The Relationship Between PTSD and Psychosis

Hearing voices and hallucinations are common in PTSD patients

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PTSD and symptoms of psychosis, such as hallucinations, often co-occur. In clinical terms, PTSD is described as consisting of three clusters of symptoms: re-experiencing symptoms, avoidance symptoms and hyperarousal symptoms. However, some mental health professionals believe that the experience of psychotic symptoms should be considered as an addition to that list, given that they commonly occur among people with PTSD.

Psychotic Symptoms

Psychotic symptoms can be divided into two groups: positive symptoms and negative symptoms. Positive symptoms are characterized by the presence of unusual feelings, thoughts or behaviors. Positive symptoms include such experiences as hallucinations or delusions. A hallucination could be hearing voices that no one else can hear or seeing things that are not really there.

Delusions are ideas that a person believes are true despite the fact that they may be unlikely or odd. For example, people with delusions may believe that the CIA is spying on them or that aliens are controlling their behaviors or thoughts.

Negative symptoms are characterized by the absence of experience. For example, a person with negative symptoms may not be emotionally expressive. She may have difficulty speaking, may not say anything for days on end or be unable to accomplish simple tasks or activities, such as getting dressed in the morning.

These positive and negative symptoms are often associated with the diagnosis of schizophrenia; however, they are also seen in other disorders, such as PTSD.

Psychotic Symptoms in PTSD

Researchers at the University of Manitoba, Columbia University and the University of Regina examined the data on 5,877 people from across the United States in order to determine the rates with which people with PTSD experience different psychotic symptoms.

They found that, among people with PTSD, the experience of positive psychotic symptoms was most common. Approximately 52 percent of people who reported having PTSD at some point in their lifetime also reported experiencing a positive psychotic symptom.

The most common positive symptoms were:

  • Believing that other people were spying on or following them (27.5 percent)
  • Seeing something that others could not see (19.8 percent)
  • Having unusual feelings inside or outside of their bodies, such as feeling as though they were being touched when no one was really there (16.8 percent)
  • Believing that they could hear what someone else was thinking (12.4 percent)
  • Being bothered by strange smells that no one else could smell (10.3 percent)
  • Believing that their behaviors and thoughts were being controlled by some power or force (10 percent)

The researchers also found evidence that the more PTSD symptoms a person was experiencing, the greater the likelihood that they would also experience positive psychotic symptoms.

To take their study a step further, the researchers also looked at which traumatic events were most commonly related to the experience of psychotic symptoms. The events that put people most at risk include being involved in a natural disaster, seeing someone injured or killed or experiencing shock as a result of a traumatic event that happened to a loved one.

What This All Means

The experience of psychotic symptoms may tell the story of just how severe a person's case of PTSD is and how well he or she is coping with the condition. It may also raise red flags about the likelihood of potentially dangerous behaviors.

It has been suggested that the experience of psychotic symptoms in those with PTSD may be connected to the experience of dissociation. Frequent dissociation may increase the risk for the development of psychotic symptoms. And studies have shown that people with PTSD who experience psychotic symptoms, as compared to those who do not, may be at greater risk for a number of problems, such as suicidal thoughts, suicide attempts and greater overall distress.

If a loved one has PTSD and is experiencing psychotic symptoms, it is very important that they seek out treatment. Positive psychotic symptoms can be effectively managed through medication. Addressing PTSD symptoms in treatment may also result in a reduction of psychotic symptoms. 

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: Author.

Kilcommons, A.M., & Morrison, A.P. (2005). Relationships between trauma and psychosis: An exploration of cognitive and dissociative factors. Acta Psychiatrica Scandinavica, 112, 351-359.

Sareen, J., Cox, B.J., Goodwin, R.D., & Asmundson, G.J.G. (2005). Co-occurrence of posttraumatic stress disorder with positive psychotic symptoms in a nationally representative sample. Journal of Traumatic Stress, 18, 313-322.

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