What Is PTSD Psychosis?

Learn how PTSD can bring about psychotic symptoms, and how to manage them safely.

Post-traumatic stress disorder (PTSD) is a severe mental health condition that affects people who have experienced traumatic events, often interfering with their ability to function in daily life. While the core symptoms of PTSD typically include intrusive memories, flashbacks, and heightened arousal, some people develop additional complications, such as PTSD psychosis. This refers to the presence of psychotic symptoms in someone with PTSD. Here is an explanation of the connection between PTSD and psychosis, the symptoms and psychotic features that may arise, and the treatment options for PTSD psychosis that are available.

What is PTSD psychosis?

PTSD psychosis is when a person diagnosed with PTSD begins to experience increased psychotic symptoms—even though psychosis isn’t a core symptom of PTSD. Psychosis refers to a state where a person loses touch with reality, manifesting in symptoms like delusions, auditory hallucinations, or other positive psychotic symptoms. In people with complex PTSD, a history of developmental trauma can make psychotic symptoms more severe, leading to greater psychotic symptom severity.

Symptoms of PTSD psychosis

The symptoms of PTSD psychosis combine both the classic PTSD symptoms and psychotic symptoms. Here are the three most commonly presented symptoms.

1. Delusions

Delusions are one of the most common symptoms of PTSD psychosis, where people experience false beliefs that are not grounded in reality. For example, a person with PTSD psychosis may believe they are constantly being watched or followed, even when there is no actual threat. These delusions can cause significant distress as the person’s perception of reality becomes distorted, making it difficult for them to differentiate between what is real and what is imagined. These false beliefs often stem from the trauma the person has experienced, and they can exacerbate feelings of fear, paranoia, and isolation.

2. Auditory hallucinations

Auditory hallucinations, commonly seen in schizoaffective disorder, can also be a symptom of PTSD psychosis. This involves hearing voices or sounds that are not actually present, often connected to the person’s traumatic memories, with the voices sometimes echoing past events or people related to the trauma. For example, a person might hear the voice of someone involved in their traumatic experience, leading to intense emotional distress. Auditory hallucinations in PTSD psychosis can be disorienting and contribute to confusion, fear, and a heightened sense of vulnerability.

3. Disorganized thinking 

Disorganized thinking is another key symptom of PTSD psychosis, where people experience difficulty organizing their thoughts, leading to confusion and incoherent speech. This can manifest as the person’s inability to follow a logical train of thought, causing them to speak in a disjointed or fragmented manner. As a result, conversations may seem confusing or nonsensical to others. This symptom often stems from the intense psychological strain of trauma and can severely impact a person’s ability to communicate effectively or function in social and professional settings. It’s similar to the cognitive disruptions seen in other psychotic disorders, such as schizophrenia, and requires careful treatment and support.

What are positive and negative psychotic symptoms?

Positive psychotic symptoms refer to behaviors or experiences that represent an excess or distortion of normal functioning. These symptoms include hallucinations, such as hearing voices or seeing things that aren’t there, delusions, and disorganized thinking. In the context of PTSD psychosis, these positive symptoms often arise in response to trauma, amplifying feelings of fear, paranoia, and distress. They can disrupt a person’s ability to connect with reality, making it challenging for them to engage in everyday activities or communicate effectively.

Negative psychotic symptoms, on the other hand, refer to a reduction or loss of normal functioning, particularly in areas like emotional expression, social interaction, and motivation. These symptoms can manifest as emotional numbness or social withdrawal, leading to isolation from friends, family, and activities. In the context of PTSD psychosis, negative symptoms may include a lack of interest or motivation to engage with others, as well as a diminished ability to experience pleasure or joy. These symptoms can make it difficult for people to maintain relationships or carry out daily tasks, further contributing to the emotional and social challenges of PTSD.

Risk factors for PTSD psychosis

Here are two of the most common risk factors that someone with PTSD will develop psychosis:

1. Developmental trauma

Developmental trauma, which refers to early-life experiences of abuse, neglect, or other forms of severe stress, is a significant risk factor for developing complex PTSD and may increase the likelihood of experiencing psychotic episodes. This type of trauma can create deep psychological scars that persist into adulthood, making people more vulnerable to the effects of stress or trauma-related triggers. As a result, the emotional and psychological wounds from early experiences may resurface in the form of psychosis symptoms, especially when the person faces new stressors or reminders of past trauma. 

2. Co-occurring mental health disorders

Those with PTSD often experience co-occurring mental health disorders, such as bipolar disorder, panic disorder, or borderline personality disorder, increasing the risk of developing psychotic symptoms. For example, the mood swings and emotional instability associated with bipolar disorder can heighten the stress experienced by someone with PTSD, potentially triggering or intensifying a psychotic episode. Similarly, the anxiety and fear inherent in panic disorder or the emotional dysregulation seen in borderline personality disorder can exacerbate a person’s hallucination or delusion, making it more difficult for them to manage both their PTSD and co-occurring disorders effectively.

How to know if you have PTSD psychosis 

The American Psychiatric Association (APA) provides diagnostic criteria for PTSD and various psychotic disorders. When a PTSD patient presents with psychotic symptoms, clinicians must carefully assess whether these symptoms are related to the trauma or if they indicate another underlying psychotic disorder. This includes considering disorders like brief psychotic disorder or primary psychotic disorders such as schizophrenia. Properly distinguishing between PTSD psychosis and other psychotic disorders is crucial for effective treatment, which may involve a combination of medication, psychotherapy, and crisis management. 

Diagnosing PTSD psychosis can be complex, as psychotic symptoms can overlap with other mental health disorders such as schizophrenia or schizophreniform disorder. Clinicians must carefully assess whether the psychosis is secondary to post-traumatic stress or if another mental disorder is at play. One commonly used tool for assessing PTSD is the clinician-administered PTSD scale (CAPS). However, when psychotic features are present, additional psychiatric assessments may be needed to evaluate the nature and severity of psychosis symptoms.

How PTSD psychosis affects daily life

The presence of psychotic features in PTSD can significantly impair a person’s quality of life, with symptoms like auditory hallucinations or delusions making it challenging to interact with others or complete everyday tasks. This often leads to increased isolation, depression, and the development of further negative psychotic symptoms such as social withdrawal. As a result, people may struggle to maintain relationships, work, or engage in daily activities, severely affecting their overall well-being and sense of self.

Treatment for PTSD psychosis

PTSD psychosis symptoms can take a toll on your well-being, but healing is possible. Here are some common treatment options for PTSD psychosis. 

1. Psychotherapy

Psychotherapy is a key component in treating PTSD psychosis, with cognitive behavioral therapy (CBT) being commonly used to address PTSD symptoms. Specialized approaches like trauma-focused CBT are particularly effective in helping people process traumatic memories and manage the psychotic features associated with PTSD. For those with complex PTSD, more intensive therapy may be necessary to help them work through deep-seated trauma and develop coping strategies for dealing with both their psychosis symptoms and PTSD-related challenges.

2. Medication 

In the treatment of PTSD psychosis, antipsychotic medications are often prescribed to manage positive psychotic symptoms like hallucinations or delusions. If a person also has a mood disorder or anxiety disorder, medications such as antidepressants or mood stabilizers may be used to address these co-occurring disorders. The combination of these medications helps alleviate both the psychotic features and any underlying mood or anxiety issues, improving overall symptom management and quality of life.

3. Integrated care approach

For those with co-occurring PTSD and disorders such as eating disorders or substance use disorder, an integrated care approach is essential. This approach involves a team of mental health professionals, including psychiatrists, psychologists, and social workers, who collaborate to create a personalized treatment plan. The plan addresses both the psychotic features and a person’s underlying PTSD, ensuring that all aspects of their mental health are treated comprehensively for better outcomes.

4. Hospitalization

In severe cases of PTSD psychosis, hospitalization may be necessary to stabilize symptoms during a psychotic episode. This is especially important when delusions or auditory hallucinations put the patient’s safety or well-being at risk. Hospital care allows for close monitoring, medication adjustments, and a controlled environment to help manage the acute symptoms and prevent harm, ensuring the patient receives the support needed for recovery.

How Charlie Health can help

If you or a loved one are struggling with a mental health disorder, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing your mental health is possible. Fill out the form below or give us a call to start healing today.