Can Untreated PTSD Lead to Psychosis?

Living with post-traumatic stress disorder (PTSD) can feel like your mind and body are constantly on high alert. For some people, the stress and exhaustion of untreated PTSD can become so intense that it begins to affect how they see and experience reality. This can lead to symptoms of psychosis, such as hearing or seeing things that aren’t there, or believing things that aren’t true.

If you are concerned about untreated PTSD causing psychosis, you are not alone. The truth is that untreated PTSD can, in some cases, lead to serious complications. However, help and healing are possible. 

In this article, we’ll explore what psychosis is, how it can develop in people with PTSD, and the treatment options that can help you find stability, strength, and hope again.

What Is Psychosis?

Psychosis is a medical term that describes when someone’s thoughts or senses become disconnected from reality. According to the National Institute of Mental Health (NIMH), psychosis is a group of symptoms that happen when a person is having trouble deciphering what’s real and what’s not.

A person experiencing psychosis may see or hear things that others do not. They may also have very strong feelings of paranoia, trouble performing simple tasks, or difficulty having a conversation.

Psychotic symptoms can look different for everyone, but they usually fall into a few main categories:

• Hallucinations
  • Meaning: Sensing something that isn’t really there
  • Examples: Hearing voices, seeing people or objects, feeling sensations others don’t
• Delusions
  • Meaning: Strongly believing something that isn’t true or based on reality
  • Examples: Believing you’re being followed, have special powers, or are in danger without evidence
• Disorganized Thinking or Speech
  • Meaning: Thoughts or speech that are confusing or hard to follow
  • Examples: Jumping between unrelated topics, giving answers unrelated to the question
• Disorganized or Abnormal Behavior
  • Meaning: Acting in ways that don’t fit the situation
  • Examples: Agitation, unusual body movements, difficulty completing daily tasks
• Negative Symptoms
  • Meaning: Loss of usual abilities or motivation
  • Examples: Reduced emotional expression, social withdrawal, lack of interest in personal care

It’s important to remember that psychosis isn’t a single disorder. It is a group of symptoms that can appear in many conditions, such as severe depression, mania, withdrawal from certain substances, schizophrenia, or with neurological diseases like Parkinson’s or dementia. 

How PTSD Can Lead to Psychotic Symptoms

PTSD is a condition that can happen after a scary or traumatic experience, causing upsetting memories, strong fear or anxiety, and changes in how you think, feel, or act. 

If you don’t get treatment for PTSD or if your PTSD becomes very severe, it can push the mind into a state where psychotic symptoms emerge. However, PTSD psychosis doesn’t happen to everyone. 

Several aspects of PTSD can put a person at higher risk of developing PTSD psychosis. 

Severe Flashbacks and Dissociation

People with PTSD often have flashbacks, where they feel like they’re reliving the trauma all over again. During these moments, it can be difficult to distinguish between past and present. These intense experiences may seem similar to hallucinations. 

Some people also experience dissociation, a feeling of being detached from reality.

Sleep Deprivation

PTSD complications often cause severe sleep problems, such as trouble falling asleep, nightmares, or waking up often during the night. When the brain doesn’t get enough rest, it can become confused or start to misinterpret what’s real. 

Long periods without good sleep can lead to hallucinations or paranoia, especially in people who are already under emotional stress.

Substance Use Complications

Many people with PTSD turn to alcohol or drugs to try to cope or numb painful feelings. Unfortunately, these substances or withdrawal from them can make symptoms worse. They can also change the way the brain processes information and increase the risk of PTSD psychosis. 

Risk Factors for Developing Psychosis with PTSD

Not everyone with PTSD will develop psychotic symptoms. However, certain risk factors increase the likelihood. 

Severity of Trauma

The more severe the trauma, the higher the risk of developing complications like psychosis. Trauma that happens repeatedly, or over a long period, can be especially impactful. 

Early-life trauma, including childhood abuse or neglect, may also make the brain more sensitive to stress later in life.

Lack of Treatment and Support

Not getting treatment for PTSD increases the likelihood that the symptoms will get worse over time. People who don’t receive therapy, support, or coping tools may be more vulnerable to developing psychotic symptoms. 

Early intervention, such as trauma-focused therapy or counseling, can reduce risk and improve outcomes.

Co-occurring Mental Health Conditions

Having additional mental health challenges can make psychosis more likely. Conditions like depression, anxiety, or substance misuse disorders often interact with PTSD and increase stress on the brain. 

Recognizing the Warning Signs

Knowing the early signs of escalating PTSD or emerging psychosis can make a huge difference. The sooner you notice these changes, the faster you can get help and prevent symptoms from worsening.

Some signs that PTSD may be getting worse include:

• Increased flashbacks or intrusive memories: You may relive the trauma more often or with greater intensity.
• Heightened anxiety or hypervigilance: Feeling constantly “on edge” or overly alert to potential danger.
• Emotional numbing or withdrawal: Losing interest in activities you once enjoyed or pulling away from friends and family.
• Frequent sleep disturbances: Nightmares, insomnia, or difficulty staying asleep can signal worsening PTSD.
  

Early indicators of a possible psychotic episode may appear gradually. Look out for:

• Hallucinations: Hearing, seeing, or feeling things that others do not.
• Delusions: Strong beliefs that aren’t based in reality, like feeling targeted or persecuted.
• Disorganized thinking or speech: Difficulty focusing, jumping between unrelated topics, or speaking in ways that are hard to follow.
• Behavior changes: Acting unusually, withdrawing from daily routines, or showing extreme agitation.
  

If you notice any of these signs, it’s important to reach out to a qualified mental health professional for assessment. Early intervention can make a meaningful difference. 

Even if your symptoms feel mild or inconsistent, professional evaluation is critical. Mental health providers can help determine whether what you’re experiencing is related to PTSD, a co-occurring condition, or an emerging psychotic disorder. Early support often leads to better outcomes and helps you regain stability and control.

Treatment and Recovery

The good news is that both PTSD and psychotic symptoms can be treated. Recovery is possible, especially when you get help early on and use approaches that target both trauma and psychosis together.

Evidence-Based PTSD Treatments

Treating PTSD includes using a combination of therapies and medications. 

• Psychotherapy: Also known as talk therapy, this mental health treatment includes talking with a mental health professional either alone or in a group setting. It can help identify troubling thoughts, emotions, and behaviors and provide guidance and support. 
• Prolonged exposure therapy (PE): This trauma therapy gradually and safely exposes you to trauma reminders to help you process them in a way that reduces fear and avoidance.
• Cognitive processing therapy (CPT): This trauma therapy helps change unhelpful or unrealistic thoughts about the trauma.
• Medications: antidepressants or anti-anxiety medications are prescribed to help manage PTSD symptoms, particularly when therapy alone isn’t enough.

Managing Psychotic Symptoms

Treating psychosis focuses on the underlying cause while also providing support, medications, and therapy.

• Antipsychotic medications: These may be prescribed to reduce hallucinations or delusions.
• Cognitive behavioral therapy: This mental health treatment is a type of psychotherapy that can help certain conditions that make psychosis worse.
• Inpatient treatment: If the psychosis is severe or if an individual poses a risk to their safety, they may need inpatient treatment for a time.  

Having a support network can make recovery smoother. Family, friends, support groups, and peer mentors can be great sources of encouragement and practical help. Community mental health centers, crisis lines, and online resources can also connect you with professional care quickly.

Hope and Recovery

Even if you’re experiencing severe PTSD or psychotic symptoms, recovery is possible. Many people who once felt trapped by their trauma have gone on to regain stability, confidence, and a sense of control over their lives. With the right treatment and support, you can manage symptoms, rebuild your life, and reconnect with the world around you.

Recovery doesn’t happen overnight, but every step toward seeking help is progress.

Here are some resources for finding help:

• National Center for PTSD – ptsd.va.gov
• National Alliance on Mental Illness (NAMI) – nami.org
• Suicide & Crisis Lifeline (U.S.) – Call or Text 988, or use 988lifeline.org
• Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline – 1-800-662-4357, samhsa.gov/find-help

Sources

American Psychological Association. (2019). PTSD treatment for patients and families. https://www.apa.org/ptsd-guideline/patients-and-families

Cleveland Clinic. (n.d.). Psychosis: Symptoms, causes, and risk factors. https://my.clevelandclinic.org/health/symptoms/23012-psychosis

Compean, E., & Hamner, M. (2018). Posttraumatic Stress Disorder with Secondary Psychotic Features (PTSD-SP): Diagnostic and Treatment Challenges. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 88, 265. https://doi.org/10.1016/j.pnpbp.2018.08.001

Giannopoulou, I., Georgiades, S., Stefanou, I., Spandidos, D. A., & Rizos, E. (2023). Links between trauma and psychosis (Review). Experimental and Therapeutic Medicine, 26(2), 386. https://doi.org/10.3892/etm.2023.12085

Grattan, R. E., Lara, N., Botello, R. M., Tryon, V. L., Maguire, A. M., Carter, C. S., & Niendam, T. A. (2019). A History of Trauma is Associated with Aggression, Depression, Non-Suicidal Self-Injury Behavior, and Suicide Ideation in First-Episode Psychosis. Journal of Clinical Medicine, 8(7), 1082. https://doi.org/10.3390/jcm8071082

MedlinePlus. (2024). Psychosis. https://medlineplus.gov/ency/article/001553.htm

National Center for Biotechnology Information. Psychosis. https://www.ncbi.nlm.nih.gov/books/NBK546579/

National Institute of Mental Health. (2023). Post-traumatic stress disorder. https://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd

National Institute of Mental Health. (n.d.). Understanding psychosis. https://www.nimh.nih.gov/health/publications/understanding-psychosis

National Health Service. (2022). Psychosis overview. https://www.nhs.uk/mental-health/conditions/psychosis/overview/

Waters, F., Chiu, V., Atkinson, A., & Blom, J. D. (2018). Severe Sleep Deprivation Causes Hallucinations and a Gradual Progression Toward Psychosis With Increasing Time Awake. Frontiers in Psychiatry, 9, 303. https://doi.org/10.3389/fpsyt.2018.00303