Abstract
The current study aimed to evaluate the potentially traumatic aspects of psychotic symptoms and psychiatric treatment of psychosis using qualitative methods. Participants included 63 people with first episode psychosis or multiple psychotic episodes recruited from an inpatient psychiatric unit and an urban state psychiatric hospital in the North East region of the United States. Quasi-structured interviews were used to explore those aspects of symptoms and treatment that were perceived as traumatic Emotional reactions to the most traumatic aspect of symptoms and treatment, during and after the event, were also examined. Participants described a number of traumatogenic aspects of psychotic symptoms, including frightening hallucinations; suicidal thought/attempts, thoughts/attempts to hurt others; paranoia/delusions and bizarre/disorganized behavior or catatonia. Traumatic aspects of psychosis elicited emotions including anger, sadness and confusion, anxiety, and numbness at the time of event. Furthermore, many participants found aspects of treatment to be traumatic, including: being forced to stay in the hospital for a long time; experiencing upsetting side-effects; coercive treatments, including involuntary hospitalization, use of restraints, and forced medication; being exposed to aggressive patients; and mistreatment by professionals. These experiences elicited emotions of anger, sadness, distrust, and a sense of helplessness. Study findings suggest that the experiences both of psychotic symptoms and psychiatric treatment, potentially traumatic, can be a powerful barrier to engaging people in mental health services and facilitating recovery. Clinical implications were discussed.
Highlights
The emergence of a psychotic disorder can be a devastating event for an individual, with major impact on perception of self, self-esteem, and ability to function adequately [1]
Psychotic symptoms and treatment experiences can lead to posttraumatic stress disorder (PTSD) symptoms similar to those observed in individuals who have experienced traumatic events such as disasters and rape [2,3,4]
This study examined traumatic reactions to the experience of psychosis and associated treatment for people with first episode psychosis (FEP) or multiple episodes of psychosis
Summary
The emergence of a psychotic disorder can be a devastating event for an individual, with major impact on perception of self, self-esteem, and ability to function adequately [1]. Psychotic symptoms and treatment experiences can lead to posttraumatic stress disorder (PTSD) symptoms similar to those observed in individuals who have experienced traumatic events such as disasters and rape [2,3,4] Psychotic symptoms such as command hallucinations to hurt self or others, persecutory delusions, or disorganized behavior can be frightening [2, 4,5,6]. Over 20 years ago, Shaner and Eth [14] reported a case study of a person who developed symptoms, following a schizophrenic episode, that were consistent with PTSD These symptoms included re-experiencing the traumatic event(s), avoidance of trauma-related stimuli, and over-arousal. In addition to traumatic reactions similar to PTSD, depression, suicidality, and low self-esteem are common negative emotional reactions after a psychotic episode
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