What You Might Not Know About PTSD: Psychosis And Paranoia

By: Abigail Boyd

Updated August 27, 2020

PTSD is a common behavioral health condition that can be debilitating and last for a long time if untreated. PTSD occurs in the aftermath of a traumatic event in which an individual either feared for their life or safety or that of someone else. Research has found a connection between PTSD and symptoms of psychosis, including paranoia, hallucinations, and delusions. But how often are these two conditions and what is the best course of treatment?

In this article, we'll provide information about each of these conditions and explore the connection between the two, as well as what treatments may be effective.

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What Is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition caused by an intensely fearful situation, such as participating in active combat, being in a car accident, or surviving domestic violence. A diagnosis of PTSD requires a specific trigger that led to the development of certain related symptoms.

The core symptoms of PTSD include avoidance, intrusive memories, emotional reactivity or numbness, sleep disturbances, panic attacks, hypervigilance, and dissociation. These symptoms may also lead to chronic low mood states and negative thinking patterns. PTSD symptoms can range from mild to severe and can get in the way of the sufferer's ability to lead a normal and fulfilling life. These symptoms indicate that the brain's fear response system has become effectively "stuck" in the on position, perceiving threats from relatively harmless stimuli and firing false alarms.

While not everyone will develop PTSD in the aftermath of a trauma, it is a common condition that affects up to 14 million adults in America. We're still learning exactly what leads to certain people developing the condition and not others. It appears to be partially related to genetics and individual vulnerabilities in certain brain structures.

Hyperactivity in certain parts of the brain, especially the amygdala, may put a person at risk for developing PTSD in the aftermath of a trauma. Dopamine, usually considered a chemical promoting reward and motivation, may also play a role in promoting anxiety and recognizing fear. Dysregulation in this area needs further investigation to understand the role it may play in PTSD and other mental health conditions.

PTSD was added to the DSM in 1980, though its symptoms had been recognized for decades before its official inclusion in the manual. Interestingly, while men are statistically more likely to have PTSD at some point in their lifetime, women are more likely to seek treatment.

For some people, psychotic disorders may occur secondary to PTSD symptoms. While the link between the two conditions is still being investigating, there is evidence of a connection.

What Is Psychosis?

Psychosis refers to a collection of symptoms that cause an individual to be disconnected from reality. Psychotic symptoms are grouped into two distinct categories: positive symptoms and negative symptoms.

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Positive symptoms are the addition of thoughts, behaviors, and mental states. The sufferer may have the awareness that these symptoms are representing things that are not real (referred to as "insight") or, in more severe cases, may not be able to differentiate between what is real and what isn't. Positive symptoms of psychosis include:

  • Paranoia: Paranoia refers to anxious thoughts that involve suspicion and distrust of other people, including people that the individual is close to, like family members and friends. You may feel like someone, or something is out to get you. You may think you're being followed or listened to, or you may have obsessive thoughts that someone is trying to conspire against you.
  • Hallucinations: A hallucination is the perception of something that is not real. Hallucinations can be visual, auditory, tactile (physical), or even a smell or taste. You may hear voices when there's no one around, smell a scent with no apparent source, or see shadowy figures that don't exist.
  • Delusions: A delusion is a belief that you hold on to despite evidence showing it is not true. An example of a delusion is if you believe that you can communicate with the characters on a TV show or that someone in the government has put a tracker in your car. Delusions can also be present on a smaller scale, such as the feeling that someone is watching you at all times.

Other positive symptoms are sometimes apparent, including racing thoughts, agitation, aggression, and fast speech.

Negative symptoms, on the other hand, represent a loss of functioning for the individual. Negative symptoms include a severe loss of motivation, emotional withdrawal, dissociation, apathy, social withdrawal, and other symptoms. Negative symptoms are seen less frequently with PTSD, but their presence can complicate the progress of treatment.

The Connection Between PTSD And Psychosis

Over the last few decades, research has begun to piece together the connection between PTSD and psychotic disorders. Lifetime rates of comorbid psychotic disorders in those with PTSD are estimated at 30%, versus less than 8% in the general population. One study of over 5000 people in the US showed 52% correlated PTSD and psychotic symptoms.

Positive symptoms are the ones most frequently identified as being connected to PTSD, although negative symptoms are sometimes reported in patients who have had PTSD for an extended period.

Trauma would be a risk factor for both conditions, especially if the trauma occurred early in life. Childhood trauma has a strong connection with both PTSD and psychotic disorders.

Trauma can trigger an actual episode of psychosis or comparatively milder, transient psychotic symptoms. Symptoms may come and go and be related to the trauma in some fashion. Fear and anxiety are often reported to be direct triggers of positive psychotic symptoms.

Paranoia

Paranoia can cause an individual to lose trust in others and withdrawal socially, which can have a circular effect on symptoms of PTSD. Paranoia can make reaching out to others difficult. You may constantly overanalyze the motivations of other people and question whether they are telling you the truth. Paranoia can damage relationships and cause you to become isolated.

Hallucinations

Perhaps the most common symptom of PTSD related to psychosis is hallucinations. You may feel like you see or hear things that aren't there that are related to the trauma. Hallucinations can be correlated with, but are distinct from, flashbacks. These are episodes in which you feel like you're reliving the trauma.

Dissociation can also be related to these types of experiences, where you perceive a disconnect between yourself and the world around you.

Delusions

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Paranoia can become severe enough to become full-blown delusions. Delusions are usually related to the trauma in some fashion and can keep a person feeling as though they can't move on from the past. Delusions can be debilitating and difficult to let go of once they have become established.

Diagnosis by a qualified professional is essential to receiving proper treatment. A diagnosis will give you a clear picture of your condition and help you receive the best treatment.

How To Treat PTSD With Psychotic Symptoms

PTSD with comorbid psychosis may often indicate a certain level of severity. If the psychotic disorder is secondary to the PTSD, the latter is usually treated first. Seeking treatment is often the first hurdle to overcome at the start of recovery.

Preliminary research has shown that atypical antipsychotics may help alleviate symptoms of psychosis when comorbid with PTSD, but more investigation is needed to make a definitive statement on the effectiveness of this type of medication.

The presence of psychotic symptoms with PTSD may also be associated with a higher risk of depression. Depression is commonly treated with selective serotonin reuptake inhibitors (SSRIs).

Both PTSD and psychotic disorders can persist for a long time on a chronic basis. Treatment can help you effectively manage these conditions.

The Role Of Therapy

Psychotherapy is considered the first-line approach for PTSD, including that with comorbid psychosis. Cognitive behavioral therapy (CBT) has so far been found to be the most effective form of therapy for PTSD. A meta-analysis of CBT for schizophrenic patients found it to be effective at managing symptoms of psychosis.

Many different types of CBT have been used to help patients with PTSD treat their symptoms, with varying degrees of evidence to support their effectiveness. These include:

  • Cognitive Processing Therapy (CPT): CPT involves examining feelings, thoughts, and emotions related to the trauma. This information is processed with the support and guidance of the therapist.
  • Prolonged Exposure (PE): During PE, memories of the trauma are processed in the present in a safe environment with the therapist. The patient works on desensitizing the effect of certain triggers in incremental steps.
  • Behavioral Activation: This type of therapy, instead of focusing on processing and relieving the trauma, encourages activating positive behaviors with the idea that your feelings and thought patterns would change accordingly.

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Another type of therapy that is gaining attention for treating PTSD, among other conditions, is Eye Movement Desensitization and Reprocessing (EMDR). EMDR involves processing traumatic memories while performing certain eye-movement exercises that encourage positive brain stimulation. Once controversial, promising research has shown EMDR to be effective in improving the symptoms of PTSD.

BetterHelp can connect you with a therapist that will help you determine the best type of therapy to treat your particular condition. BetterHelp's professional online therapy is available whenever you need support to help guide you through the process of moving forward. A therapist can be your partner in navigating the journey to have a more fulfilling life.


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