What is psychosis?
The term 'psychosis' is not considered an illness on its own but is used to describe a combination of symptoms. In a state of psychosis, the parts of our brain responsible for processing information and emotions can enter a state of stress overload, which can cause someone to misinterpret or confuse what is going on around them. This state of “altered reality” can lead to significant changes in a person’s perceptions, beliefs, thoughts and behaviors.
More common than many realize, psychosis can occur for many different reasons. It can be a feature of an underlying mental health condition, such as depression, bipolar disorder, post-traumatic stress disorder (PTSD), or schizophrenia spectrum disorder. Psychosis can also occur due to recreational drug use, drug interactions, or other health conditions, including malaria, HIV, syphilis and more.
Some typical experiences that may indicate psychosis include:
Hearing, seeing, tasting, smelling and feeling things seem real, but aren’t (hallucinations).
Beliefs that are not based in reality. Also known as delusions, some examples of common beliefs include thoughts like, “people are against me,” “people want to hurt me,” “others can read my mind,” or “I have special powers/abilities.”
Difficulty concentrating, organizing thoughts or expressing emotions. Oftentimes, sleep is also disturbed.
How common is psychosis?
According to the National Institute of Mental Health, 100,000 young people develop psychosis each year in the U.S.
Psychosis is most likely to first occur in teenage and early adult years, which is believed to relate to rapid changes in the brain that happen naturally during its final stages of development. A family history of mental illness can increase the risk of developing psychosis, as can certain environmental factors.
As with all things relating to health, there is a wide range of severity and persistence when it comes to psychosis. For some, it might be a one-time or temporary occurrence, and for others, it may recur. When psychosis symptoms recur over time and all other potential medical and environmental causes are ruled out, a mental health professional (psychologist, psychiatrist or social worker) can assess whether these symptoms are occurring due to a mental illness. Today, 3% of Americans live with this kind of mental illness, such as schizophrenia or bipolar disorder.
Most of us can relate to having psychosis-like experiences. For example, can you remember a time you felt like you were in a quasi-dream state where reality seemed altered in some way? These types of experiences can be a temporary result of extreme stress, trauma, lack of sleep, or substance use. Sometimes, fleeting psychosis-like experiences may even be a part of the natural course of brain development during childhood or adolescence.
Signs & symptoms of psychosis
Knowing the signs of psychosis can help ensure that we get the right kind of support as soon as possible. Psychosis can worsen with time, and getting help early strongly increases your chances of full recovery.
Signs of psychosis
Unfamiliar thoughts or feelings
People are against me or want to hurt me
Others can read my mind
I have special powers or abilities
Increased sensitivity to sights or sounds
Hearing, seeing, feeling or tasting things that others don’t
Challenges in processing information
It feels harder to think clearly, concentrate or stay organized
Trouble reading or comprehending what others are saying
Feeling disconnected from family and friends
Loss of interest in everyday activities or caring for yourself
What Causes Psychosis? Understanding risk factors
There is still a lot we don’t know about the exact causes of psychosis. But researchers have a pretty good idea that – just like many health conditions – it’s caused by a mix of family history (a “genetic vulnerability” that you’re born with) and stress from life events, drugs or illness.
To help better understand the stress factor, let’s imagine that your brain is a jar, and that life stressors are pennies. As the jar fills up with pennies, the way your brain cells communicate with one another begins to change. When the jar is overloaded and spills over, your brain’s ability to process information and emotions is impacted, which results in altered perceptions of reality. This state of stress-overload is what we call a “psychotic episode.”
Psychosis Risk Factors
Not everyone who develops psychosis has a family history of it, but there is a genetic component. If you have a close relative (parent or sibling) who has a mental health condition that features psychosis (such as schizophrenia or bipolar disorder), this is considered a risk factor for developing it yourself. For those of us with a family history, this also means that it may take a smaller amount of stress to trigger psychosis than people who don’t have a genetic vulnerability. This is why if you have a family history of mental health conditions, it’s especially important to limit stress and be aware of risk factors.
According to research, stressors that can increase the risk of developing psychosis – especially when a family history is present – include the following common psychosis risk factors.
Common psychosis risk factors
Stressful events such as a death in the family, transition to a new school, extreme work or academic pressure, relationship break up
Lack of sleep
Drug use/withdrawal – especially high THC marijuana, speed, cocaine, crystal meth, ecstasy/molly (MDMA), acid (LSD), mushrooms, ketamine and heroin (opiates)
Difficult delivery at birth
Being born in the winter months
Growing up in a big city
Moving to a new country
(Sources: Radua, 2018, Reeve, 2015, Khokar, 2018)
So, wait — does this mean that, if your mom has a mental illness, you were born in December, grew up in New York City, and have smoked your fair share of weed, you will definitely experience psychosis?
No. It just means that your chances might be slightly higher. At the end of the day, we all have unique brains with different responses to stress. Some people are more sensitive to certain kinds of stress or may have specific life experiences or circumstances that increase their risk of developing psychosis. In fact, even among young people who show early risk factors for developing psychosis (called “clinical high risk”), only 20-35% go on to develop psychosis.
The good news? You can lower your risk by doing some pretty simple stuff.
When it comes to risk factors for psychosis, there are some we have control over, and some we don’t. We may be stuck with our genetic makeup, for example, but we can change how our brain functions by practicing healthy behaviors and enlisting the help of supportive therapies.
It’s important to remember that if you do experience psychosis, a big part of recovery is about finding ways to “zap” the stressors that are getting between you and the life you want to lead. Keeping stress in check can greatly reduce symptoms and the potential for recurrence.
Good self-care habits are like a protective shield that can help us maintain wellness and recover when we’re unwell. Back to the penny-as-stress analogy, taking care of ourselves every day is like taking coins out of the jar, keeping it from overflowing. It's a good idea to start establishing stress-reduction practices when we’re doing well, because when we’re not, it can be really hard to remember what our wellness practices even are, let alone try something new! Do the best you can to surround yourself with a team of friends, family and health professionals who can support you as you develop a lifestyle that works best for you.
7 of our favorite effective stress-zapping tips
Get enough sleep.
Establish a support system made up of trusted friends and/or family.
Learn and practice effective strategies for dealing with stress.
Eat nourishing food.
Exercise regularly, and/or walk in nature if you can.
Take medication (if/as prescribed).
Screening and diagnosis
Though psychosis can occur in a great number of health conditions and be caused by many different things—including drug interactions, heavy metal poisoning, nutritional deficiencies, and neurological and psychiatric disorders—our focus in this section is psychosis that occurs as a feature of a mental health condition.
Unlike illnesses that are diagnosed through definitive testing methods like blood or urine tests, mental health diagnoses still rely largely on observation. A person who has had an episode of psychosis may be given any number of diagnoses, which typically fall under what doctors call “psychotic disorders.”
While it may sound daunting, it’s important to remember what a diagnostic label really is: shorthand used by health professionals to describe a particular cluster of symptoms and experiences.
This is the beauty of how our brains change based on how we use them, called neuroplasticity. Our symptoms and experiences tend to change over time, and so, too can the state of our brain health, and thus, a diagnosis.
For some, getting a diagnosis can feel like a relief, like an answer to a burning question. But for others, a label like bipolar disorder or schizophrenia can feel not only somewhat arbitrary, but also like a heavy burden to carry. And especially amid all the natural identity-forming that we’re doing as teens and young adults, it can be challenging to figure out where a diagnosis fits in with our greater sense of self and belonging.
So if you’ve been given a diagnosis, here’s our advice: Try not to dwell on it.
Rather than focusing on a diagnostic label, we’ve found that it’s way more helpful to focus on identifying the things/symptoms/experiences that stand in our way of living a full life, and zeroing in on how to best overcome those things.
This is hard work (which is why we’re here to help guide you through it!), and involves seeking out a well-rounded mix of support, therapy, self-care, and sometimes, the right medication.
Bottom line: if a diagnosis is useful to you, then great. Wear it with pride, and maybe even join the much-needed movement toward decreasing stigma, greater social dialogue and acceptance. But if you find that a label is weighing you down, remember that it’s just that: a label. No label can define who you are inside.
When I was diagnosed with psychosis, I was really scared and confused. I didn’t really know what it meant or what would happen next. 😬 It was a really tough period in my journey, but thanks to my therapist and a whole bunch of awesome resources, I was able to put things in perspective and rediscover who I was. That person wasn’t who I had been before; it was someone better, and stronger. My really tough period was also full of growth and learning.
- Syrena Clark, Advisory Board Member
Coping & Recovery
Is recovery from psychosis possible? (Spoiler alert: YES.)
First things first: You are not alone. And with the right support, full recovery is entirely possible.
Psychosis, especially in the early stages, can be treated effectively, and most people are able to resume working toward their life goals. Without treatment, on the other hand, psychosis can be seriously disruptive to your life and health, so it’s important to get help early.
You can’t simply choose to make it go away, and it’s definitely not cowardly to tell someone you’re concerned about your mental health. In fact, it takes great courage and strength to prioritize your well-being and take that first step.
What does the recovery process look like?
There’s no one-size-fits-all treatment for psychosis. The best kind of support is the kind that works for you. This is a major reason why coordinated specialty care programs for early psychosis have been found to be effective: because they enable program participants to shape their own mix of supports that further their personal recovery journey. By getting comprehensive care early on and focusing on self-care and stress management, symptoms can diminish or disappear altogether, and you’ll be back on your way to living the life you want to lead.
Choosing recovery means choosing to do the things that make you feel better day after day. It can be as rewarding as it is difficult, and the road to recovery is rarely a straight shot. It’s more often like a winding path with a few detours – and unexpected discoveries about ourselves – along the way.
While some people are able to get back to their lives and responsibilities soon after an episode of psychosis, others may need a few weeks, months or even years to recover more gradually. Longer-term medication may be helpful, or it may not be. We’re all different, and all of our experiences are valid.
Many specialty care programs for young people experiencing psychosis are two years in length, which allows time to create new, healthy routines, bolster (and educate!) one’s support network, and get back to school or work while keeping stress levels low. Some find that staying in therapy or group sessions beyond two years works best for them.
The recovery process looks different for everyone. Just bring a whole lot of patience, courage and determination with you, and you’ll rock it.
"You're still you. An illness doesn't define you. There will always be people that will stereotype you. But it's important to remember that you are strong."
- Christine Frey, Advisory Board Member
Ready to learn more about treatment for psychosis?
Visit our psychosis support and provider directory page to learn more about what coordinated specialty care is. Or, access our psychosis provider directory for a list of coordinated specialty care programs for early psychosis across the U.S.
Still thinking about waiting it out?
As with any health issue, psychosis becomes more difficult to treat the longer it goes untreated. Without specialized help, the road to recovery can get longer and tougher (and often a whole lot more lonely).
So if you’re experiencing signs of psychosis, here’s the game plan:
1. Talk to someone you trust – a school counselor, parent, coach, friend, or relative. Tell them you aren’t feeling like yourself, and you need to talk to a professional.
2. Take a self-check up quiz to better understand what you’re experiencing.
Resources for psychosis
Whether you're looking for yourself or for someone in your life, here are a few resources about psychosis to help you navigate.
Psychosis resources for teens and young adults
Think you might have psychosis? Check out this screening tool
How to Find the Right Mental Health Support For You: A Tip Sheet for Teens and Young Adults
Students With Psychosis support groups
Unhelpful thinking habits (check yourself)