Introduction

Psychosis and trauma are closely connected, as traumatic experiences can sometimes act as catalysts for psychotic episodes. Individuals who have endured severe emotional or physical trauma may be at greater risk of developing psychosis. This article explores the triggers of psychosis in relation to trauma, along with the associated risk factors, warning signs, and treatment options.

Understanding trauma-induced psychosis 

Psychosis is a mental health problem where a person loses some contact with reality. It may involve alterations in a person’s perception of reality, which can affect their reasoning, sight and hearing in the form of delusions and hallucinations.¹

Psychosis can occur independently or as a symptom of a mental health disorder. It may be associated with other mental health conditions such as schizophrenia, bipolar disorder, and depression. Psychosis may also be triggered by trauma, stress, alcohol misuse, substance use, or certain medications.²

What is trauma?

Trauma is defined as a sudden and forceful event that overwhelms one’s ability to respond to it. It is a stressful experience that may involve

• actual or threatened death
• sexual violence, or 
• serious injury that results in intense physical or psychological stress³

However, to incorporate psychologically threatening events, the definition of trauma has evolved to include any event that represents a significant physical or psychological threat to the self.¹ In essence, trauma is defined by the experience of the victim.

It is a common experience and approximately 70% of the world’s population has been exposed to a traumatic event.⁴

Types of trauma

Trauma can manifest in various forms and degrees of severity, and it can be categorized based on several factors. One common classification is based on duration:

• Acute trauma refers to a single, short-lived traumatic event that is usually narrowly focused, such as a car accident, theft, or assault. It is often linked to short-term post-traumatic stress disorder⁵
• Chronic trauma involves recurring incidents that occur over extended periods in a person's life, such as domestic violence, repeated sexual abuse, or child abuse. It is frequently associated with co-occurring mental health disorders and significant behavioural changes⁶

When an individual experiences multiple traumatic events of varying natures over a prolonged period, it is categorized as complex trauma. This term is sometimes incorrectly used interchangeably with chronic trauma, however, they are not the same.

Relationship between trauma and psychosis

Trauma and psychosis have a bidirectional relationship, meaning that trauma can be both a consequence of psychotic experiences and a risk factor for developing psychosis.⁷

Can trauma cause psychosis?

Studies suggest that exposure to traumatic events, particularly during childhood, can increase a person’s vulnerability to developing psychotic disorders. This is supported by the concept of the “dose-response relationship,” which indicates that the more traumatic events one experiences, the greater the risk of psychosis.⁸

Various mechanisms and models have been proposed to explain the link between trauma and psychosis. The most common is the Stress-Vulnerability Model, which posits that individuals with a genetic predisposition to psychosis are at a heightened risk of experiencing psychotic symptoms after trauma. Another model, known as the Dual Hit Model, suggests that trauma activates the stress response system, leading to the release of stress hormones that may initiate or exacerbate the symptoms of psychosis.⁹

Can psychosis cause trauma?

Conversely, some studies have indicated that trauma can result from psychotic experiences. A psychotic episode can be classified as a traumatic event, potentially leading to the development of post-traumatic stress disorder (PTSD). The experiences that can be encountered during a psychotic episode such as involuntary hospitalization, restraint, paranoia and disturbing hallucinations are enough to qualify for a traumatic event.

Diagnosing post-psychotic PTSD can be challenging. However, it is more prevalent among individuals with recurrent psychosis. Research suggests that between 14% and 47% of people with psychosis may experience post-psychotic PTSD. Factors associated with the development of psychosis-related PTSD include the severity of the psychosis, a history of trauma, and coping styles.¹⁰

Identifying risk factors and warning signs

To reduce and prevent psychosis, early detection and assessment are crucial. Understanding the factors that predispose an individual to develop psychosis, as well as recognizing the behavioural warning signs, can aid in identifying the onset of the condition and implementing effective interventions.

Various genetic and environmental factors increase the likelihood of the onset of psychosis. Some factors include:¹¹

• Family history of psychosis
• Childhood trauma
• Substance abuse (especially early in adolescence)
• Traumatic brain injury

Psychosis is primarily marked by delusions and hallucinations, but before it develops, there will be significant changes in behaviour. Some warning signs are:¹²

• Suspiciousness or paranoia
• Decline in self-care
• Confused speech and/or trouble communicating
• Overly intense ideas
• Strange feelings or lack of feelings
• Disruption of sleep 

Treatment options and recovery strategies

Given the varied nature of psychosis, it is essential to identify and address the underlying cause before initiating treatment. Several treatment options may be recommended for individuals experiencing psychotic symptoms, tailored to their specific needs and circumstances.

Assessment

Consulting with a mental health specialist is essential for evaluating the individual. This assessment is crucial for determining whether the person is indeed experiencing psychosis, identifying the specific types of psychotic symptoms present, and deciding on the appropriate course of action. Blood tests may also be requested to rule out any underlying medical conditions that could be contributing to the symptoms.

Medication

Antipsychotics, a class of medication primarily used to manage psychosis, play a crucial role in reducing the symptoms of an individual. The specific type of antipsychotic medication and the treatment plan to be followed are determined by the healthcare provider and a team of mental health specialists, ensuring a tailored approach to each individual's needs.

Cognitive behavioural therapy

Cognitive Behavioral Therapy is a form of talking therapy designed to change negative thinking patterns in order to manage challenging symptoms, such as hallucinations and delusions, and enhance functioning in individuals experiencing psychotic symptoms. It can be particularly effective when combined with medication and family support, helping to reduce the risk of future episodes of psychosis.¹³

Support programs

Support programs concentrate on addressing the trauma or disorder believed to be the underlying cause of psychosis. These programs aim to help individuals manage their symptoms effectively, reducing the overall impact of psychosis on their daily lives and promoting healthier coping strategies.

Family intervention and educational programs

These programs equip family members with skills to cope and communicate effectively with individuals experiencing psychosis, as well as enhance their problem-solving abilities. A well-informed family support system plays a crucial role in the recovery process for the individual, fostering understanding and resilience during challenging times.

Seek help when you get overwhelmed 

There are numerous organisations that offer valuable support and are ready to listen. If you or someone you know needs urgent mental health assistance, consider reaching out to the following resources:

• Mental Health UK
• Voice Collective
• Rethink Mental Illness

These organisations can provide guidance, support, and a listening ear for those in need.

FAQs

Is a person with psychosis dangerous?

People experiencing psychosis are not typically dangerous. Sometimes, the symptoms that individuals with psychosis experience can lead them to behave in unpredictable or confusing ways, which may result in harmful or threatening behaviour toward themselves or others; however, this is rare, and the risk is reduced with treatment. The idea that psychosis makes people inherently dangerous or violent is a misconception.

What are the types of conditions displaying psychosis?

Psychosis can be a symptom of various medical conditions. Some of these include psychotic disorders such as brief psychotic disorder (sudden psychotic symptoms experienced for less than a month), schizophrenia, and schizophreniform disorder (comparable to schizophrenia but lasting no more than six months).

Psychosis can also occur in other mental health conditions, including post-traumatic stress disorder (PTSD) (which arises after a traumatic event), postpartum psychosis (experienced after childbirth), and bipolar disorder (characterised by alternating episodes of depression and elevated mood and energy).

Secondary psychosis can occur in response to stroke, traumatic brain injury, substance abuse, and neurodegenerative disorders such as Alzheimer’s disease.

Can psychosis come and go?

Some people may experience psychosis only once in their lifetime, while others may have multiple episodes. This variability depends on the underlying cause and the individual’s response to treatment.

Can someone with psychosis live a normal life?

Many people with psychosis lead fulfilling and productive lives. The likelihood of this is increased if psychosis is detected, diagnosed, and treated early. For some, receiving the right support, medication, and therapy may mean they never experience another psychotic episode or can live a normal life even if they do have another episode.¹²

How long does a psychotic episode last?

Psychosis is said to occur in three phases:

• Prodrome phase: Characterised by changes in behaviour, thought, and perception in the early stages before full-blown psychosis is experienced
• Acute phase: This is when hallucinations, delusions, and unusual behaviours occur. These symptoms can interfere with everyday functioning and can be very distressing for the individual
• Recovery phase: Symptoms lessen, allowing the person to restore their sense of self and regain control over their life

The duration of each stage depends on the individual and the cause of the psychotic episode. It can last from weeks to months or longer. For example, a brief psychotic disorder typically lasts for a few weeks.

What happens if you don’t treat psychosis?

If left untreated in some individuals, psychosis could lead to serious complications that impair their ability to lead a fulfilling life. However, with the right support and treatment, individuals can manage their symptoms and function well. 

Summary

Just as we reduce movement when we sprain our ankle and rest while waiting for it to heal, we should also take a break when our mind is unwell. Regardless of when it occurred, trauma can have a lasting impact on our mental health and increase the risk of developing psychosis later in life.

Psychosis can arise from various factors, with evidence indicating a high prevalence of childhood trauma among those who experience it. The first episode of psychosis is often associated with early warning signs, making it essential to identify risk factors and maintain active surveillance in high-risk individuals. Psychosis can be effectively managed, and outcomes improve significantly when detected and treated early. Support programs, medication, and cognitive behavioural therapy all play vital roles in facilitating the recovery process.