The Psychology And Neurology Of Trauma-Induced Psychosis
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Traumatic events can be difficult for the human mind to process and recover from, and they may have long-lasting negative effects on mental health. One of the many potential consequences of trauma may be an increased risk of developing psychotic symptoms. The exact mechanisms involved have not yet been fully explained, but investigating them has revealed a great deal about stress, human development, and the origins of psychotic illness. This article will review what current research can tell us about the links between trauma and psychosis.
Experiencing psychological trauma during childhood is a known risk factor for psychotic disorders like schizophrenia. In addition, researchers have found considerable overlap between this mental illness and other trauma-related conditions, like PTSD. This may be partly due to the body’s inflammatory immune responses, which tend to become overactive when faced with severe mental or physical stress. The resulting wear and tear on the brain might be partly responsible for the emergence of psychosis. Both trauma and psychosis symptoms can be addressed with professional support.
PTSD and psychosis
Mental health professionals have long understood that traumatic experiences can be linked to mental disorders. The most well-known example may be post-traumatic stress disorder (PTSD), in which a person generally becomes prone to severe emotional and physiological distress following a highly disturbing experience. Characteristic symptoms of PTSD include the following:
- Re-experiencing events (“flashbacks” to the inciting traumatic occurrence)
- Involuntary memories or distressing nightmares related to the experience
- Being easily startled, especially by reminders of traumatic events
- Emotional disruptions, such as mood swings, irritability, depression, or dissociation
- Impulsive, reckless, or self-harming behavior
- Tendencies to avoid places, people, or objects related to or reminiscent of past trauma
- Difficulty sleeping
- Persistent negative beliefs and feelings about oneself or the world
However, some people with PTSD also experience symptoms of psychosis — impairments in the ability to correctly perceive and understand what is real and what is unreal. Psychosis can involve both “positive” and “negative” symptoms.
Positive psychotic symptoms can include those discussed below:
- Hallucinations: Sensory perceptions of stimuli that aren’t present or don’t exist
- Delusions: False beliefs about reality that resist contradictory evidence
- Disorganization: Patterns of thought, speech, or actions without apparent logical coherence
Negative psychotic symptoms typically involve normal mental functions being diminished or suppressed, including the following:
- Anhedonia: Lack of pleasure or enjoyment
- Avolition: Diminished energy, desire, and motivation
- Blunted affect: Decreased emotional responsiveness
- Alogia: Reduced complexity and fluency of speech
- Asociality: Diminished interest in and capacity for social interaction
PTSD and other psychotic disorders
Symptoms of PTSD may be overlooked or simply mistaken for the effects of psychosis in individuals with disorders like schizophrenia. For example, a person with PTSD might be hypersensitive to danger and easily startled because of past trauma. However, a clinician who’s aware that the person has a diagnosed psychotic disorder might assume that their frightened responses are due to threatening hallucinations.
Some evidence indicates that the content of psychotic symptoms can differ between PTSD and other forms of psychosis. For instance, people with this condition seem to be more likely to experience frightening or paranoid hallucinations or delusions. Bizarre, grandiose, or religious delusions might be less common.
Trauma as a risk factor for psychosis
Even in the absence of PTSD symptoms, traumatic stress appears to increase the likelihood that a person will experience psychosis later in life.
This effect may be particularly strong when distressing events occur in childhood or adolescence. In recent surveys, over 80% of people with psychotic symptoms reported traumatic experiences before the age of 18.
In general, participants were more than twice as likely to have psychosis if they had a history of childhood trauma and more than four times as likely if they experienced multiple types of traumatic experiences. Past trauma also seems to increase the severity of psychotic symptoms.
In addition to increasing a person’s long-term susceptibility to psychosis, traumatic experiences might sometimes directly trigger psychotic episodes. The condition known as brief psychotic disorder — a period of acute psychosis lasting less than one month — may arise due to severe emotional difficulties following a traumatic event, such as an accident or the death of a loved one.
There are also case reports of people developing conditions like schizophrenia following sudden trauma.
Types of trauma associated with psychosis
Many kinds of traumatic experiences can lead to these effects. Though there haven’t been many studies examining the significance of specific forms of trauma, current evidence suggests that intentional harm, such as physical abuse or bullying, may have a greater impact on psychosis risk than others. Childhood sexual abuse also tends to be strongly associated with later-life psychosis.
Other kinds of trauma that might lead to psychosis include the following:
- Economic adversity
- Neglect from caregivers
- Migration at an early age
- Loss of a parent
- Severe injury or illness
How does trauma induce psychosis?
There are a variety of theories about how traumatic experiences might increase a person’s vulnerability to psychotic experiences. Some involve biological mechanisms like hormonal shifts and gene expression, while others focus on psychosocial factors, such as mood instability. These explanations may not be mutually exclusive. In real-world cases of trauma-induced psychosis, biological and mental effects may trigger and reinforce each other.
The HPA axis in trauma and psychosis
One explanation for the effect of trauma on psychosis is that an overactive stress response may interfere with brain development.
People with psychotic illnesses often show structural and functional deficits in the hypothalamic-pituitary-adrenal (HPA) axis. This network of brain structures and glands typically controls a wide range of functions, including learning, memory, emotion, and behavior control. The HPA axis also tends to be highly responsive to stress hormones like cortisol.
Excessive stress in childhood resulting from traumatic experiences could desensitize the HPA axis. Since this system normally controls the formation of many other brain regions, alterations to its function could interfere with healthy neurodevelopment. Studies have found links between decreased HPA reactivity and lower brain matter volume in areas associated with psychosis risk.
Immune response to traumatic stress
Chronic stress can trigger inflammation, the body’s response to disease and damage. While inflammatory mechanisms like swelling and heat production can help kill off pathogens, they can also damage or destroy cells or suppress bodily functions.
Researchers have found evidence that excessive inflammation within the developing brain may damage brain cells and disrupt the formation of neural connections. This could also contribute to the brain abnormalities associated with psychotic diseases like schizophrenia.
Psychological impacts of trauma
A systematic review published in 2021 analyzed the existing research on psychological mechanisms linking trauma to psychosis. They noted four distinct mental processes arising from traumatic experiences that were significantly associated with psychotic symptoms.
- Dissociation: Dissociation generally refers to mental detachment from various aspects of reality, such as emotional responses, bodily sensations, or the events occurring around you. Dissociation can be a common coping mechanism in cases of childhood abuse or neglect, but this sense of disconnection from reality may contribute to false perceptions, such as auditory hallucinations.
- Emotional dysregulation: Disturbing experiences in childhood may interfere with the healthy development of emotion regulation skills, potentially leading to unstable moods and physiological responses. Poor emotional regulation may lead to hallucinations and paranoid delusions as the mind searches for reasons to explain its sudden emotional shifts.
- Negative beliefs and mental frameworks: Children who experience abuse, neglect, or other forms of trauma often form dysfunctional beliefs about themselves and others in an attempt to make sense of what’s happened to them. These maladaptive ideas may feed into delusions and paranoid thinking later in life.
- PTSD symptoms: Some psychological responses to PTSD may involve suppressing challenging memories or perceptions that remind them of trauma. These suppressed sensory impressions might intrude on an individual’s mind without any sense of connection to their felt identity, causing them to be perceived as threatening hallucinations.
Trauma-informed treatment for psychosis
Emerging research suggests that therapies focused on relieving the psychological effects of trauma, such as exposure therapies, may be helpful for people with psychosis. Though early results are still mixed, some studies have found evidence that these kinds of therapies can relieve symptoms like depression and anxiety. A few trials have also shown positive effects on psychotic symptoms.
Finding a therapist with whom you have a robust personal connection can increase the chances that you’ll experience improvement with psychotherapy. However, achieving this kind of trusting rapport may be challenging for people with psychotic symptoms and a history of interpersonal trauma. Online therapy platforms may make this easier by connecting you with a larger range of possible treatment providers, increasing your chances of finding one who works well with you.
Evidence suggests that internet-based therapies can benefit those recovering from traumatic experiences. For example, a 2019 study found that online cognitive behavioral therapy (CBT) could be as effective as face-to-face treatment at relieving PTSD symptoms. Interventions with a focus on trauma tended to show particularly strong effects.
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