PTSD Related Conditions The Relationship Between PTSD and Psychosis By Matthew Tull, PhD Matthew Tull, PhD Twitter Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial process Updated on November 15, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Frank van Groen / LOOK-foto / Getty Images Table of Contents View All Table of Contents Types of Psychotic Symptoms Disorders With Psychosis Schizophrenia and PTSD Psychotic Symptoms in PTSD Getting Help Mental health experts describe post-traumatic stress disorder (PTSD) as consisting of four clusters of symptoms: re-experiencing symptoms, avoidance symptoms, negative changes in mood and brain function, and hyperarousal symptoms. However, some mental health professionals believe that the experience of psychotic symptoms should be considered as an addition to that list. Symptoms of psychosis, such as hallucinations, often occur with symptoms of PTSD. Types of Psychotic Symptoms Psychotic symptoms can be divided into two groups: positive symptoms and negative symptoms. However, this doesn't mean that some psychotic symptoms are good and some are bad. Positive symptoms refer to an experience, such as hallucinations, while negative symptoms refer to the inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships. Positive Psychotic Symptoms 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. Positive Psychotic Symptoms Negative Psychotic Symptoms 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. Others might perceive you as being unmotivated and withdrawn. Mental health professionals often call a person's lack of emotional expression a "flat affect." Negative Psychotic Symptoms Flashbacks and Dissociation Flashbacks and dissociation occur commonly 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 other people 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 a span of time. The experience of dissociating is similar to a daydream, but unlike a normal daydream, it's very disruptive to your life. Flashbacks and Dissociation in PTSD Mental Health Disorders That Include Psychotic Symptoms 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 Schizophrenia Schizophreniform disorder Schizophrenia and PTSD Some people have both schizophrenia and PTSD. PTSD commonly occurs after a traumatic experience. Research has shown that traumatic experiences are more common among people with schizophrenia than for the general population. A 2018 study found that there is a significant genetic overlap between schizophrenia and PTSD. Treatment for both disorders is critical, yet some mental health professionals are reluctant to use certain approaches. For example, exposure therapy for PTSD may not be the best treatment for someone with schizophrenia, as it could make their symptoms worse. Studies have found that well-thought-out treatment can reduce the symptoms of PTSD. For those who have both PTSD and schizophrenia, it's important to find a mental health provider who is familiar with treating both conditions. Psychotic Symptoms in PTSD Researchers at the University of Manitoba, Columbia University, and the University of Regina examined data on 5,877 people from across the United States with the goal of determining the rates with which people with PTSD experience different psychotic symptoms. The researchers found that the experience of positive psychotic symptoms was most common among people with PTSD. Approximately 52% of people who reported having PTSD at some point in their lifetime also reported experiencing a positive psychotic symptom. Most Common Psychotic Symptoms in PTSD The most common positive symptoms in the study above were:Believing that other people were spying on or following them (27.5%)Seeing something that others couldn't see (19.8%)Having unusual feelings inside or outside of their bodies, such as feeling as though they were being touched when no one was really there (16.8%)Believing that they could hear what someone else was thinking (12.4%)Being bothered by strange smells that no one else could smell (10.3%)Believing that their behaviors and thoughts were being controlled by some power or force (10%) Not surprisingly, it appears that the more PTSD symptoms you're experiencing, the greater the likelihood that you will also experience positive psychotic symptoms. Researchers have also looked at which traumatic events are most commonly related to the experience of psychotic symptoms. The events that put people most at risk include being involved in a natural disaster, seeing someone injured or killed, or experiencing shock as a result of a traumatic event that happened to a loved one. Getting Help If you or a loved one who has PTSD is experiencing psychotic symptoms, it's very important to seek out treatment. Positive psychotic symptoms can sometimes be effectively managed through medication. Addressing PTSD symptoms in treatment can also result in a reduction of psychotic symptoms. The experience of psychotic symptoms may tell the story of just how severe a person's case of PTSD is and how well they are coping with the condition. It may also raise red flags about the likelihood of potentially dangerous behaviors. It has been suggested that the experience of psychotic symptoms in those with PTSD could be connected to the experience of dissociation. Frequent dissociation may increase a person's risk of developing psychotic symptoms. Studies have shown that people with PTSD who experience psychotic symptoms, as compared to those with PTSD who do not, might be at greater risk for a number of mental health concerns, including suicidal thoughts, suicide attempts, and greater overall distress. It's important for everyone with PTSD and their loved ones to know the risk factors and warning signs of suicide. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Miao XR, Chen QB, Wei K, Tao KM, Lu ZJ. Posttraumatic stress disorder: from diagnosis to prevention. Mil Med Res. 2018;5(1):32. Published 2018 Sep 28. doi:10.1186/s40779-018-0179-0 Gaebel W, Zielasek J. Focus on psychosis. Dialogues Clin Neurosci. 2015;17(1):9–18. Lyne J, O'donoghue B, Roche E, Renwick L, Cannon M, Clarke M. Negative symptoms of psychosis: a life course approach and implications for prevention and treatment. Early Interv Psychiatry. 2018;12(4):561-571. doi: 10.1111/eip.12501 Şar V. The many faces of dissociation: opportunities for innovative research in psychiatry. Clin Psychopharmacol Neurosci. 2014;12(3):171–179. doi:10.9758/cpn.2014.12.3.171 Duncan LE, Ratanatharathorn A, Aiello AE, et al. Largest GWAS of PTSD (N=20 070) yields genetic overlap with schizophrenia and sex differences inheritability. Mol Psychiatry. 2018;23(3):666–673. doi:10.1038/mp.2017.77 Kilcommons AM, Morrison AP. Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors. Acta Psychiatr Scand. 2005;112(5):351-9. doi: 10.1111/j.1600-0447.2005.00623.x Gibson LE, Alloy LB, Ellman LM. Trauma and the psychosis spectrum: A review of symptom specificity and explanatory mechanisms. Clin Psychol Rev. 2016;49:92–105. doi:10.1016/j.cpr.2016.08.003 Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. Choi JY, Choi YM, Kim B, Lee DW, Gim MS, Park SH. The effects of childhood abuse on self-reported psychotic symptoms in severe mental illness: Mediating effects of posttraumatic stress symptoms. Psychiatry Res. 2015;229(1-2):389-93. doi:10.1016/j.psychres.2015.05.112 Oconghaile A, Delisi LE. Distinguishing schizophrenia from posttraumatic stress disorder with psychosis. Curr Opin Psychiatry. 2015;28(3):249-55. doi:10.1097/YCO.0000000000000158 Powers A, Fani N, Cross D, Ressler KJ, Bradley B. Childhood trauma, PTSD, and psychosis: Findings from a highly traumatized, minority sample. Child Abuse Negl. 2016;58:111-8. doi:10.1016/j.chiabu.2016.06.015 By Matthew Tull, PhD Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for PTSD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.