Navigating Psychosis

not just right

Psychosis is a condition that affects the way your brain processes information. It causes you to lose touch with reality. Someone experiencing psychosis may see, hear, or believe things that aren’t real. It's a symptom, not an illness in itself, and it's more common than many people think.

Psychotic symptoms are often categorized as "positive" or "negative," which can be a bit confusing. It doesn't mean "good" or "bad." Here's a simple breakdown:

➕ Positive Symptoms

These are experiences and behaviors that are added to a person's normal experience. Think of them as an excess or distortion of normal functions.

Hallucinations Delusions Paranoia Disorganized Speech Unusual Behavior

➖ Negative Symptoms

These refer to abilities or characteristics that are lost or reduced. They can be harder to spot and are often mistaken for depression or laziness.

Flat Affect Alogia (less speech) Avolition (no motivation) Anhedonia (no pleasure) Social Withdrawal

Differentiating Disorders

Psychotic symptoms can appear in several different conditions. Telling them apart is crucial for proper treatment. Here’s a simplified guide:

Obsessive-Compulsive Disorder (OCD)

Psychotic symptoms (mainly delusions/paranoia) are directly tied to OCD themes. The person may be convinced their fears are real, but the psychosis is confined to their obsessions. These thoughts are often ego-dystonic (unwanted).

Bipolar Disorders

Psychosis is episodic and mood-congruent, meaning it only happens during a manic, hypomanic, or depressive episode. The symptoms go away when the mood episode ends.

Schizophrenia Spectrum

Characterized by both positive and negative symptoms. The key difference between Schizophreniform and Schizophrenia is duration: 1-6 months for the former, and 6+ months for the latter. Schizoaffective Disorder involves meeting full criteria for a mood disorder plus having at least two weeks of psychosis without any mood symptoms.

The Dissociative Overlap

Symptoms like hearing voices, paranoia, and derealization can also be features of dissociative disorders (like DID or OSDD), which can lead to misdiagnosis. In these cases, the experiences often stem from trauma and identity fragmentation. Proper screening is vital using tools like:

Multidimensional Inventory of Dissociation (MID): A comprehensive assessment for pathological dissociation.
Dissociative Experiences Scale (DES-II): A widely used screening questionnaire.

Insight: A Spectrum

Insight refers to a person's awareness of their own condition. It's not all or nothing:

Good/Fair Insight: The person recognizes their experiences are unusual and likely due to their illness.
Poor Insight: The person may acknowledge their experiences but attribute them to external factors.
Delusional Insight: The person is completely convinced their psychotic beliefs are real and has no awareness of their condition.

Role of Antipsychotics

When are they often NOT the first line?

Dissociative Disorders: Trauma-focused therapy is the primary treatment. Antipsychotics can sometimes worsen symptoms.
Episode-Related Psychosis (e.g., Bipolar): Mood stabilizers are the foundational long-term treatment, though antipsychotics may be used short-term.
OCD: Even with delusional beliefs, the primary treatment is ERP therapy and often SSRIs, not antipsychotics.

Need Help?

If you or someone you know is struggling with these symptoms, it's important to seek professional help. It is recommended to see a psychologist and/or psychiatrist who has experience with psychotic disorders for an accurate diagnosis and treatment plan.

A good place to start is Psychology Today, where you can search for in-network providers who specialize in treating psychotic symptoms.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
International Society for the Study of Trauma and Dissociation. (2011). Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, 12(2), 115–187.

This page is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.