Understanding psychosis and psychotic episodes

The term psychosis (also known as a psychotic episode) is when a person loses touch with reality, and the line between what is real and what is not becomes blurred.


Psychosis can prevent an individual from thinking clearly. It is common for the mind to play tricks causing unusual thoughts, feelings or behaviours. Or for individuals to perceive or interpret events differently from others. Psychosis makes the world seem like a confusing place filled with a jumble of feelings, images and sounds that are frustratingly out of immediate control.


Hallucinations may include:

  • Seeing things other people do not - faces, images or visions.
  • Distorted, blurred or abnormal images.
  • Tastes, smells, or sensations with no apparent cause.
  • Hearing voices others do not - either positive and helpful. Or destructive, hostile and frightening (either those you know or complete strangers).


Delusions of grandeur - these revolve around the belief you are rich, powerful, wealthy or important. For example, thinking you control the stock markets or weather. Or that you have special powers or abilities.

Paranoid delusions - these are frightening, leading you to feel mistrustful, threatened and suspicious. You may believe people are following you, trying to kill you, or that you are in some way being controlled or monitored.

Psychotic episodes also include:

Confusion of thought -patterns of thought that are disturbed or disrupted, rapid and constant speech, abrupt halts in the train of thought and erratic digressions in conversation.

Lack of insight -psychosis makes it difficult for someone to recognise their behaviours as bizarre or out of character. An example could be an individual receiving treatment for psychosis in a hospital, who believes everyone else around them is mentally unwell, and they are healthy and well.

Flight of ideas -when thoughts move quickly from one idea to the next without a break, and links or connections are made that other people do not see.

It can also include loss of control of words or speaking so quickly that others find it difficult to understand; linking words together because of how they sound, instead of what they mean.

Effects of psychosis

The effects of psychosis differ for each person. Some may experience it once whereas others experience short episodes throughout their lives. It can be that psychosis is not always distressing. An example of this could be seeing the faces of loved ones who have died or hearing their voices, which could be comforting. For others, psychosis is highly distressing and difficult to manage, making it difficult for people to carry out their daily lives, take part in activities, or maintain relationships.

Psychosis can make you feel:

  • anxious or stressed
  • scared
  • confused
  • angry
  • mistrustful of others or organisations
  • victimised, persecuted or threatened
  • disbelieved or misunderstood
  • alone and isolated
  • depressed
  • tired from worrying all of the time

During psychosis you may:

  • Struggle to concentrate on tasks that require your focus on one thing at a time.
  • Find it difficult to trust people or maintain relationships.
  • Find it hard to sleep, eat or shower etc.
  • Find it difficult to go outside.
  • Avoid certain situations or activities.
  • Protect yourself in ways that do not make sense to others, such as getting rid of your phone, or covering your windows with newspaper.
  • Act in ways that seem threatening to others.


Psychosis is a set of symptoms rather than a standalone diagnosis, and there is no one cause. Below are some of the ways psychosis can be brought about.

Schizophrenia - a chronic mental health condition which can cause hallucinations and delusions.

Bipolar disorder - an often chronic condition which affects a person’s mood, causing extremes from dizzying highs to crippling lows.

Drug-induced psychosis - you may begin to see or hear things as a result of taking drugs such as cannabis, as a side effect of some prescribed drugs, or coming off psychiatric medication. Withdrawing from alcohol or drugs can also induce psychotic symptoms, and sometimes these effects can end abruptly as the effects of the drugs or alcohol end.

Postpartum psychosis - a severe psychotic episode which occurs in the days or weeks after childbirth, and can include symptoms of high or low mood, depression, hallucinations, delusions, as well as feeling restless and agitated.

Abuse or trauma - if you have experienced abuse in your past or a particularly traumatic event, you are more likely to experience the symptoms of psychosis.

Other causes - can include physical illness or injury, lack of sleep, extreme hunger, bereavement, or spiritual experiences.

Help and support

Therapy - talking therapies help you to understand and explore how you are feeling, offer you the opportunity to address your negative thoughts and feelings, and assist you in developing coping strategies to work toward change and improvement. Therapy can help you challenge paranoid thoughts and feelings, and help understand the anxieties or depression you may be experiencing.

Medication - most people diagnosed with a psychotic illness will be offered antipsychotic drugs to help them manage their illness. You can visit your GP to ask for more information or advice on antipsychotic medications. These medications are not a cure for psychotic illnesses but can help control the symptoms and stop you from feeling distressed by them.

Hospital admission -psychosis can sometimes require treatment as an inpatient where you can receive support and care to help get back on your feet. In some circumstances, it may be necessary for your health and safety to be detained under the Mental Health Act, and while this is distressing, painful and frustrating, it is not a decision reached lightly or without careful thought and care.

Moving forward

Experiencing psychosis for any period of time is distressing, confusing, and difficult. However, seeking support for yourself is the first step you can take to look after yourself. You can do this by seeing a therapist, contacting your GP, or getting information from organisations such as Mind or Rethink Mental Illness. You may be struggling at this moment, and it will be frightening and difficult, but you are not alone and there is support and advice available.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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London N6 & NW5
Written by Joshua Miles, BA, MSc, BPC, BACP Accredited Psychodynamic Psychotherapist
London N6 & NW5

Joshua's an experienced integrative psychotherapist who's worked with people experiencing a wide range of mental health difficulties. He has assisted people in exploring their feelings and experiences at depth and helped them gain understanding & clarity of their mental health, and find ways to cope & manage. He's based in Shoreditch, East London.

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