Can PTSD Explain the Link Between Trauma and Psychotic Experiences?

What you need to know

• Exposure to trauma is associated with increased risk of both psychotic experiences and PTSD symptoms in adolescence and early adulthood
• PTSD symptoms partially explain the relationship between childhood trauma and psychotic experiences in adolescence
• Addressing PTSD symptoms may help prevent the development of psychotic experiences in people who have experienced trauma

Background

Psychotic disorders, which involve a loss of contact with reality, are among the most disabling illnesses worldwide. While current treatments have limited effectiveness, understanding what causes psychosis could help develop better interventions.

Research has shown that experiencing trauma, especially in childhood, increases the risk of developing psychotic experiences and disorders later in life. However, we don’t fully understand how trauma leads to psychosis. One possibility is that post-traumatic stress disorder (PTSD) plays a role in this relationship.

PTSD is a mental health condition that can develop after experiencing or witnessing a traumatic event. Symptoms include reliving the trauma through flashbacks or nightmares, avoiding reminders of the trauma, negative changes in thinking and mood, and being easily startled or on edge.

Some researchers have suggested that psychotic symptoms could be an extreme version of PTSD symptoms. For example, flashbacks in PTSD might develop into hallucinations if a person doesn’t recognize them as trauma-related memories. However, most previous studies looking at PTSD as a link between trauma and psychosis had limitations that made it difficult to determine if PTSD truly explains this relationship.

This study aimed to examine whether PTSD symptoms help explain the relationship between trauma exposure and psychotic experiences using data collected over time. The researchers looked at this relationship in both adolescence and early adulthood.

How was the study conducted?

The researchers used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large ongoing study that has followed thousands of people born in southwest England in the early 1990s.

They examined:

1. Whether childhood trauma (ages 0-14) was associated with psychotic experiences in adolescence (ages 12-18)
2. Whether PTSD symptoms at age 15 explained part of this relationship
3. Whether childhood/adolescent trauma (ages 0-17) was associated with new psychotic experiences in early adulthood (ages 19-24)
4. Whether PTSD symptoms at age 24 explained part of this relationship

Trauma exposure was measured using reports from participants and their parents about experiences like physical abuse, emotional abuse, sexual abuse, domestic violence, and bullying.

PTSD symptoms were assessed using standardized questionnaires that asked about symptoms like reliving traumatic events, avoiding reminders, and feeling on edge.

Psychotic experiences were evaluated through interviews that asked about hallucinations (seeing or hearing things that aren’t there) and delusions (strong beliefs not based in reality).

The researchers used statistical techniques to examine the relationships between trauma, PTSD symptoms, and psychotic experiences while accounting for other factors that might influence these relationships.

What did the study find?

The study found that:

1. Exposure to trauma was associated with an increased likelihood of both psychotic experiences and PTSD symptoms in adolescence and early adulthood.

2. There was a strong association between PTSD symptoms and psychotic experiences, especially in adolescence.

3. PTSD symptoms partially explained the relationship between childhood trauma and adolescent psychotic experiences. About 14% of the relationship between trauma and psychotic experiences could be explained by PTSD symptoms.

4. There was weaker evidence that PTSD symptoms explained the relationship between childhood/adolescent trauma and psychotic experiences in early adulthood. Only about 8% of this relationship could be explained by PTSD symptoms.

5. The results were similar when looking at a more narrowly defined outcome of psychotic disorder, with PTSD symptoms explaining about 19% of the relationship between trauma and adolescent psychotic disorder.

6. There was little evidence that certain types of PTSD symptoms (like re-experiencing trauma or avoidance) were more important in explaining the relationship than others.

7. PTSD symptoms seemed to play a similar role in explaining the relationship between trauma and hallucinations as they did for delusions.

What do these findings mean?

These results suggest that PTSD symptoms may play a role in how trauma leads to psychotic experiences, particularly in adolescence. While PTSD doesn’t fully explain this relationship, it appears to be one pathway through which trauma might increase the risk of psychosis.

This is important because we have effective treatments for PTSD, such as trauma-focused therapies. These treatments help people process traumatic memories in a healthy way. If PTSD symptoms contribute to the development of psychotic experiences, then treating PTSD might help prevent psychosis in people who have experienced trauma.

However, it’s important to note that PTSD symptoms only explained a relatively small portion of the relationship between trauma and psychotic experiences. This suggests that other factors are also involved in how trauma increases the risk of psychosis. These might include things like changes in how the brain processes information, other mental health problems like depression or anxiety, or social factors like isolation or discrimination.

Limitations of the study

While this study provides valuable insights, it has some limitations:

1. Although the researchers collected data over time, they couldn’t completely rule out the possibility that psychotic experiences might have led to PTSD symptoms in some cases, rather than the other way around.

2. Many people dropped out of the study over time, which could have affected the results, although the researchers used statistical techniques to minimize this impact.

3. The study relied on people’s memories and reports of their experiences, which might not always be accurate.

4. The study only looked at psychotic experiences, not diagnosed psychotic disorders, in most of its analyses.

Conclusions

• PTSD symptoms appear to be one way that trauma exposure increases the risk of psychotic experiences, especially in adolescence.
• Treating PTSD in people who have experienced trauma might help prevent the development of psychotic experiences.
• However, PTSD is likely just one of several pathways through which trauma can lead to psychosis. More research is needed to understand other factors involved in this relationship.

This study adds to our understanding of how traumatic experiences can affect mental health in complex ways. It highlights the importance of recognizing and treating PTSD, not only to alleviate its direct symptoms but also potentially to prevent other mental health problems like psychosis. For people who have experienced trauma, seeking help for PTSD symptoms could have wide-ranging benefits for their mental health.