The Relationship Between PTSD and Psychosis

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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.

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Others might perceive you as being unmotivated and withdrawn.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."

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.

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.
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Additional Reading

By Matthew Tull, PhD
Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder.