BY: T. Franklin Murphy | October 11, 2022
Definition, symptoms, and causes of psychosis
What is Psychosis?
Psychosis is a state of mind disconnected from reality, characterized by perceiving elements from the environment that do not exist. Psychosis is the ultimate escape from reality by retreating to a place of our mind's own making. A person suffering from a psychotic episode is unable to distinguish the internal experience of the mind from external realities. Appeals to logic typically fail to puncture the overwhelming sense that the psychotic episode is only a construction of the mind.
Psychosis primarily involves two main disconnections from reality—hallucination and delusions. A hallucination is when we see and hear things that do not exist. A delusion is when we believe things that are not true.
Psychosis may be a primary disorder or a secondary symptom to neurologic or medical conditions. Psychosis may be a brief psychotic episode occurring under extreme distress. or a reoccurring state associated with a mental or physical disease.
Psychosis is when perceptions (hallucinations) and beliefs (delusions) significantly depart from reality with enough severity to be considered a disorder.
History of Psychosis
Psychosis existed long before the name, even before symptoms of hallucinations were given the name dementia praecox by German psychiatrist Emil Kraepelin in the late 1800's. Psychosis has gone through "a series of labels, from different variations of the French word ‘demence’ or loss of mind in the 1800s, to dementia praecox, and now to a range of diseases, typically found somewhere on the schizophrenia spectrum (Plumptre, 2022).
Symptoms of Psychosis
The symptoms of psychosis typically are hallucinations, delusions, disorganized thoughts and behaviors, and a list of negative symptoms that impact quality of life.
Delusions are "tenacious false beliefs that are maintained despite indisputable evidence of the contrary" (Julayanont & Suryadevara, 2021). Delusional beliefs may be bizarre or possible but no supportable evidence exists, to support the belief.
I met a woman who was convinced that intruders surrounded her house, possessing "mind-stealing" lasers. No matter the logical evidence to the contrary, she could not let go of the idea that people were surrounding her house, trying to steal her mind.
A bizarre delusion may be:
Common Delusional Themes
Delusions may be persecutory, referential, somatic, religious, or grandiose in nature.
Persecutory beliefs are the most common delusion. These beliefs center around others trying to harm the individual. Persecutory beliefs is a morphing of common defense mechanisms (projection, displacement) into delusional psychosis.
In the paranoid ideations, family members, physicians, neighbors, or even television personalities may join together in an elaborate plan to haunt, destroy, or harm to person suffering from the psychosis.
Referential delusions are the beliefs that subtle things in the personal environment signify meaningful events.
Somatic delusions involve irrational beliefs about the individual's body. Hypochondria fits well into this category. In somatic delusions, the person experiences a range of bodily sensations which are interpreted as major meaningful symptoms of disease. The sensations maybe hallucinatory in nature or actual mundane sensations that are given life through magnifying the experiences, and interpreting with paranoid delusions of seriousness.
Delusions taking on religious themes is very common. Some individuals may believe they are an angel sent from heaven to save the earth, or believe they are Jesus Christ reincarnated to pronounce the truth.
Many religious delusions also include hallucinations and visions.
Grandiose delusions are majestic visions about one's self. These delusions may include heroical histories, such as a war prisoner in Vietnam, or as a former multi-millionaire that had their fortune stolen from them.
Other less common delusions may include:
Others create a theory that sounds plausible, and then treat the unsupported theory as if it was fact, reacting with distain when others fail to believe the same. This is a delusion as much as the "mind-stealing" invaders.
A hallucination is "the false perception of sensation that does not correspond with an external stimulus" (Julayanont & Suryadevara, 2021). We may experience hallucinations in any sensory modality: auditory, visual, olfactory, gustatory, tactile, nociceptive, thermoceptive, proprioceptive, and many others.
Our brains are constantly at work receiving and translating senses, from energy flowing through our system to conscious recognition with a label. When psychosis occurs, our brain begins to create its own stories without the preceding sensory input. We think we hear voices, see visions, our feel an injury. However, all these sensations are created without the normal prompting of an external event.
Disorganized thinking is revealed by disruptive patterns of speech, indicating a formal thought disorder. Some common thought disorders are:
Over inclusion of trivial or irrelevant details.
Thoughts are associated through sounds of the words rather than by meaning, often using words that rhyme that do not have meaningful relation to each other.
Derailment (synonymous with loose associations)
Lack of goal directed speech, jumping from idea to idea without logical connection, leading to nonsensical sentences.
Flight of Ideas
Quickly jumping from idea to idea, often through rapid and forced speech.
Inventing new words and phrases; or unconventional use of conventional words.
Repetitive use of words and phrases, or ideas, throughout a conversation, even after the context is no longer relevant.
Responses to questions that refer to the general topic without answering the question.
Disrupting flow of thoughts leading to sudden starts and stops in speech patterns.
Disorganized behaviors may be observed in an individuals lack of hygiene, nourishment, and sleeping patterns. They may talk to themselves, laugh or yell at socially inappropriate moments. They may become rigid or react with catatonic excitement.
Disorganized behaviors strike the observer as odd, signaling that something is amiss with the individual.
Negative symptoms are often displayed in schizophrenia. negative symptoms include:
Negative symptoms seriously impair an individuals ability to function.
When evaluating symptoms, we must keep in mind, that disfunction always is born from functional behaviors. We all express some of symptoms of disfunction to a lesser degree. When diagnosing an illness, we must determine that the severity of the symptoms are sufficient to be classified as a disorder.
Causes of Psychosis
"A cohesive understanding of the pathophysiology of the major psychotic disorders is lacking, even to the extent of defining whether one or many disease processes are involved" (Corvin and Harold, 2015).
While the exact pathophysiology allude scientists, progress is being made. Often an underlying disease or specific condition may be identified as the cause. A few common causes for psychosis are:
Psychosis is typically associated with schizophrenia which is primarily characterized by symptoms of hallucinations and delusions. A person may also be diagnosed with other mental disorders, that fall on the schizophrenia spectrum without meeting the the criteria for a schizophrenia diagnosis.
"Bipolar disorder is characterized by biphasic mood episodes that alter between depression and mania." A common delusion is thoughts of grandiosity or indestructability (Murphy, 2022b).
Major depressive disorder is characterized by a persistent feeling of sadness and emptiness. Some people experience symptoms of psychosis, such as paranoid ideations, together with the other symptoms of a depression.
Schizophrenia Spectrum Disorders
Schizoaffective disorder is similar to schizophrenia but with major episodes of shifting moods such as major depressive disorder or bipolar disorder.
Schizophreniform disorder is identical to schizophrenia but with a shorter duration of symptoms, typically longer than a month but shorter than six months.
Schizotypal personality disorder:
Schizotypal personality disorder is similar to schizophrenia, but the schizophrenic episodes are not as frequent, prolonged or intense. Individuals with Schizotypal personality disorder can usually be shown that their distorted ideas and experiences are not reality. Patients with this disorder "are spared the chronic psychosis of schizophrenia" (Kirrane & Siever, 2000).
Stress and Psychosis
Early theories of psychosis typically relied on psychological explanations such as stress as the underlying cause.
Rollo May (1904-1994) theorized that neurotic and psychotic symptoms "may be viewed as endeavors to adapt to a conflict situation when the problem causing the conflict cannot be solved." He continues, "in situations of severest conflict the individual may be powerless to cope with the threat by means of the above-mentioned compromises, and may be forced to renounce a large arena of activity or reality (e.g., psychosis)" (2015).
While extreme stress has been shown as a cause for psychosis, often these breakdowns are temporary in nature, the mind temporarily finding refuge by fleeing reality when the challenges of the moment exceed our window of tolerance.
Other theories, such as the diathesis stress model, propose that that "disorders develop as a result of interactions between pre-dispositional vulnerabilities (the diathesis), and stress caused by life experiences" (Murphy, 2021).
Whatever the cause, experiences of psychosis are serious medical issues, signaling a breakdown of normal processes of the mind and require treatment. Many pharmaceutical advancements have been made to lesson the impact of the negative symptoms associated with psychosis, improving the quality of life for those suffering from psychosis. Therapy also can assist with reducing anxiety, and improving emotional and behavioral symptoms that may impact the individual.
Please support Flourishing Life Society with a social media share or by visiting a link:
Corvin, A., & Harold, D. (2015). Biomarkers for Psychosis: the Molecular Genetics of Psychosis. Current Behavioral Neuroscience Reports, 2(2), 112-118.
Fusar-Poli, P., Salazar de Pablo, G., Correll, C., Meyer-Lindenberg, A., Millan, M., Borgwardt, S., Galderisi, S., Bechdolf, A., Pfennig, A., Kessing, L., van Amelsvoort, T., Nieman, D., Domschke, K., Krebs, M., Koutsouleris, N., McGuire, P., Do, K., & Arango, C. (2020). Prevention of Psychosis. JAMA Psychiatry, 77(7), 755-765.
Julayanont, P., & Suryadevara, U. (2021). Psychosis. Continuum, 27(6), 1682-1711.
Kirrane, R., & Siever, L. (2000). New perspectives on schizotypal personality disorder. Current Psychiatry Reports, 2(1), 62-66.
May, Rollo (1950/2015). The Meaning of Anxiety. W. W. Norton & Company; Reissue edition
Murphy, T. Franklin (2021) Diathesis Stress Model. Flourishing Life Society. Published 9-7-2021. Accessed 9-11-2022.
Murphy, T. Franklin (2022a). Schizotypal Personality Disorder. Flourishing Life Society. Published 5-17-2022. Accessed 10-9-2022.
Murphy, T. Franklin (2022b). Mood Disorders. Flourishing Life Society. Published 9-27-2022. Accessed 10-9-2022.
Pumptre, Elizabeth, (2022) What is Dementia Praecox? Verywellmind. Published 2-13-2022. Accessed 6-23-2022
Schrimpf, L., Aggarwal, A., & Lauriello, J. (2018). Psychosis. Continuum, 24 (BEHAVIORAL NEUROLOGY AND PSYCHIATRY), 845-860.