The term ‘psychotic’ is now more likely to be used as a casual insult than with reference to its true meaning. But with 3 in 100 of us expected to experience at least one episode of psychosis during our lifetimes, shouldn’t we be making ourselves aware of the reality underlying the misconceptions? We investigate the surprising truth behind the myths…
1. People with psychosis are ‘psychopaths’
Whilst the confusion is understandable, ‘psychotic’ does not equal ‘psychopathic’. In fact, the two terms refer to completely different sets of symptoms and clinical presentations. People with psychosis experience hallucinations and/or delusions. The term ‘psychopath’, on the other hand, is used to refer to those who use manipulative and/or abusive tactics which may harm others emotionally and/or physically in order to fulfil their own desires – psychopaths are said to lack the capacity to feel empathy, guilt or remorse.
2. People with psychosis or schizophrenia have split personalities
Psychotic symptoms are often associated with a diagnosis of schizophrenia. Despite the term’s misleading aetiology, however, schizophrenia is not associated with having ‘split’ or multiple personalities. Dissociative identity disorder (DID), also known as multiple personality disorder or MPD, is a completely distinct condition, and is not thought to be linked with psychosis.
3. People with psychosis or schizophrenia are dangerous
Cases in which people suffering a psychotic episode or diagnosed with schizophrenia commit violent crimes are well publicised, but relatively uncommon. In fact, people suffering from psychosis are much more likely to harm themselves. 5-10% of all murders are committed by people diagnosed with schizophrenia, but 1 in 5 of those diagnosed will attempt suicide.
4. It’s impossible to recover from psychosis or schizophrenia
Schizophrenia is treated as a long term condition, but most people do recover – a quarter of those diagnosed will only ever experience a single psychotic episode.
5. It won’t happen to me
3 in 100 of us will experience a psychotic episode at least once in our lives. Many psychologists believe that psychotic symptoms are situated on a continuum with normal experience and that, given the right trigger, the occasional hallucinatory experience or delusional belief might affect any one of us.
What is psychosis?
People suffering from psychosis experience hallucinations and/or hold delusionary beliefs (so-called ‘positive’ symptoms). These symptoms are often accompanied by ‘negative’ symptoms relating to the absence or loss of normal function, e.g. loss of enjoyment in previously enjoyable activities.
Psychosis symptoms include:
Hallucinations: Many people suffering from psychosis see and/or hear things that aren’t there. They may complain of hearing voices in their heads. Some people feel, smell or taste things that aren’t there.
Delusions: Many people experience paranoid delusions, e.g. they may believe that they are the target of a government conspiracy. Others suffer from other kinds of delusions, e.g. delusions of grandiosity.
Inappropriate or flattened emotional responses
Apathy or lethargy
Loss of libido
Psychosis is not classified as a medical disorder in and of itself. However, if someone has experienced hallucinations or delusions which impair their ability to work, study or perform daily tasks for at least a month, and no other cause for their symptoms can be found, they will usually be diagnosed with schizophrenia.
What causes psychosis?
Some people are thought to be genetically predisposed toward developing schizophrenia. Subtle differences in brain structure have been noted, and premature birth, low birth weight and other complications have also been linked with increased risk.
The way in which we think may also be a contributory factor. For example, people who experience paranoid delusions tend to show an increased tendency to jump to conclusions.
Psychotic episodes are often triggered by stress or trauma, e.g. bereavement, the loss of a job or home, the breakdown of a relationship or physical, sexual or emotional abuse.
People suffering from psychosis exhibit elevated levels of dopamine. It is thought that this is why certain drugs, including cannabis, cocaine, LSD and amphetamines, seem to be triggers. People who use cannabis regularly when they are under 15 are up to four times more likely to be diagnosed with schizophrenia by the age of 26.
Psychotic episodes may be triggered by hypoglycaemia, alcohol abuse (or alcohol or drug withdrawal), malaria, HIV and AIDS, brain tumours, syphilis, lupus, Lyme disease, MS, Parkinson’s disease and Alzheimer’s disease.
Symptoms may also be triggered by mental disorders such as bipolar disorder and depression. Depressed patients often exhibit paranoid delusions, whilst those with bipolar disorder are more likely to have grandiose delusions.
For some people, sleep deprivation may be a contributory factor.
What should I do if I am concerned?
If you believe that you may be experiencing hallucinations or delusions, you should visit your GP or local A&E department as soon as possible. However, many people suffering a psychotic episode struggle to distinguish their experiences from reality. If you believe that someone may be suffering from psychosis, take them to your closest A&E department. If this isn’t possible, call their GP or a local out-of-hours GP, or dial 999 and request an ambulance.
How is psychosis treated?
People suffering from psychosis are usually prescribed antipsychotic medication and/or offered talking therapy, such as CBT or family therapy. CBT (cognitive behavioural therapy) involves working with a therapist to identify, challenge and reinterpret the beliefs which help to maintain psychotic symptoms such as delusions.