Types Of Psychotic Disorders: Schizophrenia, Delusional Disorder, And Others

Psychotic disorders are mental health conditions that involve the experience of psychosis, a symptom characterized by a disconnect with reality. There are several different types of psychotic disorders, some of which are lifelong conditions and others that are short-term illnesses related to external events or substances. It’s estimated that around three in 100 people will have a psychotic episode at some point in their lives. Understanding the symptoms of psychosis and associated disorders can be helpful so that you can seek treatment if you or a loved one experiences them.

What is psychosis?

Psychosis is a mental health symptom that disrupts a person’s thoughts and perceptions, resulting in trouble understanding what is real and what is not. It’s a mental state that can manifest as a variety of different behaviors depending on the individual and their circumstances, but it broadly takes the form of the following:

• Hallucinations, or sensory perceptions not linked to actual external stimuli, such as hearing voices that no one else can
• Delusions, or illogical belief systems not grounded in reality, such as believing others can read one’s mind
• Disorganized thinking, which can take the form of unconnected thoughts, jumbled speech, and erratic behaviors

Psychosis is not a mental illness on its own. Instead, it’s a common symptom of many different mental illnesses. If you’ve noticed potential warning signs of psychosis in yourself or a loved one, it’s usually important to seek professional support right away. 

Types of psychotic disorders

There are several different types of mental health disorders that always or sometimes include psychosis as a key symptom. While the list below is not exhaustive, it includes several of these conditions.

Schizophrenia

Schizophrenia is a disorder that is perhaps most commonly associated with symptoms of psychosis. Schizophrenia tends to manifest as all three core psychosis symptoms (hallucinations, delusions, and disorganized thoughts) as well as:

• Difficulty reading other people’s tone and facial expressions to determine emotions, reactions, and motivations
• Inability to perform basic tasks, such as remembering to feed oneself
• Withdrawal from social situations
• Lack of awareness that any aspect of one’s own behavior may appear bizarre or disturbing to others
• Flat affect
• Absence of impulse control
• Suicidal thoughts or tendencies

If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.

Schizophreniform disorder

Schizophreniform disorder is a less severe form of schizophrenia. While schizophrenia is considered to be a lifelong condition, symptoms of schizophreniform disorder last between one and six months. It usually manifests as many of the same psychotic symptoms of schizophrenia, but these symptoms can be present to a lesser degree and, again, over a shorter term. It’s also possible for someone with schizophreniform disorder to experience some psychotic behaviors associated with schizophrenia but not others, such as hallucinations but not disorganized speech, delusions but not abnormal or bizarre movements, etc. 

Brief psychotic disorder

Like schizophreniform disorder, brief psychotic disorder is defined by the period in which a person experiences psychotic symptoms. For a brief psychotic disorder diagnosis to be considered, psychotic symptoms must last more than one day but less than one month. The three subtypes of brief psychotic disorder can be distinguished in the following ways:

• Presenting with an obvious stressor (also known as brief reactive psychosis): when psychotic symptoms are related to a recent traumatic event, such as the death of a loved one, being sexually assaulted, or surviving a natural disaster
• Presenting with no obvious stressor: when psychotic symptoms are unrelated to any identifiable cause or precipitating event
• Occurring with postpartum onset: when psychotic symptoms occur after giving birth, typically within one month

Bipolar disorder

Bipolar disorder is a type of mood disorder where a person may experience clinically significant shifts in mood, including episodes of depression and episodes of mania. There are different types of bipolar disorder according to how often a person may experience manic or depressive episodes and how severe the episodes are. 

The American Psychological Association defines mania as “a state of excitement, overactivity, and psychomotor agitation, often accompanied by over-optimism, grandiosity, or impaired judgment.” It may also manifest as impulsive decision-making and risky behavior. In over half of people with bipolar disorder, mania also has the potential to result in psychosis. (Psychotic symptoms can also happen as a result of depression, though this seems to be less common). Potential warning signs that a manic episode may be evolving into a psychotic episode include reduced social contact, suspicions of other people, difficulty concentrating, and a decline in personal hygiene and/or performance at work or school. 

Schizoaffective disorder

Schizoaffective disorder is another type of mental illness with psychotic features. It generally manifests as a combination of symptoms of schizophrenia and symptoms of a mood disorder— typically those related to major depressive disorder or bipolar disorder. It differs from bipolar disorder with mania-associated psychosis in that it features psychotic symptoms fairly consistently. While someone with bipolar disorder may occasionally experience psychosis during a severe manic episode, someone with schizoaffective disorder will tend to consistently experience psychotic symptoms in addition to symptoms of a mood disorder. 

Substance-induced psychotic disorder

Substance-induced psychotic disorder involves symptoms of psychosis brought on by using a specific substance, which typically disappear after ceasing its use. While this type of psychotic disorder is often associated with illicit street drugs, substance-induced psychosis can also be a side effect of some prescription medications. Psychotic symptoms may be linked to intoxication from the substance or withdrawal from it. 

Substance-induced psychotic disorder can be difficult for clinicians and mental health professionals to diagnose, especially if they don’t know the patient’s medical and psychiatric history. It’s not always clear whether an individual’s psychotic symptoms would still be present even without their substance use—e.g., if a person has schizophrenia but also happens to be using psychoactive substances.

Many people with symptoms of this disorder may be under the influence of multiple substances, which is another reason that the origin of their symptoms may be muddled. In terms of illicit substances, substance-induced psychotic disorder is most commonly caused by the use of methamphetamine, cocaine, and/or other stimulants. It’s also important to note that research indicates that people who demonstrate psychotic symptoms after substance use—particularly the use of methamphetamine—may be more likely to develop certain psychotic disorders such as schizophrenia in the future. 

The SAMHSA National Helpline for support with substance misuse is available 24/7 and can be reached by calling (800) 662-4357.

Delusional disorder

Delusional disorder is a psychotic disorder in which the only symptom a person experiences is the presence of one or more delusions that can’t be explained by another condition, lasting for a month or more. People with delusional disorders tend to be more high-functioning than people with other types of psychotic disorders. They are usually able to interact with others in a more typical manner as long as the subject of their delusion does not come up in conversation. However, in some cases, people with this disorder may become so fixated on their delusion that it impacts their daily functioning and ability to navigate the world. 

Treatment for psychotic disorders

Treatment for symptoms of psychosis depends on the individual, their unique symptoms and diagnosis, and other aspects of their overall health. That said, antipsychotic medication is usually suggested to help get psychotic symptoms under control. Some form of therapy is usually recommended in tandem with medication to help a person learn to build healthy habits to manage symptoms and stick with treatment. In severe cases, a person may need to be hospitalized during a psychotic episode in order to help them stabilize to minimize harm.

Seeking out compassionate mental health support

Experiencing symptoms of a mental health condition or seeing a loved one experience them can be emotionally difficult. If you’re looking for support, you might consider meeting with a therapist. Note that symptoms of psychosis generally require immediate, in-person care. However, adding a therapist to your care team for ongoing support or management is often recommended. They can offer a safe space where you can express your emotions without judgment, get support in recovery or the long-term management of any illness you may be living with, and learn healthy coping mechanisms for difficult feelings or symptoms. If you have a loved one who is living with a serious illness, a therapist can also represent a powerful source of support for you so that you can be there for this person.

Regularly commuting to in-person therapy appointments isn’t possible for everyone, whether it’s because they live in a rural area with few healthcare options or because they have a busy schedule or trouble traveling due to cost, time, or a disability. In cases like these, online therapy can represent a more convenient option. Again, although those experiencing a psychotic episode are advised to seek immediate, in-person care first, online therapy can be a valuable component of ongoing care. With a platform like BetterHelp, you can get matched and meet with a licensed therapist via phone, video call, and/or in-app messaging from the comfort of home. Research suggests online therapy may offer similar benefits to in-person therapy in many cases.