosis behave? ›

Psychosis is a term used to describe when a person interprets or perceives reality in a different way to those around them. If you experience psychosis, you may process the world around you differently to other people. You might see or hear things that others do not. Or believe things other people do not.

Can PTSD trigger psychosis? ›

PTSD can also trigger psychotic symptoms. Not everyone with the condition will experience them, but studies with veterans indicate that between 30 and 40 percent have hallucinations, delusions, or both. Some experts advocate for a sub-type of PTSD, known as PTSD-SP, or PTSD with secondary psychotic features.

Can trauma trigger psychosis? ›

In addition to the impact of trauma on the development of psychosis and PTSD, there is evidence that traumatic experiences influence the content of psychotic symptoms, including hallucinations and delusions (2, 12).

Can you hear voices with PTSD? ›

Rare cases of PTSD may involve auditory hallucinations and paranoid ideation. Individuals who experience auditory hallucinations may experience tinnitus, a constant ringing in one's ears, or they may hear a voice or set of voices that are not physically present.

What is the most severe form of PTSD? ›

Complex PTSD is one (sometimes referred to as “Disorder of Extreme Stress”), is the most severe form of the condition, requiring the most support of the five sub-types.

What disorder is most comorbid with PTSD? ›

Approximately 80 percent of patients with PTSD have at least one comorbid psychiatric disorder. The most common comorbid disorders include depression, alcohol and drug abuse, and other anxiety disorders.

How does a person with PTSD act? ›

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people.


1. Invisible wounds: Living with post traumatic stress disorder (PTSD)
(Science Museum)
2. What is the link between trauma and psychosis?
(Ava Mason)
3. 6 Hidden Signs of Complex PTSD (cPTSD) | MedCircle
4. 5 signs of complex PTSD that most people miss
5. Integrative Approaches to Working with People diagnosed with Psychosis - Lewis Mehl-Madrona, MD
6. How psychosis bends your reality - BBC
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