4% of People Experience a Psychotic Break Each Year—Learn the Signs

The U.S. population is feeling more stressed, anxious, and mentally exhausted now than ever. According to Mental Health America, over 50 million Americans experienced a mental illness or mental episode between 2019 and 2020. Additionally, a 2023 poll shows that 70% of Americans feel extremely anxious about their safety. 

This might be less concerning if everyone who experienced a mental health event sought help. Unfortunately, mental health stigmas and cultural prejudices deter more than half of those who experience a psychotic episode or other condition from seeking treatment. Perhaps, equally worse, is that many people who see someone experiencing a mental health crisis simply don’t know how to support them. 

The Clinical Psychology College of Medicine reports that about 4% of the global population struggles with a mental health condition each year in which psychosis is a symptom. Therefore, it’s important for colleagues, employers, and family members to understand the signs and challenges associated with mental health issues like psychotic disorders. 

Only through education can a supportive and compassionate society free of mental health stigmas and prejudice be created. By learning the symptoms of a psychotic break and the steps for offering support, you can recognize mental health issues better and help individuals get the care they need. 

What Is a Psychotic Break?

A psychotic break, also known as a psychotic episode, refers to a severe mental health event that causes a loss of contact with reality. It is typically associated with a psychotic disorder, such as schizophrenia, schizoaffective, or bipolar disorder. During a psychotic break, a person may experience symptoms such as hallucinations, delusions, disorganized thinking and speech, and disrupted or abnormal behavior.

According to the National Institute of Mental Health, as much as 1% of the population is affected by a psychotic break each year. However, psychotic breaks look different for everyone, as behavioral changes during a psychotic break can range from withdrawn and catatonic to agitated with unpredictable. An individual may even exhibit socially inappropriate behavior and demonstrate a significant departure from their usual functioning.

Psychotic Break vs. Mental Breakdown

It can be tempting to use the terms “psychotic break” and “mental breakdown” interchangeably. However, they do describe two separate events with different characteristics. While a psychotic break is typically associated with a psychotic disorder and is nearly always characterized by episodes of psychosis, a mental breakdown is not. 

A “mental breakdown” is not connected with any formal psychiatric diagnoses or episodes of psychosis. Instead, a mental breakdown describes a state of general mental distress or prolonged anxiety. It’s typically caused by a sudden, external factor, such as a job loss or death, and can last for days, weeks, or even months if untreated. 

Characteristics of a mental breakdown include:

• A deep, persisting expression of sadness 
• A loss of interest in things previously enjoyed
• A strained ability to relate or connect with others
• Frequent inexplainable physical issues, like headaches or stomach aches

David Harewood, a British advocate for mental health, describes his own experience with psychosis: “I’d start walking home, I’d sort of blackout, and next thing I know, it’d be two o’clock in the morning . . . I had so much energy, I’d be buzzing out of my mind . . . everything became kind of visceral and to see the sunrise was like ‘wow.’”

Characteristics of a psychotic break include:

• Delusional or paranoid thoughts, like believing wild or unrealistic things
• The presence of hallucinations, such as hearing voices or seeing things that aren’t there
• Disorganized or illogical thinking, characterized by noticeably erratic or incoherent speech
• Significantly impaired ability to perform daily tasks, like work, school, or taking care of the family

As John Kane, M.D. and Chairman of the Department of Psychiatry of Northwell Health shares, “When someone experiences the onset of these symptoms, they don’t always have the insight or judgment to recognize that they are becoming ill. So, unfortunately, it often takes many, many months before people receive appropriate treatment.”

Recognizing the Symptoms of a Psychotic Break

“Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood.”

American Psychiatric Association

A person experiencing a psychotic break likely isn’t going to be aware of it or want to communicate it. Therefore, knowing how to spot the early warning signs of psychosis can be crucial for early intervention and treatment. While the early warning signs of a psychotic break can vary by the individual, there are some common indicators a person can watch for. 

Some common early warning signs of psychosis:

• Changes in perception: The person may start experiencing subtle changes in their perception, such as seeing shadows or objects differently, hearing faint or unusual sounds, or feeling a heightened sensitivity to stimuli.
• Social withdrawal: They may begin to withdraw from social activities, hobbies, and relationships. There might be a decrease in their interest or participation in previously enjoyed activities.
• Decline in functioning: A noticeable decline in their overall functioning and performance can occur. This may include a drop in academic or work performance, neglecting personal hygiene and self-care, or difficulty with organizing tasks.
• Unusual thoughts and beliefs: They might start expressing strange or unusual thoughts, ideas, or beliefs that are not based on reality. They may become increasingly suspicious or paranoid, attributing hidden meanings to ordinary events or feeling excessively worried about being observed or persecuted.
• Disorganized speech and thinking: There may be disruptions in their thought processes and communication. They might have difficulty expressing their thoughts coherently, exhibit disorganized speech patterns, or struggle to stay on topic during conversations.
• Heightened emotional responses: The person may display intense or inappropriate emotional reactions, including excessive anger, irritability, or emotional sensitivity. They might also experience a significant decline in their ability to express or experience emotions.
• Changes in sleep patterns: Disruptions in sleep patterns can occur, such as difficulty falling asleep, experiencing frequent nightmares, or experiencing unusual sleep disturbances.
• Deteriorating relationships: They may encounter challenges in maintaining relationships with family members, friends, or colleagues due to changes in behavior, communication difficulties, or increased social withdrawal.

What Causes a Psychotic Episode

The causes of a psychotic break can be complex and multifaceted. Often, it results from an interplay between genetic, biological, environmental, and psychological factors. 

Dr. Adil Jawad, a leading consultant psychiatrist, further explains: “If you are looking at the causes of psychotic disorders, these can be a number of ideological factors or causative factors. One of them being acute stress, severe overwhelming stress for an individual. The other being illicit drugs or alcohol. Third, being prescription medications like steroids, for example.”

Common factors that can contribute to the development of a psychotic break:

• Genetic factors: There is evidence to suggest a genetic predisposition to psychotic disorders. Having a family history of conditions such as schizophrenia or bipolar disorder increases the risk of experiencing a psychotic break.
• Neurochemical imbalances: Imbalances in certain neurotransmitters, such as dopamine and glutamate, have been associated with psychosis. Disruptions in these brain chemicals can affect perception, thinking, and mood, potentially leading to a psychotic break.
• Brain abnormalities: Structural or functional abnormalities in the brain can increase vulnerability to psychosis. These abnormalities can be present from birth or develop later in life due to factors such as trauma, infection, or substance use.
• Substance abuse: Substance abuse, particularly hallucinogenic drugs or stimulants, can induce transient or prolonged psychotic symptoms. Substance-induced psychosis can mimic the symptoms of a psychotic break and may resolve once the substance is cleared from the body.
• Traumatic experiences: Severe trauma, such as physical or sexual abuse, neglect, or significant emotional stress, can contribute to the development of psychosis. Trauma can disrupt the individual’s ability to cope with stress and may trigger the onset of a psychotic break.
• Environmental stressors: Prolonged exposure to chronic stress, social isolation, or significant life changes can contribute to the development of psychosis. These stressors can exacerbate existing vulnerabilities and increase the risk of a psychotic break.
• Medical conditions: Certain medical conditions, such as autoimmune disorders, brain tumors, or infections affecting the central nervous system, can cause psychosis. In these cases, treating the underlying medical condition may alleviate or resolve the psychotic symptoms.

How Psychotic Breaks Are Treated

There are a number of ways a psychotic episode can be treated, depending on the person, the cause, and the severity. The method of treatment prescribed will ultimately be determined on a case-by-case basis by a healthcare professional. 

Common methods of treatment include:

• Medication: Second-generation antipsychotic medications, according to the Cleveland Clinic, are prescribed to help manage the symptoms of psychosis. These medications, like Abilify and Zyprexa, target neurotransmitters in the brain to reduce hallucinations, delusions, and other psychotic symptoms.
• Psychotherapy/CBT: Various forms of psychotherapy can be beneficial in treating psychosis. Cognitive Behavioral Therapy (CBT) is commonly used to help individuals challenge and modify distorted thoughts and beliefs associated with psychosis.
• Psychosocial Interventions: These interventions focus on developing coping strategies for a person experiencing a psychotic break. They may include psychoeducation to help the person understand their condition, support groups, and assistance with daily living skills.
• Coordinated Specialty Care (CSC): Collaboration between different healthcare specialties is crucial in the treatment of psychosis. This may involve a multidisciplinary team consisting of psychiatrists, psychologists, social workers, nurses, and other mental health professionals working together to provide comprehensive care and support.

5 Ways to Support Someone With Psychotic Symptoms

In a MedCircle interview, psychiatrist Dr. Domenick Sportelli explains, “When someone’s experiencing acute psychosis, it’s real, I’m not going to talk them out of it. So loved ones, family, supporters, caregivers, if someone is experiencing a psychotic episode, there’s no need to try and talk them out of it . . . be supportive, be caring . . . think about how you are going to get that individual to the next step, which is help.”

As tempting as it can be to try to “shake” someone out of psychosis, it’s not going to work. Instead, employers, team members, and family members can show support by practicing empathy, listening, and offering to help, while the person moves toward receiving professional help. 

1. Offer to Help

When a person experiences symptoms of a psychotic break or episodes of psychosis, they’re not able to perform their usual tasks. Perhaps they haven’t been able to clean their house, buy groceries, or walk their dog. Depending on their situation, they might not have even had a full meal in a while or clean clothes. If you suspect someone is experiencing mental illness, simply offering to help them in small ways is one of the best things you can do. 

Ways to help:

• Offer to pick up their groceries and cook them a meal. 
• Offer to walk (or even watch) their pets.
• Ask them if there is anything that they need from the store.
• Offer to help with a work project or a task they must complete.

2. Create a Safe Space

When we feel safe, we let our guard down. Therefore, to maximize recovery efforts for a person experiencing psychosis, it’s critical to first create a safe space for them.  

Tips for creating a safe space:

• Respect their boundaries; avoid touching them or entering their personal or work space unannounced.
• Minimize noise and overwhelming stimuli, such as lights or people, when engaging with them.
• Remain calm and non-threatening; keep their stress low by speaking gently.
• Avoid challenging delusions or distorted thought patterns; it’s their reality.

3. Practice Empathy

A person feels most understood when someone tries to see and relate from their perspective. This is why practicing empathy is so important. While you may not know what a person going through a psychotic break is feeling, you can tap into what may have triggered it and empathize with them. 

How to practice empathy:

• Ask the person questions.
• Look inward and recognize the emotion they are feeling; connect with it.
• Let them know you’re there to support them.
• Give them the benefit of the doubt and don’t pass judgment.
• Practice active listening—don’t listen to respond; listen to understand.

4. Don’t Assume

The problem with making assumptions is that it hinders our ability to relate. When we assume something about someone else, we separate ourselves from them, effectively closing off the potential for connection, empathy, and open communication. For this reason, it’s important to cast aside any assumptions or beliefs when supporting someone experiencing a psychotic break or other mental illness.

How to stop making assumptions, according to Dr. Sheri Jacobson with Harley Therapy:

• Spend time watching when you are making assumptions and write them down.
• Analyze what you’ve written and ask questions, like “Is this true?” and “How can I prove this?”
• Relinquish the false sense of control that assumptions provide.
• Observe the areas in your life where you feel stuck; this is where assumptions often live.

5. Respect Their Privacy

When supporting someone through a mental illness, privacy is critical. A person’s situation could be such that certain aspects of their life could be severely impacted by a mental health event, such as their housing, their job, and their future opportunities. This is why it’s so important to respect the person’s privacy even as you support them through a psychotic break.

How to respect the privacy of others:

• Don’t share anything they say privately to you with anyone who does not need to know, except a medical professional or key family members.
• Mind your language when talking about someone experiencing a psychotic break.
• Watch for non-verbal cues, like facial expressions, that indicate other things a person would not want people to know.

Overcoming Stigmas for Improved Mental Health Advocacy and Support

“People will need help and support either intermittently or continuosly, but their mental health experience no more defines them than their sexuality, gender, personality, or any other aspect of their identity.”

Mike Slade, Ph.D.

A 2016 report in The Lancet on the health crisis of mental health stigmas shares, “Many people with mental illness experience shame, ostracism, and marginalization due to their diagnosis, and often describe the consequences of mental health stigma as worse than those of the condition itself.” 

The American Psychiatric Association shares that the driving factor behind stigmas is inaccurate information that leads to a lack of understanding, or even fear, around mental illness.

The best way to create a compassionate and supportive society is to become educated. By being educated on psychotic disorders and other mental health conditions, colleagues, employers, and loved ones gain the confidence and skills required to help those in need, benefitting everyone. 

Resources for continued mental health education and advocacy:

• National Alliance on Mental Illness (NAMI)
• Mental Health America (MHA)
• Mental Health First Aid at Work

For more insights on mental health, check out 15 Mental Health Books to Read in 2023.