Psychosis commonly occurs as part of other mental health diagnoses
such as bipolar disorder or schizophrenia and sometimes also Borderline Personality Disorder and severe depression.
People we spoke to talked about other mental or physical health experiences that impacted on their lives, including:
- Depression, severe anxiety and low mood
- Asperger’s Syndrome
- Physical health challenges
A few also said they used recreational drugs and alcohol as part of their social life
and that this affected their psychosis.
When other health experiences were at their worst, it could be harder to manage hallucinations and paranoia associated with psychosis.Depression, severe anxiety and low mood
Many people we spoke to were experiencing depression and severe anxiety alongside their psychosis. Some had been given a diagnosis of “depression” but others had been seeing school counsellors in their early teens or had been referred to CAMHS
for anxiety and low mood when they had their first experience of psychosis
For some, depression, anxiety and low mood had been a part of life from a young age (sometimes due to bullying
in school or traumas in childhood
). Nikki, Peter and Luke experienced depression from their early teens and Joe doesn’t “really remember being happy” before his first year of university. See low mood and depression more generally in young people
. Some people who had never experienced low mood, anxiety or depression, noticed that periods of psychosis seemed to happen at times when they were stressed, and a few felt there was some link between them. Sameeha had never had low mood, but was highly stressed and anxious around the time of her first experience of psychosis.
Depression, low mood, high stress and anxiety could also occur after a period of psychosis: Luke described it as “the catastrophe that comes with [psychosis]”. Joseph said he had post-traumatic type symptoms and couldn’t deal with day to day activities like changing his bed sheets.
Self-harm and thoughts of suicide with psychosis
There is some evidence that people who experience psychosis are more likely to be at risk of self-harm and suicide (NHS Choices December 2016
). However, psychosis is a very varied experience and not everyone we spoke to experienced self-harm or suicidal thoughts. Those who did, talked about specific things that led them to think about self-harming or about suicide: such as low self-esteem (‘self-loathing’), low mood and depression, or fear and anxieties caused by bullying or abuse.
Self-harm and suicidal thoughts, or attempts, had been part of life before psychosis for some people, but coincided with the first experience of psychosis for others. Nikki, Sam and Ruby had begun to self-harm before their first psychotic experience. When she later started experiencing psychosis Ruby’s voice would command her to self-harm. But Tariq, Luke, Andrew X and Lucy all had thoughts of taking an overdose or ending their life around the same time of their first experience of psychosis. Sometimes suicide attempts were what prompted people, like Lucy (below) to receive help with their psychotic experiences.Autism and Asperger’s Syndrome
Ruby, Emily and Lucy still talk about self-harm and thoughts of suicide as part of their lives.
Several of the people we spoke to had received a diagnosis of autism or Asperger’s syndrome. When he was young Barry was diagnosed with autism and Andrew Z was diagnosed with Asperger’s. Because of their diagnoses, they both already had support in place when they began to experience psychosis later on. When Barry experienced psychosis his mother took him to a service run by CAMHS where he was seen by a counsellor who had worked with him, because of his autism, in the past. But Hannah, who had always struggled with making friends, only found out she had Asperger’s when she was assessed in hospital after seeing visions. She says her life would have been very different if she had known earlier.
People we spoke to had different views about whether or how psychosis and Asperger’s or autism may be related.Physical health experiences
A few people talked about physical health experiences. Sometimes physical health difficulties could be linked to stress and anxiety. Becky and Peter described having “crippling pain” in their stomachs which they felt was stress related. Ruby had been diagnosed with joint hyper mobility syndrome and suspected Ehlers-Danlos syndrome. This means she is more likely to become anxious, because hyper mobility syndrome increases the body’s production of adrenaline.
Physical health problems that needed major medical interventions could also add to stress and trauma.