A study of individuals suffering from both complex PTSD and psychosis found that disturbances of self-organization—a set of symptoms specific to complex PTSD—predicted the appearance of paranoid thoughts and hallucinations (both auditory and visual) within the next 90 minutes. The research was published in Psychological Medicine.
Complex posttraumatic stress disorder (complex PTSD) is a mental health condition that arises from prolonged or repeated exposure to traumatic events. These events typically involve interpersonal harm, such as abuse, neglect, or captivity. A defining characteristic of these events is that the person is unable to escape them.
Complex PTSD includes the core symptoms of posttraumatic stress disorder—re-experiencing the trauma, avoidance, and hyperarousal—along with additional difficulties in emotional regulation, self-perception, and relationships. These additional characteristics are referred to as disturbances of self-organization.
Traumatic life experiences also increase the risk of developing psychosis. Studies suggest that PTSD symptoms mediate the relationship between traumatic events and psychotic symptoms. Psychosis is a general term for various mental health conditions characterized by a loss of contact with reality, resulting in symptoms such as hallucinations (perceiving things that are not present) and delusions (strongly held false beliefs).
Study author Peter Panayi and his colleagues sought to examine the dynamic effects of complex PTSD on psychotic symptoms in individuals with both complex PTSD and a psychotic disorder within the schizophrenia spectrum. Schizophrenia spectrum disorders are a group of mental health conditions characterized by symptoms such as delusions, hallucinations, disorganized thinking and speech, abnormal motor behavior, and negative symptoms like reduced emotional expression or social withdrawal.
To investigate this, the researchers conducted an experience sampling study. The participants were 153 individuals from the Study of Trauma and Recovery (STAR) who consented to provide experience sampling data. All participants were diagnosed with PTSD and depression, but 75% also had at least one additional diagnosis, the most common being depression.
As part of a larger study, participants completed an extensive battery of assessments evaluating traumatic experiences, PTSD and complex PTSD symptoms, paranoid thoughts, and psychotic symptoms. Additionally, participants used a mobile app (m-Path) that delivered experience sampling questionnaires to their phones up to 10 times a day over six days during waking hours. For participants without smartphones or internet access, the researchers provided smartphones with preloaded SIM cards. Each experience sampling questionnaire consisted of 29 items assessing participants’ emotional states, current context, complex PTSD symptoms (core PTSD symptoms + disturbances of self-organization), and psychotic symptoms.
On average, participants completed approximately 60% of the experience sampling questionnaires. Symptoms of disturbances of self-organization at one time point predicted the appearance of paranoid thoughts and hallucinations (voices and visions) at the subsequent time point—typically within 90 minutes.
“This study highlights the profound impact of cPTSD [complex PTSD] on people with psychosis. Specifically, DSO [disturbance of self-organization] symptoms (i.e. emotional dysregulation, negative self-concept, and interpersonal difficulties) may maintain psychosis symptoms in the flow of daily life to an even greater extent than core PTSD symptoms. In turn, the exacerbation of distressing psychosis symptoms is in addition to the direct impact of these difficulties on individuals’ quality of life and daily functioning,” the study authors concluded.
The study sheds light on the connection between symptoms of complex PTSD and psychosis. However, it is important to note that the study relied on self-reports and required very frequent introspection over six days. While this frequent introspection is an inherent characteristic of this study design, it may have influenced the results.
The paper, “Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life,” was authored by Peter Panayi, Emmanuelle Peters, Richard Bentall, Amy Hardy, Katherine Berry, William Sellwood, Robert Dudley, Eleanor Longden, Raphael Underwood, Craig Steel, Hassan Jafari, Richard Emsley, Liam Mason, Rebecca Elliott, and Filippo Varese.