Those with Post Traumatic Stress disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD) can experience psychotic symptoms as part of their PTSD without any other disorders being present. It is not currently a diagnosis in and of it’self but some psychologist propose calling it Posttraumatic Stress Disorder With Secondary Psychotic Features (PTSD-SP). It has been seen to be an experience separate enough from PTSD without psychosis and other psychotic disorders to be a discrete diagnosis. (Compean & Hamner, 2019)

In a study it was shown that 72.7% of those with a current psychotic disorder diagnosis had histories of childhood trauma, this was of a population receiving care (Powers, Fani, Cross, Ressler, & Bradley, 2016). It also observed that those with trauma connected psychosis the symptoms can often be drawn from traumatic experiences. Traumatic events, toxic stress, and huge life-changing events are noted to often precede episodes of psychosis. Chronic trauma and C-PTSD can raise the likelihood of trauma linked psychosis as well.

Psychotic class disorders ¹ are not considered trauma induced so not all psychosis is trauma based. Some people do meet both criteria (especially seen in schizophrenia) for psychotic and trauma disorders they can feel blurred and overlap. Major Depressive disorder, Bipolar disorder and personality disorders are very common in trauma survivors and both of those disorders can have psychotic symptoms. Trauma and psychosis both leave you at a higher risk to develop the other symptom clusters.

Positive psychotic symptoms including hallucinations, delusional thoughts and disorganized behaviours ² are the most common in trauma survivors. Auditory and tactile hallucinations are quite common. Delusions of persecution, ³ control ⁴, surveillance and paranoia ⁵are also very common in PTSD patients. Negative psychotic symptoms like severe executive dysfunction ⁶, alogia ⁷, flat affect ⁸, and extreme social withdrawal can happen as well but are less common or less pronounced.

PTSD and psychosis have some overlapping symptomology and have some symptoms that are not the same but are very similar.

Hallucinations and flashbacks can seem really similar. They both include sensory inputs that aren’t “there” and obviously not experienced by those around them so they are sometimes mixed up. The difference, of course, being hallucinations don’t have to have anything to do with trauma while flashbacks do.

Hypervigilance and paranoid delusions also heavily overlap in experience. Generally, the difference is delusions are more formed like the government is watching me, while hypervigilance is more diffuse and generalized. Again both can be experienced at the same time as well. The two also do function a bit differently in the physical brain.

Dissociation and negative psychosis symptoms can seem similar in they both affect: movement, slow thinking, emotional understanding & expression, focus and communication. The executive function issues also are in both disorders so this adds to the similarity. Both can, of course, happen at once but the overlap can cause them to be confused and even more so compound on each other.

Trauma linked psychosis is relatively common within the population of those with PTSD/C-PTSD and can be confusing. The hyperfocus on diagnosis, while the language is helpful, can put people into one camp or the other and loose types of help that they need. For example, if the psychosis symptoms are prominent a diagnosis that is in the psychotic class while some help they received could be beneficial they would not receive support for trauma and they can get locked in this because of the system and not be able to really heal. This strict classification system can be very harmful. Understanding that your experience might break the boxes a bit is important, understanding the symptom overlap can also make it easier to understand and communicate.

The lack of full body and life centred care also can further this struggle. An example is body memories, they can be assumed to have to be pure hallucinations when it might be a mix. Not focusing on the whole person and everything in there life effects this too as it’s been noted that episodes of trauma linked psychosis occur most commonly when a stressor in life happens ones that are similar to trauma and/or are re-traumatizing are the most common. When people split off psychosis symptoms from the full life experience this understanding can be overlooked.

PTSD linked psychosis is not super common but is not exceedingly rare or fake. If you think you’re struggling with this reaching out for help can be amazingly helpful. Treatments for trauma can be helpful and give good quality of life like any other trauma survivors. It can be hard work but you can heal.

-Admin 2

Glossary:

1. Conditions that have psychosis as a main symptom including: Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, Delusional Disorder, Brief Psychotic Disorder, Schizotypal Personality Disorder (SPD, also a personality disorder), Substance-Induced Psychotic Disorder, Shared Psychotic Disorder, Disorder Due to a Medical Condition,
2. Disorganized behaviour refers to behaviours that don’t fit the situation; difficulty in completing tasks or reaching a goal, wearing inappropriate clothing, answering a question in a way that doesn’t make sense to the other person, displaying an inappropriate emotional response to the situation, or going on tangents.
3. A delusion that centres on being mistreated, and/or that someone is surveilling them and planning to harm them.
4. A delusion that another person, group of people, or other external force controls one’s thoughts, feelings, impulses, and/or behavior.
5.  Intense anxious or fearful feelings and thoughts often related to persecution, threat, or conspiracy
6. An impaired ability to use the executive functions in the brain that acts as a regulatory system. These functions are physically located in the temporal lobe. The main things affected by this dysfunction are motivation, the ability to start tasks, emotional regulation, self-monitoring, multitasking, task switching and forward planning.
7. Alogia is a term used in psychology to reflect a lack of personal content in speech or conversation. Can also include a lack of unprompted speech where the person won’t start conversations either. Referred to as “poverty” of speech, the affected individual uses only the bare minimum needed to communicate, such as yes or no answers or short sentences.
8. A severe reduction in emotional expressiveness.A delusion that centres on being mistreated, and/or that someone is surveilling them and planning to harm them.Disorganized behaviour refers to behaviours that don’t fit the situation; difficulty in completing tasks or reaching a goal, wearing inappropriate clothing, answering a question in a way that doesn’t make sense to the other person, displaying an inappropriate emotional response to the situation, or going on tangents.
9. A severe reduction in emotional expressiveness.

Resources:

1. Tull, M. (2019, June 24). Hallucinations and Delusions Can Affect People With PTSD. Retrieved July 3, 2019, from https://www.verywellmind.com/relationship-between-ptsd-and-psychotic-symptoms-2797525
2. Dean, A. (2019, July 03). What You Need to Know About PTSD and Psychosis. Retrieved July 3, 2019, from https://themighty.com/2017/08/ptsd-psychosis-connection/
3. Brico, E. (2018, January 31). Posttraumatic Stress Disorder and Psychosis, HealthyPlace. Retrieved on 2019, July 3 from https://www.healthyplace.com/blogs/traumaptsdblog/2018/01/ptsd-psychosis
4. Powers, A., Fani, N., Cross, D., Ressler, K. J., & Bradley, B. (2016). Childhood trauma, PTSD, and psychosis: Findings from a highly traumatized, minority sample. Child Abuse & Neglect,58, 111-118. doi:10.1016/j.chiabu.2016.06.015
5. Compean, E., & Hamner, M. (2019). Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges. Progress in Neuro-Psychopharmacology and Biological Psychiatry,88, 265-275. doi:10.1016/j.pnpbp.2018.08.001
6. S. (n.d.). Symptoms of Psychosis. Retrieved July 3, 2019, from https://www.earlypsychosis.ca/pages/curious/symptoms-of-psychosis
7. S. (2018, May 10). Paranoia and Delusional Disorders. Retrieved July 3, 2019, from https://www.mentalhealthamerica.net/conditions/paranoia-and-delusional-disorders
8. S. (Ed.). (2018, January 23). Delusional Disorder. Retrieved July 3, 2019, from https://my.clevelandclinic.org/health/diseases/9599-delusional-disorder
9. Alogia. (n.d.). In Alleydog.com’s online glossary. Retrieved from: https://www.alleydog.com/glossary/definition-cit.php?term=Alogia
10. Goldberg, J., MD (Ed.). (2017, November 07). What Are the Types of Psychotic Disorders? Retrieved July 3, 2019, from https://www.webmd.com/schizophrenia/ss/slideshow-types-of-psychotic-disorders