What is the relationship between trauma and psychosis? Data suggests that psychosis frequently co-occurs with trauma, including PTSD. Since CDC and Kaiser Permanente first published the Adverse Childhood Experiences (ACE) study in the 1990s, there has been a greater understanding of the relationship between traumatic events in childhood and poor mental health outcomes in adulthood. One of these outcomes is the onset of psychosis, in which a person loses touch with reality. Psychosis is characterised by hallucinations and delusions, which can be confusing and frightening, and may be experienced as traumatic themselves.
Dialogues in Clinical Neuroscience reports that several population-based studies in recent decades suggest a strong link between childhood trauma and psychosis in adulthood. Until recently, much of the focus on the effects of childhood trauma has been on the development of psychiatric disorders such as anxiety disorders, eating disorders, dissociation, personality disorders, and substance use disorders. These are classed as non-psychotic disorders. Recent research suggests a much stronger link between trauma and psychotic disorders than previously understood.
What is Psychosis?
Psychosis is defined as a ‘loss of contact with reality’. It is not a condition itself but a symptom of another psychotic illness, such as schizophrenia. Psychosis is characterised by ‘positive’ and ‘negative’ symptoms. The terms positive and negative in this context do not mean ‘good’ and ‘bad’. They refer to how the symptoms are experienced. Positive symptoms are experienced in the form of arousal. In contrast, negative symptoms refer to a distinct lack of arousal, such as the inability to show or feel emotions. There are three primary features, or manifestations, of positive symptom psychosis. These are:
Hallucinations are a defining feature of psychosis. The person suffering sees and hears things that do not exist outside of their minds. Real sensory stimulus is absent, but the mind of a psychotic person struggles to differentiate between imagined sensory stimulation and real, external sensory information.
Delusions are false beliefs that do not reflect the person’s lifestyle, culture, or lived experience. Delusional thinking may cause a person to believe that others are out to get them, that they are being followed, or that someone they know has been replaced by someone else.
Delusions can be bizarre or non-bizarre, classified by how plausible the delusion is. For example, believing that someone you know has been replaced by someone else is a bizarre delusion, while believing that someone has stolen something from you or that a partner is cheating is considered non-bizarre.
A person who has psychosis may experience delusions of grandeur. They believe themselves to be of a certain importance or authority, of which they are not.
- Thought disorganisation
Thought disorganisation refers to disorganised and incoherent patterns of thought and speech. A person might experience racing thoughts, where thoughts and ideas arise and pass through the mind so quickly that they feel out of control. One might also experience a flight of thoughts and ideas, where they make connections between things that others do not.
Rapid speech and stumbling or stuttering can also happen in psychosis. Others may find it difficult to understand what the person suffering is trying to say due to how they use words and link sentences together.
Research on Trauma and Psychosis
“There is a strong association between different types of trauma and later psychosis”, explains Stanley Zammit, a psychiatric epidemiologist at the University of Bristol. The ACE Study and subsequent studies have found that patients struggling with schizophrenia and other psychotic disorders generally report experiences of abuse in childhood more often than those who do not suffer from a psychotic disorder.
“The more trauma a child experiences, the more likely they will have physical problems, including chronic physical conditions like obesity and heart disease, later in life. The same goes for mental health issues like depression and even schizophrenia”, explains Vincent J. Felitti, whose discoveries while running a weight loss program led to the launch of the ACEs program.
In the weight-loss program, Felitti investigated why so many participants were dropping out despite successful outcomes. He found that the reversal of obesity and overall health improvement awoke earlier trauma in some of the participants. Their obesity, it seemed, developed from an attempt to suppress certain feelings and memories, in this case using food. When this maladaptive coping mechanism was stopped, their earlier trauma had resurfaced, and they were not prepared to process it.
In light of the weight loss program and Felitti’s discovery, it becomes clear that health care and treatment programs should be trauma-informed. Regarding psychosis. Treatment must account for the presence of ACEs in a person’s childhood so that appropriate treatment can be provided.
Toxic Stress, Inflammation, and the Development of Psychosis
Exposure to trauma in childhood can create toxic stress in the individual. The body is designed to handle stress in small amounts. If the body’s stress response is activated for too long, as happens following many types of trauma, stress becomes toxic and jeopardises our overall health. One way stress leads to poor health is through inflammation. The prolonged release of cortisol, norepinephrine, and adrenaline can cause inflammation in both the brain and body.
Psychosis and psychotic disorders have been linked to inflammation in the brain. While more research is needed in this area, current findings offer hope for more effective treatment approaches based on improving physical brain health and reducing inflammation.
PTSD and Psychosis
In individuals with psychotic disorders, there is a high risk of repeated traumatisation throughout the lifespan. Early childhood trauma contributes to the development of psychotic disorders, but throughout the lifespan, there may be multiple instances of further traumatisation. Social stigma, vulnerability to interpersonal victimisation, repeated involuntary hospitalisation and restraint, and the experience of psychotic experiences can all easily be perceived as traumatic and further complicate a person’s mental health and well-being, often leading to the onset of post-traumatic stress disorder (PTSD).
Research published in Child Abuse & Neglect, and later research published in Social Psychiatry and Psychiatric Epidemiology, links childhood sexual abuse to hallucination and delusions in later life, in which the theme of the hallucinations delusions are linked to traumatic experiences themselves.
Although PTSD assessments and evaluations usually focus on symptoms such as avoidance, anxiety, hyperarousal, and negative thinking, it is also well-known that PTSD is ‘frequently accompanied by psychiatric symptoms such as hallucinations and delusions.’
Treatment for Trauma and Psychosis
Psychosis can happen to anyone. Those with an ACE score of one or higher are at a greater risk of experiencing psychosis than those with no ACE score. Assessment, treatment, and education should be provided as early as possible to those at risk of psychotic episodes and those who have experienced first-episode psychosis. If treatment is delayed, the person suffering may experience a range of problems, including suicidal thoughts, legal issues, and substance abuse.
Both trauma and psychotic symptoms must be identified and addressed for treatment to be successful. Treatment for psychosis is available and effective, but without addressing the trauma that contributed to psychosis in the first, treatment is less effective.
At Khiron Clinics, we specialise in treating trauma and co-occurring conditions. We evidence-based trauma treatment modalities to provide comprehensive trauma-informed care to each client. Please reach out to us today to discover more about our services. If you have a loved one suffering, we are here to help.
If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).