Can experiencing trauma plunge people into psychosis? Research reported in
the April British Journal of Psychiatry suggests that it can indeed
In 1997 the Australian Bureau of Statistics conducted the National Survey
of Mental Health and Wellbeing. Survey respondents answered questions
regarding their mental health, including whether they had experienced any
trauma and/or delusions.
Of the 10,641 persons surveyed, 5,725 (53.8 percent) had been exposed to a
trauma, but had not developed posttraumatic stress disorder (PTSD) from it,
379 (3.6 percent) had been exposed to a trauma and had developed PTSD, and 478
(4.49 percent) reported delusional experiences.
James Scott, M.D., a child and adolescent psychiatrist at the Royal
Children's Hospital in Herston, Queensland, Australia, and his colleagues
decided to use the trauma and delusion findings from the National Survey of
Mental Health and Wellbeing to conduct their own study. They wanted to see
whether individuals who experienced various types of trauma also experienced
delusions. The rationale behind their hypothesis, Scott explained to
Psychiatric News, was that "an emerging body of evidence
suggests an association between psychotic symptoms and abuse in childhood. It
was thus illogical to us that psychotic symptoms should be confined to one
specific type of trauma, so we were interested in examining if the association
existed with other types—say, natural disaster, combat, or physical
Their analyses of the survey's traumadelusion results confirmed their
hypothesis. Individuals who had experienced trauma were more likely to have
experienced delusions than were individuals who had experienced no trauma. The
difference was statistically significant.
They also found a dose-response relationship between trauma and delusions.
The relative risk varied but remained significant with exposure to all
traumas. For example, those who had experienced one or two traumas were three
times more likely to have had delusions as were nontraumatized persons, but
those who incurred five or more traumas were 10 times more likely to have done
Moreover, those who had developed PTSD after trauma were more likely, to a
statistically significant degree, to have delusions than were indiv iduals who
had not developed PTSD after trauma. For instance, whereas only 8 percent of
those who had been in combat had delusions, 12 percent of those who had
developed PTSD in the wake of combat did, and whereas only 3 percent of those
who had been raped had delusions, 18 percent of those who incurred PTSD after
a rape did. "We were surprised by the size of the relative risks of
delusional experiences with PTSD," Scott said.
Finally, the links between various types of trauma and delusions and the
links between PTSD and delusions remained statistically significant even after
possibly confounding factors were considered. The factors included age,
gender, marital status, socioeconomic status, employment status, country of
birth, urban living, a diagnosis of schizophrenia, and alcohol or marijuana
In their study report, Scott and his group speculated on how trauma might
cause delusions or other types of psychotic symptoms. For example, trauma
might lead to altered stress hormones, which might then catalyze the
neurobiological mechanisms contributing to the onset of psychosis.
They also suggested that the evidence linking trauma and psychosis might
help explain why persons living in urban areas are especially susceptible to
schizophrenia. However, they said that the 87 persons in their survey sample
who had been diagnosed with schizophrenia were not significantly more likely
than other survey respondents to have been traumatized.
As for the implications of their findings, they noted, clinicians should
ask people with psychot ic sy mptoms about past exposure to traumatic events.
Also, if trauma can contribute to development of psychosis, then prompt
treatment of trauma may not only prevent PTSD, but trauma-induced psychosis as
However, the most important implication of their study, Scott said,"
is the overlap of symptoms between psychotic disorders and PTSD. This
may create diagnostic uncertainty where people with PTSD are misdiagnosed as
having a psychotic illness or, alternatively, where people with an emerging
psychotic illness who have a history of exposure to trauma are misdiagnosed as
having PTSD, and psychosis intervention is delayed. At this time, the symptom
overlap between these disorders potentially creates diagnostic confusion and
may result in administration of inappropriate treatment."
There was no external financial support for this study.
An abstract of "Association Between Trauma Exposure and
Delusional Experiences in a Large Community-Based Sample" is posted at<http://bjp.rcpsych.org/cgi/content/abstract/190/4/339>.▪