I have worked with clients experiencing psychosis for almost twenty years, in private practice, managing programs focused on clinical care, and supervising training for interns entering the field.
Psychosis is a broad term describing different states wherein a person disconnects, to varying degrees, with reality. It covers a range of disorders including schizophrenia, schizoaffective disorder and certain manic or depressive behaviors. Psychotic episodes can be brief, or recurrent, or a psychotic state can be ongoing. Psychosis may be manifested by shifts in mood, disorganized or paranoid thoughts and speech, voice-hearing, or catatonic states. Symptoms of psychosis most often begin to appear in the late teens and early twenties. Psychotic episodes can be exacerbated by periods of intense stress or substance abuse. Seeking support and treatment early generally results in more positive outcomes.
Not every symptom associated with psychosis means that a person is psychotic. The same behaviors may be the result of dissociation, bipolar disorder, substance abuse, medical conditions including type 1 diabetes, or borderline or narcissistic personality disorder. In treating these symptoms it’s critical for the clinician to correctly understand and recognize the symptoms in context, as an incorrect diagnosis can negatively impact treatment and overall success.
Untreated psychosis can be a very frightening thing for both the individual experiencing the symptoms and for their friends, families and coworkers. The resulting behaviors can be difficult to understand and easy to misinterpret. When changes are sudden and severe, it’s natural to worry that they will escalate into dangerous situations. While persons experiencing psychosis may be suffering internally because of the constant pressure of voice-hearing or confused states, aggression and violence are not usually associated with psychosis. But unpredictable behaviors, coupled with inaccurate and negative depictions of psychosis in the media, can make a difficult situation harder to manage for all concerned.
With proper treatment and support, most individuals are able to mitigate the effects of these symptoms. Learning to manage stress, anxiety and PTSD, and understanding that all symptoms of psychosis are meaningful forms of expression can help individuals reduce those symptoms and engage more fully in the life they wish to have.
Catherine Keech, LMFT