What Are the Symptoms of Psychosis?

Positive symptoms

Positive symptoms are behaviors or thoughts you acquire. The positive symptoms of psychosis contribute to your disconnection from reality.

Positive symptoms include:

• delusions
• hallucinations
• disorganized speech
• disorganized behavior

Delusions

Delusion is one of the primary features of psychosis. It causes you to hold firm beliefs, even when evidence proves those beliefs false.

When you experience a delusion, what you believe is absolute. No one will be able to change your mind, and you may fiercely defend your new way of thinking.

Delusions can be about anything. For example, you could believe someone is spying on you or trying to harm you, or you could be convinced a Hollywood star is in love with you.

Hallucinations

Along with delusions, hallucinations are a primary feature of psychosis. While delusions involve your thought process, hallucinations involve your physical senses.

When you experience a hallucination, you may see, smell, taste, touch, or hear things that aren’t really there or that others in the same situation cannot perceive.

For example, you could be in your living room with your partner and suddenly see spiders crawling all over the furniture, while your partner doesn’t see the same thing. Or, you could smell roses and taste honey out of the blue without changing environments or eating anything.

Sometimes during an episode of psychosis, a person can have hallucinations that are linked to their delusions. For example, someone who believes they’re being followed all the time could actually see a person or creature coming their way when there’s actually nobody there.

Disorganized speech

Disorganized speech can manifest in many ways, and you’re usually not aware of it.

It may be that you jump from one topic to another without a clear connection between them, or you may repeat words instead of forming sentences. For example, you could go back and forth saying the same three words.

You may also use made-up words or forget what you’re talking about.

Disorganized speech makes it difficult for others to understand what you’re saying, and it makes it really challenging for you to express yourself clearly.

Disorganized behavior

When you persistently behave in a way that doesn’t line up with the activity you are doing or your age, it may be considered disorganized behavior.

Peeling apples in the middle of cleaning the bathroom might be considered disorganized behavior.

Disorganized behavior can range from being bizarre to being potentially harmful (to yourself or others). For example, a person exhibiting disorganized behavior could go from talking to themselves to running naked in the streets to moving all their furniture into the street without any apparent reason.

Negative symptoms

Symptoms of psychosis that cause you to lose ability or function are called negative symptoms.

These may include:

• withdrawn mood
• decreased motivation
• lack of emotional display
• decreased gestures and movement
• lack of interest in other people, activities, or events
• changes in personality
• other symptoms

Withdrawn mood

Psychosis may make you wary of other people or social events. You may find that you’re more inclined to stay home than do things you enjoy.

Decreased motivation

You may find it difficult to start simple tasks like brushing your teeth or bigger ones like going to work.

Lack of emotional display

During an episode of psychosis, you may appear emotionless and inexpressive, even when the situation would merit otherwise.

Decreased gestures

In addition to a lack of emotional display, you may also move and react less. For example, you might stop using hand gestures or facial expressions to support your words or feelings, or you could sit down for hours looking at a wall.

Lack of interest in other people, activities, or events

Psychosis may make you reluctant to socialize. You may have feelings of distrust toward people and places, or just a general sense of apathy.

Personality changes

While psychosis affects everyone differently, personality changes are a common symptom. This means you may start behaving in a way that is out of character for you. For example, you may shift from being outgoing to being introverted, or you may be loud and talkative when in the past you were quiet.

Other symptoms

Psychosis may also show up as other symptoms, such as:

• substance abuse
• difficulty sleeping
• feelings of anxiety or depression
• thoughts of suicide

While psychosis can have a sudden onset, many people exhibit more subtle early signs.

The early signs of psychosis can be difficult to identify. They may mimic symptoms of other mental health conditions or major stress.

While your experience may be unique to you, common early signs of psychosis can include:

• significant changes in school or job performance
• feelings of unease or suspicion around people
• strong or absent emotions
• a decline in personal hygiene
• difficulty concentrating
• social withdrawal
• unusual, persistent thoughts and beliefs
• seeing, hearing, or feeling things that aren’t there
• confused speech

Any of these signs may be attributed to other causes, including other mental health conditions or temporary emotional difficulties.

Only a mental health professional can accurately diagnose psychosis.

Significant changes in school or job performance

You may start having trouble concentrating and holding on to thoughts. This may make work and school more challenging.

Feelings of unease or suspicion around people

Thinking of or seeing people in a different light may be an early sign of psychosis in some instances. For example, someone you once considered a close friend might suddenly feel threatening to you.

You might feel as though people are “out to get you” or talking about you as you pass by.

You may not want to be around people, and your thoughts and behaviors might cause conflict with peers.

Strong or absent emotions

Research shows a link between low emotional self-awareness and some types of psychosis.

Early signs of psychosis may include a sudden inability to describe the emotions you’re experiencing or feeling increasingly disinterested in people and events.

Emotional outbursts that are otherwise uncommon in you and have no evident cause might also be an early sign.

Decline in personal hygiene

Your motivation to complete daily tasks may decrease, which can lead to a lack of self-care or personal hygiene.

Difficulty concentrating

Early signs of psychosis may mean you have difficulty concentrating, following thoughts, or completing problem-solving processes.

Social withdrawal

It’s natural to want to be left alone once in a while. But if you’re starting to persistently avoid family, friends, or social events you would regularly attend before, you might be experiencing an early sign of psychosis.

Unusual, persistent thoughts and beliefs

You might start experiencing subtle signs of delusion like having intrusive thoughts that may be contrary to what you would otherwise think.

Seeing, hearing, or feeling things that aren’t there

You might also start experiencing hallucinations like seeing someone in the room or feeling like someone’s sitting next to you when there’s nobody there.

Confused speech

You might start experiencing difficulty expressing yourself or notice people have a hard time understanding what you mean.

When it comes to psychosis, receiving a formal diagnosis involves a number of factors — for example, what triggers the episode, which symptoms are present, and how long they last.

The primary types of psychosis include:

• psychosis in psychotic disorders
• brief psychosis or brief psychotic disorder
• medical psychosis
• substance-induced psychosis
• unspecified/other psychosis

Psychosis in psychotic disorders

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (5th ed.), psychosis is a symptom of a mental health condition, not a diagnosis.

It’s the primary symptom in what are called “psychotic disorders.”

Examples of psychotic disorders include:

• schizophrenia
• schizophreniform disorder
• schizoaffective disorder
• delusional disorder

Brief psychosis (brief psychotic disorder)

When you experience psychosis suddenly, without symptoms of any other mental health conditions, you may be experiencing a brief psychotic disorder.

Brief psychotic disorder presents as psychosis that lasts less than a month and results in a full recovery.

Postpartum psychosis may be a case of brief psychosis.

Medical psychosis

Defined by the DSM-5 as “psychotic disorder due to another medical condition,” medical psychosis may occur if you’ve suffered an injury or another medical condition.

Head trauma, for example, could have resulting symptoms of psychosis due to brain injury.

Substance-induced psychosis

Medication, medication interactions, and certain substances may cause psychosis. In the DSM-5, this is called “substance/medication-induced psychotic disorder.”

Sometimes, after the brain has become accustomed to a certain substance, withdrawal from that substance may also result in psychosis.

Unspecific or other psychosis

In unspecified psychosis, there isn’t always a clear reason why you’re experiencing symptoms.

If no other medical conditions or causes can be identified, and no other diagnostic criteria are met, your doctor may give you the diagnosis of “unspecified or other schizophrenia spectrum and other psychotic disorder.”

This means you’re experiencing psychosis, but your symptoms don’t clearly line up with another diagnosis.

Episodes of psychosis warrant immediate care.

Despite misconceptions and stigma, psychosis doesn’t make you dangerous. However, because it’s a mental state in which your perception of reality is altered, there may be safety concerns for you and those around you.

For example, if you’re experiencing delusions about being able to fly or hallucinations about being attacked by someone else, you could react in ways that might put your safety in jeopardy.

Getting medical help as soon as possible can help you manage these symptoms during an episode.

Psychosis is when your brain has difficulty separating what’s real from what isn’t. It can occur for a number of reasons.

Symptoms vary and may mimic those of other mental health conditions or stress responses.

While it may be difficult to tell when an episode of psychosis begins, there are often early warning signs that could help you anticipate an episode.

In all cases, seeking the help of a mental health professional is highly advisable. Symptoms of psychosis can be managed, and often a full recovery is possible.