People w/ Psychosis, Other Delusional States, or Autism Are Also at Risk

Chris R Brewin, Emeritus professor in Clinical Psychology, Freya Rumball, Clinical psychologist, & Francesca Happé, Professor of Cognitive Neuroscience

Post-traumatic stress disorder (PTSD) has been defined by successive editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (most recently DSM-5). The diagnosis requires an objectively traumatic event that involves exposure to “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.” This focus on objective event characteristics maintains PTSD as a response to extreme rather than everyday stress, but it overlooks mounting evidence that subjective responses to traumatic events predict PTSD just as or more strongly.

Groups of patients who are at risk of developing PTSD might be overlooked because the triggering event is subjectively rather than objectively traumatic. We describe three such groups here, but there are undoubtedly others. Traumatic events, both objective and subjective, are common in the lives of patients with psychosis. Experiences, such as being forcibly sedated or admitted to hospital during an acute episode, can be terrifying to someone who cannot understand fully what is happening or appreciate the motives of those involved.

Hallucinations and delusions can also be extremely frightening and can be experienced in the same way as an actual threat of serious physical injury. People with the delusion that others are trying to kill them, for example, might experience PTSD symptoms such as intrusive memories, flashbacks, and nightmares related to episodes when they thought that they were about to be attacked. That the experience of psychosis itself can be traumatic has been known for at least 30 years,and in recognition of this an informal category of “psychosis related PTSD” has been proposed by researchers.