What Is a Psychotic Break? Learn How to Identify the Signs

Genetic factors, traumatic life events, and underlying medical problems can all contribute to psychotic breaks. Find out the symptoms of a psychotic episode and how to handle it.

What is a psychotic break?

Many things might come to mind when you hear the term psychotic break, but what does it really mean? First, it's important to understand psychosis, which describes mental disorders in which some sense of reality has been lost. Many different mental illnesses, such as depression, schizophrenia, schizoaffective disorder, substance abuse disorders, and bipolar disorder can include symptoms of psychosis.

The definition of psychotic break is when an individual's mental health worsens to the point that they no longer recognize the world around them. This experience is also known as a psychotic episode.

Psychotic break vs. mental breakdown

Mental breakdowns, also known as nervous breakdowns, are not a diagnosis. These events are signs of a mental or emotional crisis that likely requires professional evaluation or care.

A psychotic break or episode occurs when a person shows the first signs of psychotic symptoms, which can include auditory and visual hallucinations, delusional thoughts and beliefs, and paranoia.

Symptoms of a mental breakdown vary greatly, from a depressed mood to outbursts and mood swings, emotional numbness, and in some cases where stress is especially high, even psychosis. Stress-induced psychosis does not have to be linked to any other mental disorder and typically lasts no longer than one month.

How long does a psychotic episode last?

There is a wide range of how long psychotic episodes last. A short psychotic episode, or brief psychotic disorder, usually lasts no longer than one month, but can last as short as a day. Psychotic symptoms in other disorders last much longer.

In schizophreniform disorder, a serious but short-term psychotic disorder that affects how you act and think, psychosis can last for days or weeks, and in rare cases, months. Psychosis for people with schizophrenia can last much longer. In fact, in some cases, psychosis symptoms are chronic or ongoing.

What does a psychotic break look like?

Psychotic episodes can be alarming for both the person having them and their loved ones. The symptoms of any psychotic break vary widely from person to person. However, psychosis usually includes two main symptoms: hallucinations and delusions. Understanding both can help illustrate what many psychotic breaks look like.

1. Hallucinations. These are when a person hears, tastes, sees, touches, or smells things that do not exist outside of their own mind. The most common hallucination is hearing voices. Several types of mental illnesses can cause hallucinations, but they can also be a side effect of certain medications, or physical illnesses like alcohol use disorder or epilepsy. Not getting enough sleep can also increase the likelihood of hallucinations.
2. Delusions. These are firm beliefs in something that is untrue. An example of a delusion is the belief that you are being followed or watched when that is not the case. The types of delusions are somatic (a belief that something is wrong with your body), persecutory (a belief that someone is out to get you), grandiose (also known as delusions of grandeur), erotomanic (a belief that someone is in love with you), jealous, and mixed/unspecific.

Does a psychotic break damage the brain?

A 2012 Yale study found that, even in healthy individuals, stress can cause the brain to shrink. Experiencing stressful life events can reduce gray matter in the brain, and because psychosis is triggered by stress, this is also true.

In a large, multi-site study of young adults at clinically high risk for psychosis, researchers found notable changes in brain tissue thickness as more psychotic episodes happened. However, these changes in the brain do not mean people who experience psychosis are not able to live satisfying lives. In fact, with the right treatment life after psychosis can be just as fulfilling as it is for anyone else.

Who is at risk for psychosis?

As the brain is also changing throughout this time, the onset of psychosis usually happens during the transition from adolescent to early adulthood. About 3 out of 100 people (or up to 3.5%) may experience a psychotic episode at some point.

Though experts are still studying its causes, psychosis has various known risk factors. For example, psychosis related to drug use is more common in males. However, thyroid disease that causes mood changes is more likely to cause psychosis in women. Also, studies show that people who live in urban areas are more likely to have psychotic episodes than those who do not.

Here are some of the main risk factors to psychosis:

• Mental illness. Schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder are all conditions that may have psychotic symptoms.
• Genetics. A family history of psychotic disorders and genetic mutations like the DISC1, associated with dopamine impairments, can contribute to the development of psychosis.
• Physical health issues. Brain trauma, including a stroke or traumatic brain injury (TBI), and some brain diseases like Alzheimer’s, Parkinson’s, and dementia can sometimes cause psychosis.
• Trauma. Childhood trauma is a known risk factor for psychosis and other mental disorders in adulthood.
• Substance use. People who are already at risk are more likely to get psychosis if they use LSD, alcohol, amphetamines, and other drugs.

What are signs of a psychotic break?

Very often, a person will show signs of a psychotic break before the episode actually begins. Gradual changes in a person’s behavior usually happen before the First Episode of Psychosis (FEP), or early psychosis including a decline in personal hygiene, spending more time alone, or trouble thinking or concentrating.

It’s important to notice these early signs as they may help lead to early treatment which can slow, stop, and even reverse psychosis.

Left untreated, early signs can lead to full FEP, which includes hearing and seeing things that aren’t there, withdrawing from family or friends, lack of self-care, intense emotions, or a lack of emotions. Over time, FEP becomes psychosis which includes the usual symptoms: hallucinations, delusions, and trouble concentrating.

Treating a psychotic break

People who experience a psychotic breakdown may resist treatment due to delusions as well as stigma attached to psychotic disorders. In this case, the situation can be very hard on families, but there are ways to still get help.

Before any treatment, medical professionals will need to do a diagnosis to see exactly what might be causing psychosis. Doctors will look at specific risk factors like the person’s family’s history, or whether they have substance abuse problems.

Traditionally, a combination of medicine and psychotherapy are typically used to treat psychosis.

However, studies show a treatment approach called Coordinated Specialty Care (CSC) has an especially high success rate. CSC includes psychotherapy, medication management, peer support, family support guidelines and education, employment assistance and case management.

What to do if someone is having a psychotic break

Research shows that people with psychosis will have a better quality of life in the long run if they get help as soon as possible. If someone you love is showing early signs of a psychotic break, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a resource called the Early Serious Mental Illness Treatment Locator to help find them care.