Awareness In Psychotic Disorders: Can You Be Aware Of Your Own Psychosis?

A common misconception is that someone with an altered perception of reality—such as an individual experiencing psychosis—can’t recognize their compromised mental state. While this may sometimes be the case, it’s not necessarily the rule. In some instances, it can be possible for a person who experiences psychotic symptoms to build an awareness of their mental state during these times through various treatment methods. Read on to learn more about what psychosis is, how it can affect perception, and approaches that may help a person build self-awareness in order to better adhere to treatment for psychotic disorders.

What is psychosis, or a psychotic episode?

Psychosis is not a standalone, diagnosable mental illness. Instead, it can be thought of as a group of psychological symptoms like delusions, disorganized thinking and speech, and hallucinations, which usually indicate an altered perception of oneself and the world. It’s also a symptom in and of itself. An episode of psychosis may occur once, such as due to severe and prolonged mental stress, or more than once as a result of a physical or mental health condition. Below, we’ll explore in more detail what exactly can trigger psychosis, but psychotic disorders like schizophrenia are a common cause.

Onset of a psychotic illness usually occurs during the late teenage years through the mid-20s. Early diagnosis and intervention, and ongoing treatment can have significant implications, potentially dramatically improving the long-term prognosis of someone with such a disorder. 

If you begin to experience the early warning signs of psychotic episodes, it can be crucial to seek the support of a licensed mental health professional as soon as possible. For signs of acute psychosis, immediate hospital treatment may be necessary.

How do common psychotic symptoms affect perception? 

When someone’s connection to reality breaks, it can drastically alter how they experience and perceive their surroundings. Let’s explore some key signs of psychosis in order to better understand why it can be difficult to be aware of it when experiencing these symptoms—such as hallucinations, delusions, confused thinking, and others.

Hallucinations

Hallucinations are sensory experiences that involve stimuli that aren’t physically there. They can manifest as sights, sounds, tastes, touches, and smells or involve more than one sense. Auditory hallucinations tend to be the most common type, with many people reporting hearing voices or incoherent sounds others can’t perceive. 

It can be critical to note that hallucinations usually appear and feel very real to the person experiencing them, which makes learning to recognize them more of a challenge—though it’s not impossible. With a developed sense of self-insight and an ongoing focus on their own mental state, people with schizophrenia and other psychotic disorders may be able to learn to recognize when they’re having or are about to have a hallucination, potentially lessening its impact. 

Delusions

Delusions can be defined as unshakable beliefs in things that aren’t true, such as believing the government can monitor your thoughts through the television or that a celebrity you’ve never met is obsessed with you. When you lack the insight to recognize that a current cognitive pattern isn’t sound, it can be challenging to identify delusional thinking. Somatic delusions are also possible, such as mouth delusions, or feeling an oral sensation that has no physical cause.

Disorganized or confused thoughts and speech

When your mind disconnects from reality, thought patterns can devolve into chaos, making it difficult to settle into linear thinking and communicate in a logical manner. A person may jump from one thought to another without finishing an idea, and others may struggle to understand them. 

Negative symptoms

Psychosis can affect one’s functional ability in many areas of life. Negative symptoms in this context refer to diminished normal behaviors or the absence of them. For example, an individual experiencing psychosis may talk, think, and move more slowly, demonstrate less significant emotional responses, withdraw from social contact, or lose interest in things they used to enjoy. These are in contrast to positive symptoms, which represent an excess of normal functioning.

Catatonia

Some people with advanced psychosis may experience catatonia, where the disconnection with reality becomes so strong that they are unaware of and unresponsive to their surroundings or stimuli. Catatonia can present as very little to no reaction to the world around an individual, or it may involve unexpected behavioral irregularities. At this point, it can be nearly impossible for an individual to recognize that they’re experiencing psychosis.

What can cause psychosis and related mental health conditions?

Psychosis can be caused by a number of potential factors or conditions, from giving birth to a baby (as with those who have developed postnatal psychosis) to sustaining a head injury to having a lifelong psychiatric disorder. Experts also believe that certain environmental factors and genetic markers may increase a person’s risk of experiencing psychosis—such as experiencing a traumatic event or having a family history of schizophrenia.

Examples of potential causes of psychosis include:

• Certain physical illnesses, such as malaria, lupus, and metabolic syndrome
• A brain injury
• Some neurological conditions, like Parkinson’s disease
• Extreme, prolonged mental stress
• Substance or alcohol use and addiction
• Medication- or substance-induced psychotic disorder
• Schizophrenia
• Schizoaffective disorder
• Schizophreniform disorder
• Schizotypal personality disorder
• Postnatal psychosis, or puerperal psychosis
• Shared psychotic disorder
• Severe depression
• Severe forms of bipolar disorder

Remember, seeking treatment for signs of psychosis right away can be paramount to both short-term safety and long-term treatment outcomes. In the case of postnatal psychosis (also called puerperal psychosis) for example, birthing parents are at risk of suicide and of harming their children without treatment. It’s estimated that a postnatal psychosis affects birthing parents in only around two of every 1,000 births and most other psychotic disorders are similarly rare, but being familiar with the signs nevertheless can be potentially life-saving.

Can you be aware that you’re experiencing psychosis?

That said, many people who experience psychosis as a result of schizophrenia, for example, experience anosognosia, or a lack of insight or awareness of one’s own symptoms. Anosognosia can make it difficult for a person to recognize they’re experiencing things outside of the “norm,” including hallucinations or delusions. This phenomenon is one reason why schizophrenia can be challenging to diagnose and treat, as many with the condition are unaware that they’re experiencing symptoms and could benefit from seeking treatment.

Researchers suggest that a lack of insight concerning one’s own psychosis may be an aspect of the illness’s progression rather than a predictor of its outcome. The details indicate that insight may interact with the natural course of a person’s mental illness, influencing their understanding of themselves and those around them.

Treatments for improving symptom insight when living with psychosis

According to a recent review of several psychological studies on psychosis and how various treatments may affect a person’s awareness of its symptoms, it may be possible to increase one’s insight—or awareness of symptoms currently being experienced—while living with a psychotic disorder. Since a person may be more likely to stick to their treatment regimen (i.e., taking medications, attending appointments) if they’re aware of their symptoms, increasing insight can be important in promoting better treatment outcomes. Options that may help promote insight include:

• Psychoeducation
• Cognitive behavioural therapy (CBT)
• Family therapy, which can equip loved ones with communication, coping, and conflict-resolution skills to help manage symptoms
• Couples therapy, which could help partners find ways to support each other and communicate when symptoms of psychosis arise
• Group therapy
• Prescription antipsychotic medications
• Transcranial direct current stimulation (TDCS)

Getting support for a mental health condition

If you experience signs of psychosis, it’s usually important to meet with a doctor or psychiatrist in person right away for an initial assessment, evaluation, and treatment. Once they’ve helped you establish an effective treatment plan, you may find it useful to add sessions with a therapist to your care regimen. They can help you understand your symptoms, learn to recognize situations that may be triggering and signs of an episode and develop healthy coping mechanisms for living with mental health challenges.

Those who are hesitant to add regular in-person therapy appointments to their schedule or who can’t find a suitable provider nearby may find it convenient to pursue online therapy instead as part of their broader treatment plan. With an online therapy platform like BetterHelp, you can get matched with and meet with a licensed therapist from anywhere you have an internet connection. 

More research regarding the efficacy of online therapy for those experiencing schizophrenia and other psychotic disorders is needed. However, existing studies suggest that online therapy for treating mental health concerns in general is typically as effective as in-person therapy. It may be best to speak with your doctor or psychiatrist first if you’re interested in adding virtual care to your treatment plan.