Understanding PTSD With Psychosis

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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.

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

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.

While PTSD and psychosis are separate conditions, research suggests that there is evidence that PTSD with secondary psychotic features (PTSD-SP) might be a distinct form of PTSD.

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.

Psychosis-Related PTSD

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

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.

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.

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.

Psychosis Symptoms

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 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 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.

Related Conditions

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

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.


PTSD and psychosis have overlapping symptoms that can make diagnosis more challenging. Doctors will evaluate symptoms, including flashbacks, dissociation, and psychosis, to make a diagnosis. They also have to rule out other conditions that feature psychotic symptoms. Some people may experience PTSD and other conditions such as schizophrenia.

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, it can 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.

Studies have found that well-thought-out treatment can reduce the symptoms of PTSD. For those with PTSD and schizophrenia, finding a mental health provider who is familiar with treating both conditions is important.

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.

The experience of psychotic symptoms may tell the story of how severe a person's PTSD is and how well they are coping with it. If symptoms are severe or worsening, it is essential to talk to your doctor.


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.

A Word From Verywell

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.

If you or a loved one are struggling with PTSD or psychosis, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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