Stress-Induced Psychosis: Contributing Factors
Stress can be a part of life. However, extreme stress can sometimes lead to mental health conditions and challenges, including psychosis. Psychosis is often considered a mental health emergency, as it can lead to a severe lack of connection with reality. Understanding how stress might incite psychosis can be a first step to preventing psychotic episodes and finding treatment when signs of psychosis first occur.
What is stress-induced psychosis?
As psychosis isn't considered a mental health condition in and of itself, it may affect anyone under certain circumstances. Stress-induced psychosis refers to psychosis caused by severe stress or traumatic events.
The National Institute of Mental Health (NIMH) describes psychosis as consisting of "a collection of symptoms that affect the mind, where there has been some loss of contact with reality." A person experiencing psychosis may experience hallucinations, delusions, and disorganized or confused thinking, which may manifest when communicating thoughts and ideas.
Psychotic disorders related to stress-induced psychosis
Psychotic symptoms are also associated with various mental health conditions, such as psychotic disorders, whose symptoms may worsen or be caused by stress. Below are a few conditions related to this form of psychosis.
Brief psychotic disorder
Brief psychotic disorder is a diagnosis referring to "the sudden onset of psychotic behavior that lasts less than one month followed by complete remission with possible future relapses." Unlike schizophrenia, it lasts for one month before remission. This condition is considered an acute but transient disorder causing delusions, hallucinations, and disorganized speech; however, a person may experience other episodes in the future.
If there's a specific, marked stressor that causes a brief psychotic disorder, the condition is then referred to as brief reactive psychosis. Reactive psychosis relates to symptoms of psychosis stemming from a traumatic event or situation that might be considered unsettling for those of a similar culture and under similar circumstances.
A person who experiences severe stress and trauma may be more prone to developing brief psychotic disorder, making it a possible cause of stress-induced psychosis. However, genetic, neurological, and environmental factors may also play a role. Brief psychotic disorder is more likely to affect vulnerable populations experiencing high stress levels, such as refugees and survivors of natural disasters. It may also be more prevalent in developing countries.
A diagnosis of this condition may be made retrospectively after a person has experienced the brief episode since the psychotic episode must be in remission after one month of symptoms. Moreover, manifested symptoms may be considered part of another disorder with a psychotic feature. Before the remission period, a person may receive the diagnosis of "psychotic disorder, not otherwise specified."
Treatment of brief psychotic disorder often involves the use of antipsychotic medication and psychotherapy with a mental health professional.
For a diagnosis, the specific event causing brief psychotic disorder must be identified as follows:
- Brief psychotic disorder stemming from a marked stressor (reactive psychosis)
- Brief psychotic disorder without a marked stressor, where no specific traumatic event can be identified
- Brief psychotic disorder stemming from childbirth within four weeks postpartum (also known as postpartum psychosis)
Other psychotic disorders
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) list of psychotic disorders includes:
- Schizophrenia
- Schizophreniform disorder
- Delusional disorder
- Brief psychotic disorder
- Psychotic disorder due to another medical condition
- Substance-medication-induced psychotic disorder
- Unspecified schizophrenia spectrum and other psychotic disorder
- Other specified schizophrenia spectrum disorder and other psychotic disorder
Bipolar disorder and psychosis
Bipolar disorder is often considered a mood disorder that causes extreme mood swings of mania and depression. A person with bipolar disorder may experience symptoms of psychosis, especially in connection with a mania episode, which is only present in people with bipolar I disorder.
Stress is known for precipitating psychotic episodes in bipolar disorder. This factor may be partly attributed to early life stressors like childhood trauma and early dysfunction in biological systems. Moreover, being exposed to stress at critical points in life, such as childhood, is associated with "the development of the brain dysfunction that represents psychosis vulnerability."
Psychosocial stress
According to findings, individuals with psychosis "tend to experience high levels of psychosocial stress and social withdrawal"—factors linked with increasing the risk of a relapse of psychosis.
Moreover, stress has been implicated in the onset and worsening of psychotic symptoms. A systematic review examining evidence of psychosocial stress, interpersonal sensitivity, and social withdrawal in people identified as Clinical High Risk (CHR) indicates that "greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis."
Stress and psychotic symptoms
The role of stress in inciting symptoms of psychosis— within or without mental disorders—has been noted by researchers.
Recent studies suggest that high stress levels are associated with increasing psychotic symptoms in clinical and non-clinical populations. These studies also indicate that "perceived stress and coping styles can be critical factors affecting the association between cognitive biases and psychotic-like experiences." Cognitive biases refer to one's subjective perception of reality. Researchers also note that more adaptive coping strategies are linked with reducing attenuated psychotic experiences. A coping strategy may be considered adaptive when it focuses on problem-solving and cognitive reconceptualization.
Psychosis treatment
Treatment of psychosis often involves a combination of psychotherapy (talk therapy), antipsychotic medications, self-help groups, family intervention, and other approaches, such as rehabilitation for psychosis.
Cognitive-behavioral therapy (CBT) is an evidence-based treatment approach specifically geared toward reexamining the way one thinks and behaves and finding healthy ways of coping with stressors. CBT has been found to address a wide range of mental health conditions, including bipolar disorder and psychotic disorders, alleviating symptoms and improving functioning.
Ways to manage stress
Stress can also be managed independently alongside treatment as a psychosis prevention method. Below are a few stress-relief activities to try:
- Exercising to alleviate the intensity of certain emotions and clear the mind
- Keeping in touch with friends, family, and significant people in your life
- Participating in hobbies or activities you enjoy
- Avoiding unhealthy habits, such as drinking excess coffee and alcohol
- Seeking out nature to unwind—Spending time in nature has been proven to reduce stress and anxiety. One study suggests that 20 minutes in nature can reduce stress hormone levels.
- Taking a yoga class
- Trying deep breathing exercises
- Practicing mindfulness meditation to be more grounded and present—Numerous studies have linked mindfulness meditation with the ability to reduce stress and foster mental health.
- Taking a hot bath or shower
- Aiming to get at least seven to nine hours of sleep
- Eating nutritious meals
Therapy for stress reduction
If you or someone you know are experiencing symptoms of psychosis, a physical and psychiatric evaluation can be valuable. Sessions with a therapist can also be supportive, as a therapist can help you manage stress and increase your toolbox of coping strategies to manage symptoms. They may also help you integrate approaches like mindfulness into your life.
Online therapy through platforms like BetterHelp can be convenient for some people. These platforms allow clients to speak with a licensed therapist by phone, video, or in-app messaging. Therapists working through online platforms often specialize in cognitive-behavioral therapy, an approach that is considered a gold standard for addressing mental health conditions and symptoms of psychosis.
One study suggests that "online interventions are both feasible and acceptable to individuals with psychotic disorders and may be effective in assisting with clinical and social outcomes." The same study noted that online therapy is associated with a reduction in psychotic symptoms.
Takeaway
Severe stress is known for negatively impacting mental health. Psychosis can affect anyone under certain circumstances and may sometimes be caused by severe stress or traumatic events. In these cases, an individual might be living with brief psychotic disorder. Brief reactive psychosis refers to psychosis stemming from an event or situation that might be considered traumatic for others under similar circumstances.
There are various ways to reduce stress, including spending time in nature and practicing mindfulness meditation. A person experiencing stress-induced psychosis may also receive treatment in the form of antipsychotic medication, psychotherapy, and therapeutic approaches.
Reach out for a physical and psychiatric evaluation if you're experiencing symptoms of psychosis. A therapist can also help you manage symptoms you may be experiencing, fostering your ability to cope with stressors.
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