What Is Trauma Induced Psychosis? How Trauma Can Lead to Psychosis

Trauma can leave deep psychological scars and for some, it may increase the risk of developing psychosis.

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Traumatic experiences can be incredibly difficult for the mind to process. In some cases, their psychological impact may contribute to long-term mental health challenges, including an increased risk of psychotic symptoms. While the connection between trauma and psychosis isn’t fully understood, research has shed light on how trauma affects brain development, stress regulation, and the onset of serious mental illnesses like schizophrenia.

This article explores how trauma, especially in childhood, can increase vulnerability to psychosis, how symptoms may overlap with post-traumatic stress disorder (PTSD), and what treatment options are available.

What is the link between post-traumatic stress disorder and psychosis?

Mental health experts have long known that trauma can lead to various psychiatric disorders. PTSD is one of the most well-known conditions, marked by emotional distress, intrusive memories, and avoidance behaviors following a highly disturbing event.

Common PTSD symptoms include:

• Flashbacks and intrusive memories
• Nightmares related to the traumatic experience
• Hypervigilance and startle responses
• Mood swings, depression, or dissociation
• Reckless or self-destructive behavior
• Avoidance of trauma-related reminders
• Sleep disturbances

How psychosis symptoms present in PTSD

Some individuals with PTSD also experience symptoms of psychosis—impaired perceptions of reality. Positive psychotic symptoms that add something to a person’s perception, behavior, or negative psychotic symptoms, which involve a loss or reduction of normal functions. 

Here are some common positive and negative psychotic symptoms that people with PTSD may experience: 

• Seeing or hearing things that aren’t really there (hallucinations)
• Holding strong beliefs that aren’t based in reality and don’t change even with evidence (delusions)
• Feeling little or no pleasure from things that used to be enjoyable (anhedonia)
• Speaking very little, even when communication is needed (alogia)
• Avoiding social interaction or losing interest in relationships (asociality)

Individuals diagnosed with PTSD are statistically more likely to also meet criteria for a psychotic disorder, including schizophrenia and bipolar disorder, particularly during manic or depressive episodes with psychotic features. One study found that 16% of individuals diagnosed with a psychotic illness also had PTSD—significantly higher than the general population rate of 3–4%. Some studies suggest that the figure may be closer to 30%.

Diagnosing PTSD-induced psychosis

PTSD symptoms can sometimes be mistaken for signs of primary psychotic disorders like schizophrenia. For example, an exaggerated startle response might be misinterpreted as a reaction to hallucinations rather than trauma. People with trauma-related psychosis are more likely to report distressing, paranoid, or fear-based hallucinations, while bizarre or grandiose delusions are less common during a psychotic episode.

Trauma as a risk factor for psychosis—even without PTSD

Trauma doesn’t need to result in PTSD to increase the risk of psychosis. Here are some key examples of trauma-related risk factors for psychosis:

1. Childhood trauma

Many studies indicate that a traumatic experience, particularly in childhood, is linked to a higher likelihood of developing psychosis later in life. Experiencing developmental trauma early in life is one of the most well-established risk factors for developing a psychotic disorder, including schizophrenia and dissociative disorder, as indicated in the earlier source.

2. Ongoing trauma

Also, exposure to multiple types of past trauma increases the risk more than fourfold, with the severity of psychotic experiences often correlating with the extent of past trauma. This connection may be partly driven by how the body responds to intense stress.

3. Brief psychotic disorder

Sometimes, trauma can lead to an acute but temporary episode of psychosis known as brief psychotic disorder. This condition involves a sudden onset of psychotic symptoms that resolve within approximately one month, and may follow traumatic experiences such as a serious accident, violent attack, or the sudden loss of a loved one. In some cases, a traumatic event may even trigger a chronic psychotic illness like schizophrenia.

4. Schizophrenia

Schizophrenia is a serious mental illness that often includes hallucinations, delusions, and impaired cognitive function. While its causes are not entirely understood, trauma is increasingly recognized as a contributing factor.

Why trauma exposure can trigger psychosis

There’s no single explanation for how trauma increases the risk of psychotic symptoms. Current research points to several overlapping biological and psychological mechanisms.

HPA axis dysregulation

The hypothalamic-pituitary-adrenal (HPA) axis helps regulate stress responses, mood, memory, and emotion. In people with trauma histories, the HPA axis may become overactive or desensitized, especially if the trauma occurred during childhood. This dysregulation can disrupt brain development, leading to changes in areas associated with psychosis. Studies have found that trauma-related stress can reduce brain volume in regions involved in emotional regulation and cognitive processing.

Inflammation and brain development

Chronic stress and trauma can activate the body’s inflammatory response, which may damage brain cells and interfere with the development of neural circuits. This inflammation is often seen in people with psychotic disorders, suggesting a possible connection between early-life stress, immune system activation, and later mental illness.

Treating trauma-related psychosis with therapy

Recovery is possible, but it requires an approach that addresses both trauma and psychotic symptoms. Traditional treatments for psychosis, such as antipsychotic medication, may not fully resolve distress rooted in past trauma, which is why trauma-informed therapy has become a vital part of care. This section explores evidence-based strategies designed to help individuals heal from trauma while managing symptoms like hallucinations, paranoia, or dissociation.

Mental health professionals increasingly recognize the value of trauma-informed care for individuals with psychosis, particularly within practices of clinical psychiatry. Some research suggests that therapies targeting trauma, such as exposure therapy or trauma-focused CBT, can reduce not only PTSD symptoms but also psychotic symptoms like paranoia and hallucinations.

How Charlie Health can help

If you or a loved one is struggling with trauma-induced psychosis, 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, including trauma-induced psychosis, childhood trauma, and more. Our expert clinicians incorporate evidence-based therapies into person counseling, family therapy, and group sessions. With treatment, managing trauma-induced psychosis and other mental health concerns is possible. Fill out the form below or give us a call to start healing today.