Post-traumatic stress disorder (PTSD) is a serious anxiety disorder that you can experience after experiencing trauma. It can cause nightmares, intrusive thoughts, and flashbacks to the event. But can PTSD symptoms cause psychosis and symptoms like hallucinations or delusions? PTSD psychosis may not be common for people with post-traumatic stress, but it may be a symptom of a severe disorder.
Why Does PTSD Happen?
A traumatic event often triggers post-traumatic stress disorder (PTSD). It’s normal for people to experience distress after trauma that eventually fades. But PTSD causes you to experience lasting mental distress, such as anxiety, flashbacks, and nightmares, even long after the event has ended. Many PTSD symptoms cause you to relive your trauma in nightmares, flashbacks, or intrusive thoughts. These are called intrusions symptoms, according to the DSM-5, which can include:
- Distressing and involuntary thoughts and memories of the traumatic event. Children may act out these memories in play.
- Distressing dreams related to the traumatic event or those that make you feel like you did during the event.
- Flashbacks or dissociative episodes when you feel like you’re re-experiencing the traumatic event. In severe flashbacks, you may be completely unaware of your surroundings.
- Psychological distress when you’re confronted by something that reminds you of the traumatic event.
- Clear psychological reactions to things that remind you of the traumatic event.
PTSD can lead to behavioral changes as it progresses. Avoidance is a common behavioral change. As you experience more and more psychological distress, you may start to avoid people, places, or activities that remind you of the traumatic event or cause PTSD symptoms. Another symptom is hypervigilance, which is when you are constantly alert and on edge. You may also have increased reactivity to external events. For instance, you may be irritable and prone to angry outbursts, you may be easily startled, and your response when startled may be exaggerated.
There is a wide range of PTSD symptoms, and not everyone will experience the same set of symptoms. Other PTSD symptoms may include:
- Reckless behavior
- Concentration problems
- Insomnia and sleep issues
- Frequent nightmares
How Does PTSD Happen?
PTSD is caused by a frightening, disturbing or stressful event. It can be caused by a single traumatic event or a period of high stress in your life. Some common causes include:
- Participation in a military battle
- Natural or accidental disasters
- Physical assault
- Sexual assault
- Car accidents
- High-stress jobs
- Serious health problems
- Severe injuries
- Childbirth, especially losing a baby
It’s unclear why some people experience PTSD after experiencing trauma while other people don’t. But it’s likely caused by several factors working together, including genetics, development, and environment. Your exposure and response to a traumatic event can also play a role. When it comes to first responders, PTSD seems to be more likely if people spend more time near the scene of a traumatic incident. For instance, emergency workers that limit time near the epicenter of a disaster may be less likely to develop PTSD.
What you do after experiencing trauma can also influence your risk of developing the disorder. Watching news coverage of a traumatic event after you experience it firsthand may increase your likelihood of PTSD. Conversely, discussing the event with a therapist soon after it happens may help. Peer support can also be helpful following a traumatic event.
What Is Psychosis?
Psychosis is a break from reality that makes it so that it’s hard to tell the difference between what is real and what is imagined. There are two major hallmarks of psychosis: hallucinations and delusions.
Hallucinations involve seeing and hearing things that aren’t actually there and that other people can’t see and hear. Hallucinations can be subtle, like seeing something in the corner of your eye or hearing a voice in your head. But they can also involve fully imagined people and conversations.
Delusions involve false beliefs despite logic or evidence to the contrary. For instance, a delusion can cause you to believe the meteorologist on TV is sending you secret messages. There a several types of delusions, including:
- Grandiose. Delusions of grandeur involve the belief that you are especially gifted, good, or powerful beyond what is reasonable.
- Erotomanic. Eromanic delusions involve the belief that someone is in love with you, even if you barely know each other or have never met. This often involves famous people you believe will contact you.
- Jealous. This often involves a spouse or partner. You may believe they’re being unfaithful, whether or not you have reason to believe it.
- Somatic. Somatic delusions are the belief that you have some sort of medical issue or physical defect. This can lead to anxiety about your health and well-being.
- Persecutory. This delusion causes you to believe you or someone you’re close to is being treated poorly or persecuted. You may believe you are being oppressed by powers beyond your control or that there’s someone who’s out to get you.
- Mixed. Mixed delusions involve multiple types of delusions that are experienced at the same time and may be interconnected.
Delusions and hallucinations are both called positive symptoms of psychosis. That doesn’t mean they are good. Rather, positive refers to something that’s being added to your normal experience. However, psychosis is also associated with negative symptoms, which means that something is taken away. Negative symptoms include flat affect, monotone voice, lack of interest in things around you, and a loss of motivation.
Are Flashbacks Psychosis?
Flashbacks are psychological symptoms of PTSD that involve dissociative episodes in which you mentally relive a traumatic event. Flashbacks can be momentary reminders of the event, like flashes of an image in your mind. You may be aware of your surroundings, but you can’t stop picturing an intrusive image. In other cases, flashbacks can be more extreme, causing you to be completely unaware of your surroundings as you relive the traumatic experience in your mind.
Dissociative episodes are thought to be mental defense mechanisms that help you deal with a traumatic event as it’s happening. It involves the feeling of an out-of-body experience, or like there is a barrier between you and the real world. Under normal circumstances, dissociation occurs during a traumatic event and ends soon after it begins. In those cases, dissociation is considered to be a normal function of the brain and not a mental health problem.
However, sometimes trauma can cause dissociation to continue to occur long after the event is over. Then it can contribute to mental health problems, such as dissociative disorders or PTSD. A PTSD flashback can cause dissociative symptoms that fall into two categories: depersonalization and derealization.
Depersonalization is the feeling of being detached from your body. You may feel like you’re an outside observer of what’s going on around you. This is often called an out-of-body experience. Derealization is the feeling that the world around you isn’t real. It may feel like you’re in a dream or that there is distance or barriers between you and the world.
Is Dissociation Psychosis?
The dissociation that comes with flashbacks can make for a strange experience, but dissociation isn’t usually considered a psychotic symptom. The key difference between psychosis and dissociation is the awareness of what’s real and what’s not. Dissociation can cause people to have a strange sensation that the world around them isn’t real or that they are detached from their bodies, but they are still aware of what is real. Someone with psychotic symptoms is not aware of what is real and what is not, and psychosis is characterized by a break from reality.
Most of the time, PTSD flashbacks involve momentary disruptions that remind you of the traumatic event, like a moment playing on a loop in your mind. People who experience them are aware that the flashback isn’t real. However, some severe cases of flashbacks can cause you to feel like the flashback is actually real. In those cases, people may behave and take actions as if they are in real danger, which can be dangerous. While PTSD is not a psychotic disorder, a person with PTSD may also experience psychosis during severe flashbacks. However, that’s out of the ordinary for most people with PTSD.
Anxiety and Psychosis
PTSD is a form of anxiety, and it can cause many symptoms consistent with anxiety, such as insomnia, worry, social problems, and other issues. In some cases, severe mental health issues like anxiety and depression are associated with psychotic symptoms. These psychotic episodes are considered distinct from other issues that cause psychosis, such as schizophrenia, if they are associated with the escalation of an issue like depression.
A common disorder that can cause psychotic symptoms with anxiety is bipolar disorder. Bipolar disorder is a mood disorder like depression, but it can cause very high moods called mania. A manic episode is a high mood that can also come with anxiety, paranoia, and restlessness. Severe mania can lead to delusional thinking, especially paranoid delusions and delusions of grandeur.
A 2012 study found that instances of psychotic symptoms with anxiety and depressive disorders may be common, and the line between psychotic disorders and other mental health problems may not always be clear. Severe anxiety caused by PTSD could lead to psychotic symptoms, especially if flashbacks blur the line between what is real and what isn’t.