The link between trauma and psychosis is a complex, evolving topic in mental health. Trauma is often experienced prior to the onset of psychosis, but the relationship between the two is not straightforward. Psychosis can manifest through symptoms like hallucinations, delusions, and disorganized thinking, and while it’s linked to conditions such as schizophrenia, the role of trauma remains a subject of debate among experts.
The Role of Trauma in Psychosis
Psychosis has numerous potential triggers, including sleep deprivation, substance use, and mental health conditions. However, trauma has emerged as a potential contributor, especially in individuals experiencing their first episode of psychosis. A large-scale review of studies found that childhood trauma rates were notably higher in those with early psychosis compared to typically developing individuals. This connection indicates that trauma may play a significant role in the development of psychotic disorders.
Despite this, the field of psychiatry has struggled with how to approach the trauma-psychosis relationship due to its complicated past. In earlier times, clinicians blamed parents for conditions like schizophrenia, coining terms such as “schizophrenogenic mother.” Though these outdated ideas have since been debunked, they left a lasting impact on mental health discussions, making trauma-related psychosis difficult to study without raising concerns about stigmatizing families.
The Stress-Diathesis Model and Psychosis
One well-known theory in the study of psychosis is the stress-diathesis model, which suggests that genetic vulnerability combined with overwhelming stress can trigger psychosis. Studies indicate that cortisol, the body’s stress hormone, may alter brain structure and neurotransmitter activity in individuals with psychosis. However, this does not mean trauma directly causes psychosis. Instead, genetics create a predisposition, and traumatic experiences can trigger the condition.
Research also shows that psychosis may be influenced by cumulative trauma rather than one significant traumatic event. This ongoing trauma could shape the course of psychosis and make recovery more challenging. Unfortunately, the symptoms of psychosis are often distressing and can further compound the emotional difficulties of trauma survivors.
PTSD With Psychotic Features
Another avenue of research focuses on posttraumatic stress disorder (PTSD) with secondary psychotic features. While not officially recognized in diagnostic manuals, some researchers believe that PTSD can manifest through psychotic symptoms, such as hallucinations or delusions tied to traumatic events. For example, individuals may hear the voice of an abuser long after the trauma has occurred.
Historically, treating individuals with both PTSD and psychosis was considered risky, as therapists feared that trauma-focused treatments could destabilize psychotic patients. However, recent studies suggest otherwise. Trauma-focused therapies like prolonged exposure and eye-movement desensitization and reprocessing (EMDR) have shown promise in treating PTSD in individuals with psychotic symptoms, without worsening their condition.