When a person loses touch with reality and the line becomes blurred between what is real and what is not, this is known as psychosis.
Psychosis often prevents a person from thinking clearly and inhibits their ability to define reality from their imagination. If you have psychosis, your perception and interpretation of what’s happening may be very different to that of those around you. Your mind may play tricks on you, causing unusual thoughts, feelings and behaviours and you may see, hear or believe things that other people do not.
For individuals with psychosis, the world can seem like a confusing jumble of feelings, images and sounds that are frustratingly outside of their immediate control.
This fact-sheet explores the symptoms and the possible causes of psychosis, treatment avenues and some practical suggestions on ways in which you can help yourself.
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What is psychosis?
‘Psychosis’ is a medical term used to describe mental health problems that prevent an individual from thinking clearly and from being able to lucidly identify fact from fantasy. While psychosis is not a diagnosable disorder in itself – it is triggered by other conditions and is usually identified by the following two symptoms:
Seeing, hearing or physically feeling something that isn’t there is known as a hallucination. Please find some examples of common hallucinations below:
- Seeing things that other people don’t - This could include a vision of an animal or religious figure, seeing people’s faces or viewing objects as distorted or as moving in a way that they wouldn’t normally.
- Hearing voices - The voices could be those of loved ones or complete strangers. There may be a single voice or many, and they could be kind and sensitive or malicious and intimidating.
- Experiencing sensations that other people don’t - Often psychosis can stimulate tastes, smells and sensations that aren’t really occurring. An example of this would be to feel someone touching your hair when there is no one there, or smelling a strong scent such as petrol, when others cannot.
A delusion is a belief that is unlikely to be true and which others don’t share. Delusions often fall into one of the following two categories:
- Delusions of grandeur - Delusions of grandeur tend to revolve around the belief that you are incredibly important, rich and/or powerful. For example, perhaps you believe you are a member of the royal family, or that you have special powers and are on a mission. In some cases, individuals believe themselves to be God.
- Paranoid delusions - Paranoid delusions can be incredibly frightening and can lead to you feeling mistrustful, threatened and suspicious. You may believe you are being followed, that someone is trying to kill you or that you are being controlled.
In addition to hallucinations and delusions, psychotic episodes can also include:
- Confusion of thought - Psychotic episodes often trigger disturbed and disrupted patterns of thought, leading to rapid and constant speech, abrupt halts in train of thought and erratic digressions in the conversation topic.
- Lack of insight - A person with psychosis might be unable to recognise that their behaviour is in any way bizarre or out of character. For example, an individual being treated for psychosis in a psychiatric ward may comment that their fellow patients are mentally unwell while they are perfectly healthy in mind and body.
This combination of symptoms can severely disrupt and alter thoughts, emotions, behaviour and awareness.
In addition, each individual’s experience of psychosis will be unique. Some may experience psychosis only once, others will go through a number of short bouts and some individuals will live with psychosis long-term.
What are the causes of psychosis and how is it diagnosed?
Psychosis is a set of symptoms and thus is not given as a standalone diagnosis. You might have symptoms if you have one of the following conditions:
Schizophrenia is a long-term condition that causes a number of psychological symptoms that are usually classified in one of two categories:
- Positive symptoms represent behavioural changes such as hallucinations, delusions and disorganised thinking.
- Negative symptoms represent withdrawal that detracts from your normal experience, such as a lack of feeling (emotionless and apathetic).
Although there are cases in which individuals successfully recover completely from schizophrenia, it is typically a long-term condition. With the right treatment and support however, it can be managed.
Bipolar disorder is a chronic mood disorder characterised by periods of depression (lows) and periods of mania (highs). During extreme highs or manias, some individuals may experience psychosis. For example, believing they have been given special powers in order to complete a mission. Not everyone with bipolar will experience psychosis.
You may experience psychotic episodes as a result of taking street drugs or as a result of prescribed drugs. Individuals who are withdrawing from alcohol and/or drugs may also experience psychosis and sometimes these symptoms will come to an abrupt end as the effects of the drugs and alcohol wear off. In cases where symptoms are prolonged, a psychotic illness may be diagnosed.
Puerperal psychosis (or postpartum psychosis) is a severe episode of mental illness usually occurring in the days or weeks after childbirth. Symptoms include high mood (mania), depression, hallucinations and delusions and feeling restless and agitated. Puerperal psychosis is very different and far more severe than postnatal depression and most women will need to be treated for this in hospital.
There are a number of personality disorders in which psychotic symptoms occur, for example schizotypal personality disorder and borderline personality disorder (BPD).
In some cases, a psychotic episode may be triggered by a stressful event in your life such as the death of a loved one or a dramatic shift in your personal circumstances. Symptoms can be severe but often when the individual begins to naturally recover from what has happened, a quick recovery can be made with no further psychotic symptoms.
Causes of psychosis are of course not limited to the above, and there are many varying explanations as to why people experience it. Below are some additional avenues of thought regarding possible causes:
- Genetics – According to experts you are more likely to experience psychosis if a blood relative has been affected in the past.
- Physical injury – If you have sustained a head injury for example, this may increase the likelihood of you experiencing symptoms.
- Severe lack of sleep – Severe sleep deprivation can increase the risk of hallucinations.
- Extreme hunger – If you have not eaten for a long period time, are not getting enough food overall or if you have low blood sugar, you may be at a higher risk of hearing voices.
- Trauma or abuse – If you have experienced abuse or an exceptionally traumatic event, you are at a higher risk of experiencing psychosis.
The diagnosis you receive will take into account how severe your episodes are, how often they occur and whether you experience them alone or in conjunction with additional symptoms.
Psychosis treatment and support
While there is no magic pill or one size fits all remedy, with the right support and psychosis treatment, it is possible to manage the symptoms and/or make a recovery. In many cases, the symptoms won’t vanish entirely and you may experience them from time to time – but with the right support and advice you can find ways of coping so that they are less distressing and disruptive.
As a precursor to the implementation of any psychosis treatment plan, your mental healthcare provider should lay all of the possible options out on the table – taking into account your preferences, environment and possible physical causes before you make a joint decision about which treatment avenue would be most suitable.
Below are some psychosis treatment options:
Talking therapies help you to understand and explore how you are feeling so that you can address negative thoughts and feelings and develop coping strategies to pave the way for positive change.
In the case of psychosis, a professional counsellor or psychotherapist may be able to help you challenge paranoid feelings while also helping you to address anxiety or depression that may have developed as a result of experiencing psychotic episodes.
Talking therapies that have been found particularly beneficial for psychosis treatment include:
Counselling for psychosis will provide you with an opportunity to explore your thoughts and feelings and the impact they may be having on your behaviour. As part of counselling you will also discuss any past experiences that may have influenced your present situation – and will find ways and methods of addressing them.
CBT for psychosis
CBT for psychosis revolves around the way you think (cognitive) and the way you behave (behavioural). It is designed to help you recognise and foster the idea that it is possible to change, or recondition these thoughts and behaviours in order to overcome specific problems.
These therapies take a more in-depth look into unconscious thoughts and perceptions to identify issues from your past that may have acted as a trigger for your current experiences.
The National Institute for Health and Care Excellence (NICE) has recommended therapies such as music therapy and art therapy as treatment avenues for schizophrenia and other related conditions. These therapies harness your creative side and use it as a vehicle for communication and expression.
In most instances, individuals diagnosed with a psychotic illness will be offered antipsychotic drugs that may help to control symptoms and any associated anxiety and/or depression.
In cases where antipsychotic drugs aren’t suitable or additional medication is needed to treat severe depression or mania, antidepressants or mood stabilisers may be prescribed.
If you have experienced a very severe episode of psychosis and are feeling distressed, you may require treatment as an inpatient. In hospital you can receive around the clock care and support to help you get back on your feet.
In some circumstances, it’s considered necessary for both your own health and safety, and for the health and safety of others that you be detained under the Mental Health Act. This can be an incredibly frustrating and upsetting experience but is not a decision that is taken lightly.
When someone has been under certain treatment sections of the Mental Health Act, it then becomes the duty of the healthcare provider to plan fully funded aftercare for after hospital discharge – with the aim of helping individuals to settle back into society and their lives.
How can I help myself?
While professional help will be needed to treat psychosis, there are of course some personal steps you can take to help you manage symptoms more effectively:
Support groups provide a place for you to meet other individuals with similar life experiences so that you can outlet your thoughts and feelings and share tips for coping. Individuals who attend support groups often report that this supportive and collaborative environment makes them feel more accepted, less isolated, more understanding of their own and other people’s experiences and more confident about making decisions.
It’s surprising what a simple change here and there can do in terms of helping to improve your physical and mental well-being. See below for some ideas:
- Eat, snack and drink regularly in order to minimise psychosis triggered by unstable blood sugar and/or hunger.
- Be sure to get enough sleep so as to avoid stress and worry associated with tiredness – both of which can make it more difficult to manage symptoms.
- Relax! Try some relaxation exercises such as mindfulness or yoga, or treat yourself to an alternative therapy such as reflexology or aromatherapy to reduce any stress you may be feeling.
- Keep yourself busy by cooking, gardening, meeting up with friends etc. These activities can boost self-esteem and keep you connected with the world around you.
Know your triggers
If you tend to experience repeated psychotic episodes then start a day-to-day diary in which you record daily activities and mood. It may be that after you have jotted down a few weeks worth, you are able to identify patterns or times at which you are vulnerable, and things which have been helpful so that you can then use this information to help you anticipate, prevent or manage an episode.
What should I be looking for in a counsellor or psychotherapist?
While are there no specific laws in position which stipulate the level of training and experience a counsellor or psychotherapist offering general talk therapy must have in order to treat psychosis, the National Institute for Health and Care Excellence (NICE) have issued guidelines which outline recommended psychological treatment.
It is also important to note that counsellors and psychotherapists offering arts therapies such as music therapy and art therapy, must be registered by law with the Health and Care Professions Council (HCPC) in order to deliver these therapies to clients.
Please find the NICE guidance below:
Psychological and psychosocial interventions
- Offer CBT for psychosis or schizophrenia sufferers. This can be started either during the acute phase or later, including in inpatient settings.
- Offer family intervention to all families of people with psychosis or schizophrenia who live with or are in close contact with the service user. This can be started either during the acute phase or later, including in inpatient settings.
- Consider offering arts therapies to all people with psychosis or schizophrenia, particularly for the alleviation of negative symptoms. This can be started either during the acute phase or later, including in inpatient settings.
- Arts therapies should be provided by a Health and Care Professions Council registered arts therapist with previous experience of working with people with psychosis or schizophrenia. The intervention should be provided in groups unless difficulties with acceptability and access and engagement indicate otherwise. Arts therapies should combine psychotherapeutic techniques with activity aimed at promoting creative expression, which is often unstructured and led by the service user.
For more information, please see the full NICE guidelines:
What our experts say
- Understanding Cognitive Behavioural Therapy (CBT)
Dr. Sidrah Muntaha, Chartered Clinical Psychologist2nd July, 2016
- Making sense of psychosis
Dr. Sidrah Muntaha, Chartered Clinical Psychologist9th April, 2016
- Understanding psychosis and psychotic episodes
Joshua Miles MBACP (Accred) Integrative Psychotherapist & Bereavement Counsellor17th February, 2016
- How can an understanding of Anxiety assist in the treatment of Psychosis
Ray Maloney MSc, UKCP Accreditted23rd June, 2008
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