The Connection Between Childhood Trauma And Schizophrenia Symptoms

The World Health Organization (WHO) estimates that 1 in 222 adults, or 24 million people globally, live with schizophrenia, a disorder characterized by hallucinations, delusions, disordered thinking, social withdrawal, and changes in emotion or behavior. While schizophrenia may not be as common as other mental health disorders, impacted individuals may face many challenges. One of these challenges can be finding the potential causes or connections that schizophrenia has to other phenomena, such as trauma. Childhood trauma may predispose an individual to develop schizophrenia later in life, and schizophrenia can sometimes be challenging to differentiate from trauma-related disorders, such as PTSD with psychotic features. However, both schizophrenia and PTSD are treatable, and symptoms may be managed with a combination of therapy and doctor-prescribed medication.

What is trauma? 

The American Psychological Association (APA) describes trauma as an emotional response to stressful events, including those that involve physical, sexual, psychological, and emotional harm. These responses may be characterized by emotional changes, relationship difficulties, flashbacks to the event, and physical symptoms, such as nausea or headaches.

Symptoms of post-traumatic stress disorder (PTSD)

Significant trauma may also result in a condition known as post-traumatic stress disorder (PTSD). PTSD may develop within several months of a traumatic event and can present with several different classifications of symptoms.

Avoidance symptoms

Individuals experiencing PTSD may avoid specific people, places, objects, or events that remind them of a traumatic experience. As a result, individuals with PTSD may make significant changes to their lives or routines. 

Arousal and reactivity symptoms

Individuals living with PTSD may experience a consistent sense of tension or irritability, which may result in emotional outbursts. These individuals may also have difficulty concentrating, falling asleep, or staying asleep, which can impact their ability to function in daily life. In addition, individuals with PTSD may engage in risky, reckless, or destructive behavior, which may have a variety of negative effects. 

Re-experiencing symptoms

Re-experiencing symptoms can remind a person of a traumatic event, either through memories, thoughts, or dreams related to a specific instance of trauma. One of the most well-known re-experiencing symptoms may be flashbacks, which can involve vividly reliving a traumatic incident. During a flashback, a person may experience:

• Partial or complete images of the traumatic event
• Physical sensations (including pain or pressure) 
• Sounds relating to the traumatic incident
• Rapid changes in mood
• Bodily reactions, such as increased heartbeat or sweating
• Confusion

Cognition and mood symptoms

Those with PTSD may experience a variety of cognitive and mood-related symptoms, which could lead to negative thoughts about themselves or others, a lack of interest in previously enjoyable activities, and ongoing feelings of fear, anger, shame, or guilt. These symptoms may cause a person to isolate themselves from friends or family, which may cause further harm. 

While trauma and PTSD usually have a clear and significant connection, those with schizophrenia may wonder what role trauma plays in their disorder, including whether trauma can directly lead to schizophrenia development. 

Are childhood trauma and schizophrenia connected?

Research on the link between childhood trauma and schizophrenia symptoms

In a 2022 systematic review, researchers analyzed data from 15 studies (from an initial 741 total articles) relating to schizophrenia, psychosis, and childhood trauma. The review found that individuals living with schizophrenia were usually 2.7 times more likely to have adverse childhood experiences (ACEs), or traumatic events that occur between birth and 17 years of age. These events may include those that involve experiencing or witnessing violence, abuse or neglect. ACEs may also relate to the environment in which a child grows up, specifically those that jeopardize a child’s sense of stability, safety, or bonding. Potentially traumatic environments may involve struggles with parental incarceration, substance use, or mental health challenges. 

How trauma and PTSD share a connection to psychosis

This systematic review also found that childhood trauma (whether it is related to ACEs or not) may result in more severe, persistent, and treatment-resistant psychotic symptoms. Childhood trauma could also impact neurobiological growth, leading to “vulnerable neurobiology preceding disadvantageous psychiatric outcomes.” Childhood trauma may have a stronger link to positive schizophrenia symptoms, such as hallucinations and delusions, than negative symptoms. The relationship may work in both directions, with evidence suggesting that those with PTSD may be five times more likely to be diagnosed with psychotic disorders than those without PTSD. This and other data may indicate that distinguishing schizophrenia and trauma disorders can be difficult. 

*If you or someone you know is experiencing abuse or domestic violence, reach out for help immediately. The National Domestic Violence Hotline can be reached 24/7 by dialing 1-800-799-SAFE (7233).

What is the difference between schizophrenia and PTSD?

In some cases, differentiating schizophrenia from PTSD can be difficult, particularly if an individual is experiencing PTSD with secondary psychotic features. These features may be similar to the positive symptoms of schizophrenia, including hallucinations, delusions, and disorganized thoughts or behaviors. Distinguishing certain symptoms of psychosis from traditional PTSD symptoms may also be challenging. For example, one of the hallmark symptoms of PTSD is flashbacks, which can involve re-experiencing sights, sounds, and feelings related to a traumatic event. Flashbacks may be similar to hallucinations, which can also involve auditory, visual, and tactile experiences that aren’t actually occurring at that moment. 

Seeking support from a mental health professional

For someone experiencing these symptoms, they may have trouble determining which condition they have, or if they might have both PTSD and schizophrenia. In order to distinguish between these disorders and receive a diagnosis, seek the assistance of a medical or mental health professional who can determine whether an individual is experiencing schizophrenia, PTSD, or PTSD with secondary psychotic features. Once diagnosed, a person may be able to find a treatment regimen that can alleviate symptoms. 

How to treat schizophrenia and PTSD

Treatments may vary depending on whether a person is experiencing schizophrenia, PTSD, or PTSD with psychosis. For example, research suggests that trauma-focused treatment for individuals experiencing PTSD with psychosis may not only be safe but could provide several benefits, such as reduced symptom exacerbation and adverse events.

Treatment options for post-traumatic stress disorder

These trauma-focused treatments usually include prolonged exposure and eye movement desensitization and reprocessing.

• Prolonged exposure (PE): PE is a type of cognitive behavioral therapy that generally aims to expose individuals to traumatic memories and feelings in a safe, controlled environment. While the avoidance symptoms of PTSD may cause a person to stay away from anything that reminds them of a traumatic event, this may hinder recovery. PE usually works to help an individual gradually confront their trauma while also discussing their experiences to aid recovery. 
• Eye movement desensitization and reprocessing (EMDR): EMDR is a therapeutic approach that typically allows individuals to focus on traumatic memories through talk therapy while engaging in bilateral stimulation, such as side-to-side eye movements. This type of therapy uses the adaptive information processing model, which addresses the brain’s potential to store traumatic memories in a manner that can increase the difficulty of recovery. 

Treatment options for schizophrenia

Therapeutic approaches can also be effective for those with schizophrenia, sometimes in conjunction with the use of doctor-prescribed medications like antipsychotics. According to the UK National Health Service, several forms of talk therapy may be beneficial, such as the following:

• Cognitive behavioral therapy (CBT): CBT can help to identify potentially unwanted thought or behavior patterns through a series of sessions. Once identified, a CBT practitioner may provide ways to replace these patterns with more realistic and beneficial thoughts and behaviors. CBT may also help individuals with schizophrenia reduce symptom severity, learn coping skills, and decrease feelings of isolation. 
• Art therapy: Art therapy may empower individuals with schizophrenia to develop a creative form of self-expression that allows them to acknowledge their disorder in a new and beneficial manner. Not only can this type of therapy facilitate socialization and allow people with schizophrenia to relate to others, but art therapy may also alleviate negative schizophrenia symptoms. 
• Family therapy: Family therapy may involve the loved ones of a person with schizophrenia connecting through a group therapy session to address a variety of topics. These topics may include education about schizophrenia symptoms, techniques to reduce stress, or discussions about their own experiences. Family therapy can address the impact schizophrenia can have on a person’s support system and help family members who may not understand the disorder. 

Have you experienced trauma?

Learn coping skills in online therapy

Online mental health treatment for PTSD and schizophrenia symptoms

However, in-person forms of talk therapy may not be available in all areas. Some individuals may live in healthcare provider shortage areas (HPSA) or regions where there may not be enough mental health or medical providers to service the population. In other cases, a person experiencing schizophrenia or PTSD may feel more comfortable attending therapy via online chat, phone calls, or video conferences. In these situations, it may be beneficial to explore alternative approaches, such as online therapy. 

Effectiveness of online therapy

Research suggests that online therapy can offer similar levels of effectiveness, but with benefits that in-person therapy may not provide. In a 2023 economic evaluation of studies involving a total of 27,540 mental health patients, researchers compared the efficacy of internet-delivered and in-person CBT. They found that internet-delivered CBT often resulted in increased health benefits at a lower cost and shorter wait times, while also displaying similar levels of clinical effectiveness. Please note that individuals currently experiencing acute psychosis may require in-person professional support.