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Psychosis

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General Information

Psychosis is a general term to describe a set of symptoms that result in strange or bizarre thinking, perceptions (e.g., sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors like drug use and stress. Schizophrenia is the most well-known psychotic disorder, but there are other psychotic disorders as well (see below). Other conditions, such as severe depression, bipolar disorder, sleep deprivation, and use of or withdrawal from certain drugs or alcohol can also cause psychotic symptoms.

One frequently cited statistic is that about 3.5 percent of the U.S. population experiences psychotic symptoms, although only about 1 percent are diagnosed as schizophrenic. Hearing voices and seeing things that aren’t there are more common than we think. While these experiences can be scary and confusing, it is possible to cope and sometimes recover, especially when psychosis is addressed early on.

What Are the Different Kinds of Psychotic Disorders?

Conditions that have psychosis as a main symptom are referred to as psychotic disorders. Psychosis can also be caused by certain medical conditions. Some of the more common types of psychotic disorders include:

Schizophrenia: A serious mental health disorder that affects how a person thinks, feels, and acts. People with schizophrenia may have trouble distinguishing what is real and what is imaginary.

Schizophreniform Disorder: Has the same symptoms as schizophrenia but occurs for a time period 1 to 6 months. If symptoms last longer than this period, a person is given a diagnosis of schizophrenia.

Schizoaffective Disorder: Characterized by persistent symptoms of psychosis resembling schizophrenia, with additional periodic mood symptoms (e.g., depressive episodes).  

Delusional Disorder: Characterized by irrational or intense belief(s) or suspicion(s) that the person believes to be true. These beliefs may seem outlandish and impossible ("bizarre"; e.g., a belief that the person is Jesus Christ) or fit within the realm of what is possible ("non-bizarre"; a belief that someone is following the person). Symptoms must last for 1 month or longer in order for someone to be diagnosed with delusional disorder.

Brief Psychotic Disorder: Includes symptoms of psychosis that last at least 1 day but no longer than 1 month. Symptoms typically come on suddenly and are sometimes responses to a stressful life event. While an individual may experience severe distress during the episode, people quickly return to their daily lives, and their symptoms do not return.

Schizotypal Disorder: A personality disorder that can easily be confused with schizophrenia. People with schizotypal disorder are seen as odd and/or eccentric and usually have few, if any, close relationships. They have "magical" or eccentric beliefs (e.g., that they can control events through certain rituals), unusual thoughts, and paranoia. They are often anxious and isolated. People with schizotypal personality disorder may experience brief psychotic episodes with delusions or hallucinations, but the episodes are not as frequent, prolonged, or intense as in schizophrenia.

Signs and Symptoms of Psychotic Disorders

The symptoms and signs of psychotic disorders may be present to some degree in childhood or early adolescence, but often, they emerge in the late teens or young adulthood (or sometimes in middle adulthood). When a person who was not previously psychotic has a first episode of psychotic symptoms, it is called a psychotic break. A change in behaviors or symptoms for one or two days might be a related to sleep, substance use, or stress, but symptoms that are severe or that last more than a few days or weeks indicate the need for evaluation by a mental health professional. If you’re concerned about a loved one, pay attention to sudden changes in their thoughts, emotions, and behaviors. Changes that seem really out of character might be early warning signs of psychosis. The following is a list of common signs and symptoms:

  • Hearing or seeing something that others can't hear or see
  • Talking or muttering to oneself
  • A constant feeling of being watched, paranoia
  • Disorganized or bizarre speech or writing
  • Inappropriate or unusual behavior
  • Strange body movements or body postures
  • Strange facial expressions (e.g., staring into space, smiling randomly)
  • Feeling indifferent to or numb in important situations
  • Deterioration of academic or work performance
  • A notable change in personal hygiene, appearance, or personality
  • Increasing withdrawal from social situations
  • Irrational, angry, or fearful responses to loved ones
  • Inability to sleep or concentrate
  • Extreme preoccupations that seem bizarre (e.g., fixation on a teacher or acquaintance)
  • Fears that seem bizarre (e.g., concern that others can hear or see them through the Internet)
  • Substance abuse (which may be a way to try and dull or cope with symptoms and may also be a cause or trigger for symptoms)

Myths About Psychosis

  • Violence: Many people associate psychosis with violence, especially because of several high-profile news stories about violence committed by people who may have psychotic disorders. However, most people with psychotic disorders are not violent. Psychotic people are more likely to be victims than perpetrators. Violence to self (e.g., suicide) or others is possible, however. The risk of violence may be increased in people with psychosis who abuse substances, are male, have a history of hostile thoughts and behaviors, have a strong belief that others are "against" them, have a history of criminal behavior, and lack treatment or are not compliant with treatment recommendations.
  • "Split personality": Schizophrenia is not the same thing as "split or multiple personality disorder" (Dissociative Identity Disorder). Schizophrenia's symptoms are described above. Dissociative Identity Disorder, which is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person's behavior, is thought to be a complex psychological condition that is likely caused by many factors, including severe trauma during early childhood (usually extreme, repetitive physical, sexual, or emotional abuse).
  • "Not real": Some mistakenly believe that people with psychotic symptoms are pretending, acting eccentric for attention, or choosing to be different. Psychotic disorders are caused by changes in the brain and typically cannot be easily controlled by the person.
  • Weakness/Immorality: Psychotic disorders are the result of complex biological, genetic, and environmental factors and are not a sign of weakness, bad parenting, or bad morals.
  • Hopelessness: It's not true that psychotic symptoms are untreatable or that they are always permanent. In some people, symptoms are short-term; in others, while the disorder is chronic, the symptoms can be managed effectively with treatment, and symptoms may change and improve over time.

Getting Help

Coping with chronic psychosis and recovery from short-term psychotic symptoms are possible with treatment. Treatment is most effective when started early after symptoms first emerge. What is needed varies from person to person, but effective treatment often combines medication, case management, education, social support, and therapy. Many people with psychosis require long-term medication treatment but others don't. For people with more severe psychotic disorders, additional interventions may include supported employment, supported living environments (e.g., group homes), and services at a day treatment center.

Some tips for coping with psychotic symptoms include the following:

  • Seek professional assessment and treatment early on when you notice your brain "playing tricks on you." Treatment is most effective when started early after symptoms first arise.
  • Find ways to stay grounded, such as reminding yourself that voices and visions you experience may not be real.
  • If your senses feel overstimulated, give yourself a break by being in a calmer environment in which you feel safe and comfortable.
  • Stay away from alcohol, recreational drugs, and prescription drugs that were not prescribed to you: Even if these substances seem to temporarily calm you or relieve symptoms, they can also worsen or trigger symptoms and usually will cause additional problems.
  • Find ways to manage and cope with stress, such as exercise, relaxation exercises, hobbies, calming music—whatever works best for you.
  • Try to get 7 to 8 hours of sleep a night; it's important for your physical and mental health.
  • Seek support from trusted family members and friends.
  • Eat a healthy, balanced diet. Consider increasing your intake of omega-3 (found in some fish or in fish oil supplements), which may help reduce symptoms.

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