The Schizophrenia-PTSD Connection: Can Trauma Lead To Symptoms Of Schizophrenia?

Schizophrenia and post-traumatic stress disorder (PTSD) can have various similar symptoms. Current research theorizes that exposure to trauma could increase the risk of developing schizophrenia and that experiences with schizophrenia and other forms of psychosis can themselves be traumatic and potentially lead to the development of PTSD. A more thorough understanding of both conditions and their interactions may be helpful in navigating these illnesses or supporting a loved one experiencing symptoms. 

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What is schizophrenia?

Schizophrenia is a serious and potentially severe mental illness that typically worsens without treatment and can significantly impact a person’s ability to function. Schizophrenia belongs to the class of psychotic disorders within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These disorders are defined primarily by psychotic symptoms, meaning a person with schizophrenia can have difficulty determining what is and is not real. These symptoms are typically classified as follows:

• Positive symptoms: These symptoms include behaviors that a person with schizophrenia may display and a person without schizophrenia typically doesn’t, such as hallucinations. 
• Negative symptoms: These symptoms are behaviors that may be considered typical or expected for day-to-day functioning but that a person with schizophrenia may not perform, such as withdrawal from usual social interactions. 
• Cognitive symptoms: Cognitive symptoms are not typically defined as the presence or absence of certain behaviors but as symptoms that impact overall functioning. 

Positive symptoms 

Primary positive symptoms of schizophrenia can include the following: 

• Hallucinations: Hallucinations involve having a sensory experience associated with a stimulus that is not present, such as seeing visions, hearing sounds, or smelling scents that are not real. Hearing voices is one of the most common forms of schizophrenic hallucination.
• Delusions: Delusions may occur when someone holds illogical beliefs, such as believing that the government is surveilling them or that one’s internal organs have been removed and replaced with another person’s.
• Disorganized speech: This symptom can include the inability to use language to communicate effectively, including randomly switching between topics and engaging in “word salad,” or dialogue with no associations between words.
• Abnormal motor behavior: Abnormal behavior might include bizarre movements, repetitive movements, difficulties with goal-directed movements like walking, languid movements, or lack of movement or reaction to external stimuli (also known as catatonia). 

Negative symptoms 

Primary negative symptoms can include the following: 

• Anhedonia: This symptom causes extreme difficulty in experiencing pleasure, happiness, and other positive emotions. 
• Absent facial expressions or gesturing: This symptom can cause a blank or unexpressive expression or a lack of gestures. 
• Poor personal hygiene: Hygiene difficulties may result from a lack of interest in caring for oneself.
• Flat voice or tone: This symptom can cause flatness or a monotone voice in conversations with others. 
• Lack of motivation: A lack of motivation may occur when thinking of interacting or communicating with others. 

Cognitive symptoms 

Primary cognitive symptoms can include the following: 

• Executive functioning difficulties: Executive functioning challenges refer to difficulty comprehending new information and using that information to make decisions, complete organizational tasks, and practice self-care. 
• General inability to focus: People with schizophrenia or psychosis may have difficulty paying attention to any one specific stimuli. 
• Confusion: Even when not experiencing active hallucinations or delusions, people with schizophrenia can have difficulty understanding how to navigate everyday situations.
• Trouble with memory: Memory difficulties might include misplacing objects and forgetting information as soon as it is learned.

What is post-traumatic stress disorder (PTSD)?

Traumatic events that may lead to the development of PTSD include but are not limited to:

• Sexual assault or coercion 
• A natural disaster
• Serving in armed combat
• Living in or fleeing a war zone
• Domestic violence
• Becoming a refugee
• Being bullied in a school or workplace setting
• Surviving a car accident
• Losing a loved one to violence
• Being a survivor of a crime
• Past experiences of abuse, including emotional abuse and childhood abuse

Symptoms of PTSD may manifest in different ways, depending on the traumatic experience and the strength of an individual’s support system. 

If you are facing or witnessing physical, emotional, verbal, financial, sexual, spiritual, digital, or mental abuse or stalking, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text “START” to 88788. You can also use the online chat. 

Cognitive PTSD symptoms

Cognitive PTSD symptoms might include the following: 

• Difficulty concentrating
• Dissociation, in which a person has the sensation that they are not physically present in their body or that the world around them has been altered or is fundamentally strange (i.e., seeming as if they are looking at their surroundings through blurry glass)
• Hypervigilance
• Memory loss, particularly regarding memories associated with the trauma

Emotional PTSD symptoms

Emotional PTSD symptoms include the following: 

• Negative core beliefs about oneself or the world, such as “Something is wrong with me” or “The world is a dangerous place”
• Heightened risk of developing depression and anxiety disorders
• A persistent sense of fear
• Anhedonia
• Loss of interest in previously enjoyed activities
• A negative mood
• A sense of detachment from other people and the world

Behavioral PTSD symptoms

Behavioral symptoms of PTSD may include: 

• Difficulty sleeping
• Nightmares related to the trauma
• Flashbacks, in which a person has the sense that they are re-experiencing the traumatic event
• Angry and unpredictable outbursts and irritability
• Avoidance of situations, people, places, or emotions that remind a person of the trauma
• Participation in risky and self-destructive behavior
• A heightened startle response

Schizophrenia vs. PTSD

Symptoms of schizophrenia and PTSD may overlap, although there are some defining differences. Both people with schizophrenia and people with PTSD may display fear or nervousness, have difficulty feeling pleasure and happiness, or have an increased risk of developing other mental health conditions. Some individuals may interpret specific PTSD symptoms, particularly flashbacks and negative beliefs, to be comparable to the hallucinations and delusions associated with psychosis. However, there are core distinctions between the experiences. 

Flashbacks vs. hallucinations 

A person experiencing a flashback associated with a traumatic event may physically perceive the world around them to resemble the event's setting. They may re-experience the sounds, sights, and smells of the trauma. However, these flashbacks are typically short-lived, and a person amid a flashback can usually be “snapped out of it” by an external observer. Once they are no longer experiencing the flashback, they are typically capable of recognizing that the trauma is not actually playing out again.

In contrast, hallucinations associated with schizophrenia can be persistent and ongoing, potentially lasting for months at a time. A core feature of schizophrenia is anosognosia, also referred to as “lack of insight,” meaning that a person with this condition may not be capable of recognizing that they have an illness that could be altering their perception of reality. It is typically not possible to “snap out” of schizophrenic hallucinations. 

Negative beliefs vs. delusions 

The core negative beliefs associated with PTSD are distinct from psychotic delusions. A person with PTSD may be able to assess their belief systems on a logical and intellectual level and conclude that they may be flawed or distorted (although they might still experience emotional symptoms based on these beliefs). However, with delusions, as with hallucinations, a person is typically incapable of recognizing the implausibility of their beliefs. 

Comorbidity and the schizophrenia-PTSD connection

Although there are distinctions between symptoms of schizophrenia and PTSD, that does not mean that a person cannot have both disorders. A schizophrenia patient could have comorbid post-traumatic stress disorder and a person with PTSD could have a comorbid psychotic disorder, such as schizophrenia or schizoaffective disorder. These conditions, even when occurring in the same individual, could be unrelated, although there may be some evidence that the conditions may exacerbate each other. 

Each condition may also be a risk factor for the other. People with unprocessed trauma may be at greater risk of developing schizophrenia, even if they have no other risk factors. Current clinical understanding of this phenomenon hypothesizes that trauma can alter a person’s brain and neurotransmitter system in ways that may produce psychotic symptoms. Research has also found that schizophrenia may heighten the impact of trauma on the body and the brain and lead to more severe instances of PTSD. One study of elderly chronic schizophrenia patients found that those who also had PTSD experienced higher levels of neurodegeneration, meaning each condition may have been making the other worse.  

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Finding mental health support for schizophrenia and PTSD

While both schizophrenia and PTSD can be serious conditions, there are options for pursuing recovery. However, the fear and nervousness associated with both disorders may make it difficult to attend traditional in-person therapy sessions. In these cases, online therapy through a platform like BetterHelp may be a more practical option. 

Prescription medication and medical intervention can also be necessary for schizophrenia and PTSD. However, online therapy can supplement these additional forms of support. Through an online platform, clients can receive affordable care that is often similar to or more affordable than insurance co-pays. In addition, they can choose between phone, video, or live chat sessions, giving them control over how they receive support. 

Research has found that online therapy can be an effective form of intervention for several mental health disorders, including the psychotic symptoms associated with schizophrenia and the mood symptoms associated with PTSD. Working with an online therapist may minimize the distress either of these conditions may be causing.