Understanding Psychotic Breaks

MAR. 20, 2017

By Ryann Tanap


When you hear the phrase “psychotic break,” what comes to mind? Probably nothing good. In everyday conversation, the phrase carries a negative meaning for many because it’s perceived as a harsh and abrupt disconnect or “break” from reality—though it is more accurately described as an episode of psychosis.

Carlos Larrauri, for example, describes his experience with psychosis as more of a gradual decline, as opposed to a “break” occurring during a single event. His behavior deteriorated for a year, though he recalls warning signs as early as two to three years prior. He was in his first year of college when he noticed changes in his mental health: “I couldn’t do routine assignments,” Larrauri noted. “I stayed up all night talking to myself and had trouble concentrating.” His behavior worsened as he isolated himself, stopped showering, ate out of trashcans and picked cigarettes up off the floor.

Rather than seeing psychosis as something that out-of-the-blue one day “breaks” or “snaps,” it’s important to realize that possible warning signs can occur along a continuum of time. The problem is, people often don’t recognize psychosis until an individual reaches a point of crisis.

So, What Should I Look For?

“Psychosis can look different for many people,” says Chantel Garrett, founding director of Partners for StrongMinds (P4SM). “[But] early in the development of psychosis, a person tends to withdraw from their family and social networks.” Garrett notes other early signs can include:   

  • Difficulty sleeping
  • Difficulty reading or comprehending what someone is saying
  • Seeing shadows or flashes of light
  • Hearing ringing or voices
  • Smelling or tasting things that others can’t

There are additional early warning signs to look out for, especially among adolescents. In the U.S., 100,000 young people experience psychosis each year. Psychosis is a symptom and therefore temporary; however, if not treated early, it may develop into more intense experiences, including hallucinations and delusions. Psychosis can also be a sign of a mental health condition, such as schizophrenia or bipolar disorder.

What Causes Psychosis?

Many factors can lead to psychosis, including genetics, trauma, substance use, physical illness, injury or mental health conditions. However, we are still discovering why and how psychosis develops. “What we do know is that during an episode of psychosis, the brain is basically in a state of stress overload,” says Garrett.

Stress can be caused by anything, including poor physical health, loss, trauma or other major life changes. When stress becomes frequent, it can affect your body, both physically and mentally. “When a brain can no longer effectively process a certain level of stress, the processing of information and emotions is impacted, resulting in trouble perceiving reality,” explains Garrett.

Thus, it is very important to listen to our bodies so we can properly manage our stress. However, even with properly managing stress, some people will still experience psychosis.

How Can I Support Someone Who May Be Experiencing Psychosis?

Being supportive and persistent in helping a loved one find the right treatment can make a world of difference for someone experiencing psychosis.  Larrauri explains his journey to recovery was largely due to his friends, family and academic community. In college, a trusted friend notified his mother that something was “going on” with her son. Soon after, his mother arranged a meeting with him and his thesis advisor. After being reminded by his thesis adviser that he was not required to disclose anything private, Larrauri insisted on full disclosure while away at college.

“With all due respect, I have a Cuban mother. I’ve never had privacy,” Larrauri recalls telling his advisor. He knew his health was at risk. Over the next few years, his family played a key role in his recovery. Larrauri’s mother took him to several doctors until he finally received the correct diagnosis of schizophrenia. His father helped him enroll in classes part-time to encourage structure and develop coping skills. Today, Larrauri is in graduate school pursuing a career as a psychiatric nurse practitioner.

“People have maintained high aspirations for me,” adds Larrauri. “I’ve gone from someone who was seeking help to someone on the NAMI Miami Dade County board of directors. People recognize NAMI as a bridge builder in the community. We need to focus on early intervention,” he says. It’s a game changer for people experiencing early psychosis.

Want to learn more about how NAMI is getting involved with early intervention programs across the country? Register for the Schizophrenia Research Forum’s webinar on March 22 featuring Andrew Sperling, NAMI’s Director of Federal Legislative Advocacy.

Register here


SEP, 12, 2018 12:16:10 PM
This article has helped me to understand. Thank you.

AUG, 29, 2018 09:16:26 AM
Dorris Coppinger
My husband has been in a severe psychotic/schizo state for almost 3 weeks. He's in total denial, thinks there's nothing out of the ordinary. Refuses to take meds prescribed for the condition.

AUG, 01, 2018 04:42:16 PM
I think it's very important to remember that people with psychosis and other mental illness are not "doing it" on purpose. I am reading a lot of comments questioning why someone's son, daughter, bf or other loved one is "doing this" to them. Please understand that by you saying this, whether it be here on a forum or actually to their face, places fault on them and makes you out to be a victim. It is not only hurtful but it's flat out disgusting. You are not a victim of anything and they are not doing anything to you on purpose- do you think a loved one would want to hurt you or make you feel concerned and worried about them? Likely not. Their psychosis has nothing to do with you, and by asking such a question "why are you doing this (being mentally ill)? places blame when what they need is a support system. It is exhausting. I have experienced this myself with my boyfriend, who had family members who victimized themselves and placed blame on him for "making them lose sleep over worry about him" or "it's not fair I can't handle this anymore I don't understand why you are like this". It's not our job to understand...it is our job to support and love and do whatever we can to help this person. It is frightening, it turns your world upside down but the brain is very fragile. Our loved ones who are ill need someone to hold space for them, in a non-judgmental way and they need our help. Please consider what type of impact you pointing fingers at someone with psychosis can have on them... think of increased feelings of guilt, shame, etc. Be source of positivity for them even if it kills you inside- that is what they need.

JUL, 28, 2018 08:54:51 AM
My son has had 3 psycotic episodes in the last 3 yrs, he is now 25. The worst one was last yr, he dissapeared for almost 3 days and had to be hopitalized for almost 1 month.
He accepted treatment the first 7 months but for the last 8 he refuses to even see a Dr
His behaibor is getting worst by the day, he stopped washing his teeth, looks like a very dirty persone, doesn’t want to study or work, eats & drinks cumpulsively, has gain a lot of weight and is not sleeping but refuses help.
Please, I really need your helo

JUL, 17, 2018 02:59:06 AM
Google search very helpful

MAY, 25, 2018 02:02:55 AM
I have suspected this pschosis and possibly bi-polar and PTSD after the deaths of my wife and best friend a year apart. I know my 83 y.o. Mom is next, or me. I lost feeling is massive. I've never read a forum like thisand thank everyone for their openess and understanding. Please continue.

MAY, 12, 2018 09:42:56 AM
My 16 year old son has been smoking cannabis for one year , I do not know how much but with his GCSEs getting closer he started smoking more frequent and ended up having a physcotic episode .why

NOV, 28, 2017 11:21:57 AM
Linda Holyoak
I'm dealing with a person who demands from me what he is unable to do for himself emotionally.Relating to him quickly deteriorated soon after our relationship began.No matter what I say to him he becomes combative with dramatic outbursts and accuses me of starting arguments no matter the conversation.He always talks down to me manipulating and demanding he is self- focused on his own emotions and needs.He repeats his obsessions and those get repeated time after time.There seems no break in this personality disorder and it's been four years.

SEP, 21, 2017 09:51:13 PM
My family notices when I am in psychosis, they say I quit calling or talking to them. My boyfriend says I talk crazy and bring up the past. But I on the other hand believe it all to be real. What scared me the most was acting on a delusion I had. I wish there was a way for me to know that my thoughts are not real. I do not feel I was stressed out, like they say stress can bring it on; But I am so into my head and do not bring up what I am thinking that you would not even know all the thoughts that are going thru my head. I have never had therapy for my delusions and still think even while on medicine some of the delusions are true and do not believe they are delusions. I am on medicine now and stable but worry one day the medicine will quit working and I will be in a delusional state again, afraid to act on the delusions. I also hear voices but on medicine i no longer hear the voices.

APR, 11, 2017 12:04:30 AM
"However, we are still discovering why and how psychosis develops."

I'd rather exercise, take stress management classes, learn meditation and stay far away from the medication since they are still "discovering".

APR, 07, 2017 11:45:39 PM
Thank you so much for this article. My son has schizo affective disorder. He gets a monthly injection. He goes through these awful periods where he smokes marijuana for days/weeks and then gets completely psychotic. He can't afford to rent as he works part time. When he gets psychotic he is up for 24 hrs and has to take olanzapine to help him sleep. He can become very aggressive too. It is very hard on me and my husband and his brother. I just don't get why he has to do this....

APR, 06, 2017 11:19:01 AM
Alice S.
No one should feel guilty about missing the warning signs of psychosis. My daughter was a senior in college when she began feeling paranoid and exhibited several other "text book" warning signs of the prodromal stage of schizophrenia. She was under the care of two psychiatrists during this time and visiting a therapist weekly and she shared all of her symptoms with them. Yet not one of them recognized the seriousness of her symptoms. The psychiatrists just kept increasing her Prozac dose and prescribed Adderall to address her deterioration in thinking and function. Her psychotic break came one year later and she is finally on appropriate medication. It's great that NAMI educates families once loved ones are diagnosed, but efforts should also be directed at educating mental health professionals who clearly do not recognize early warning signs of serious mental illness.

APR, 02, 2017 07:45:12 PM
Mary ann
Great article

APR, 01, 2017 05:35:17 PM
Lucy Marie
I have been suffering over three decades with clinical anxiety and depression. My biggest fear is not being able to work because of it but not get approved for disability. I also have been diagnosed with ADD, which explains a lot. I do want to work but when I am in work my anxiety is off the charts. I take clonazepam which helps, but I just can't seem to get the control I had when I was younger.

APR, 01, 2017 01:10:08 PM
Linda Parsons
Your comments were such a gift to me and others. I can't wait to talk to my shrink because I know when an episode is coming on even a month or two before it happens so let's slow things down. Thank you!

APR, 01, 2017 12:30:33 AM
Therese M McClane
To date, I take medication for my mental illness and see a therapist and a psychiatrist monthly and bimonthly for medication management. I was diagnosed officially in 2012 with Bipolar Disorder, Schitzo Affective Disorder, Chronic clinical depression, PTSD, Panic Disorder and Generalized Anxiety Disorder. Now looking back on the 5250 involuntarily hold placed on me in May 2012, I see how much Acute Distress, trauma, anxiety, fear, and isoulation were occurring simultaneously before my psychotic break. This 5250 was a horrific experience for me and not anything I'd openly relay to anyone...I still to date can't get myself to believe I actually suffer from Mental Illness. There is such a stigma placed on those with mental illnesses. My mother has not spoken to me since February 2011 and we used to be close...very very close like talking multiple times a day. Losing my mother was treated in therapy via grief therapy. She will never or cannot ever get over this stigma attached to my Mental Illness. I think that bottom line I was an embarrassment to her and she chose her career and a relationship with a man over me. I'm still sad and confused but I continue to see my therapist and take my meds as prescribed by my psychiatrist. :(

MAR, 31, 2017 02:17:57 PM
That was a great story. One comment is above is confusing. PTSD ...listening to your body. It lies. I find that our bodies don't lie. Trauma is stuffed inside somewhere and depending on the age of the trauma our minds are only able to help re-create the story with the age we preserved the trauma.

MAR, 31, 2017 11:29:40 AM
I was diagnosed bipolar around 12 yrs ago. I'm in my 50's now. I've had major depression since I was a young child, but looking back now, I had bipolar also for a very long time. I never thought about psychosis until this article. I have a number of things from what this article says is psychosis. Smelling things that others don't, seeing shadows out of the corner of my eyes thinking they are people (which terrifies me), bright orbs of light in the corners of my vision, not being able to read (reading has been my #1 activity my whole life), isolation, can't sleep without meds, hearing sounds when I'm in the shower - like someone yelling or phone ringing. Guess I need to talk to me psychiatrist about these things. Thanks for the article.

MAR, 31, 2017 09:43:07 AM
Excellent article. So much more knowledge is needed about the genetic basis of psychotic disorders. Those with multiple generations of these illnesses in their families need doctors that will help monitor the slow onset of illness in their teenagers. Why? Because the prompt treatment of first episode psychosis promises a better outcome. If you have these illnesses in your family, I urge parents to seek help at the first sign of severe anxiety, depression, lack of concentration, cyclical mood changes and poor school performance, and paranoia. There is no point in pretending that a child is not at risk if there is a history of illness in the family.

MAR, 30, 2017 08:58:51 PM
Gradual is right, I have had bi-polar illness for years, I never recognize my own symptoms or early warning signs. Other friends do tell me I'm not being ok.

MAR, 30, 2017 08:12:37 PM
Comments are all interesting and insightful. I am a health care professional and Breast Cancer survivor. Respectfully, I would like to reply to Marcia Lawrence's comment "...a low-dosage birth control pill to counter the hormonal imbalance and to help regulate her periods is a preferred treatment. Estrogen replacement for postpartum and menopause will alleviate the symptoms." I would say that it should be up to each individual's medical practitioner, as we know so much more now about of the role HR2 positive as it relates to Breast cancer(s). I strongly advise caution in introducing hormones to both young and menopausal women for regulatory purposes. It can be very risky and certainly not appropriate to post as a blanket statement.

MAR, 30, 2017 04:52:54 PM
Dawn Hoppe
I have to disagree with some of you, I suffered from Migraines and was put on Birth Control for Psychiatric purposes, it backfired and I had to be wheeled into the Hospital thinking that I had had a stroke, I depend on my Psychiatrist and also Brad's adolescent Psychiatrist to monitor our meds to go along with Therapy. I never try to self medicate though.

MAR, 30, 2017 04:09:22 PM
This article helped me better understand my psychosis more than ever. I am Bi Polar 1 with psychotic episodes.

MAR, 30, 2017 12:16:17 PM
marcia lawrence
psychiatric illness in adolescent girls is generally not recognized as a hormonally related condition. In fact, one of the potential hazards for women who experience a hormonally induced psychotic episode during adolescence and later (postpartum/perimenopause) is that they may present constellations of symptoms that resemble those of mental illness. A low-dosage birth control pill to counter the hormonal imbalance and to help regulate her periods is a preferred treatment. Estrogen replacement for postpartum and menopause will alleviate the symptoms. Not anti-depressants or anti-psychotic drugs.! [author of" Menopause and Madness, the truth about estrogen and the mind"

MAR, 30, 2017 11:43:11 AM
Thank you for sharing this information. Our 22 year old son struggles with schizoaffective disorder. While we have boundaries, we also are his advocates. We are thankful that we have been able to maintain a loving relationship. This article confirms what we believe in our hearts.

MAR, 30, 2017 11:00:20 AM
I love this article! It breaks down the psychotic break in a totally understandable way, and explains that is not a quick process but a downward spiral. That's great for the general public to know!

MAR, 30, 2017 12:52:45 AM
A very informative reminder

MAR, 30, 2017 12:37:11 AM
Jennifer Sprague
waa proud rn R104458..complex ptsd..my episodes have all been directly related to sleeplessness more than one night

MAR, 29, 2017 10:49:17 PM
Dawn Hoppe
Although I have always known this, it helps to see it in an article and know that I am proud to have a Psychiatrist that helps me and that I trust to tell her everything. I come from an abusive background where my x husband belittled me for my mental illness and called me a Drug Addict. I never took my meds in front of him because I was scared of being looked down upon. Thank-you for NAMI for helping overcome this abuse and feel proud that I have the intelligence and knowledge to ask for help. I also train PTSD Service Dogs for Veterans and Women in Domestic Violence , one of the reasons that I am so good at what I do is because I have experienced and truly understand the Psychotic mind and how scary it is to be in that state of mind thinking that you will never be able to get out of it !

MAR, 29, 2017 10:41:28 PM
Excellent article and information reguarding early warning signs. i have two bi polar kids now adults doing very well in life. Early intervention was key. The most difficult thing for me as a parent to deal with was early on and how scared I was and no one would say it would be ok. I fought hard to find doctors who found *****tail meds for both kids. Hospitals were a nightmare. If either son or daughter were acute they didn't know to sign a confidentiality form so I could be a source for the staff. Very scary when the hospital doesn't feel like they are helping you. Once you get to know staff and have meetings with social worker who helps you navigate the mental health system it gets easier.

MAR, 29, 2017 10:19:30 PM
I have psychosis at times, which is usually seeing shadows and even figures that I describe as ghosts. However, I do believe in ghosts and am afraid to tell my therapist when I am seeing them because I don't know if they are dellusions or not. When I feel paranoid, as if I constantly am being watched while I am alone, I do realize this is psychosis, but I'm still trying to learn how to deal with this. Thanks so much for the article and elaborating o psychosis.

MAR, 29, 2017 08:46:08 PM
Connie ashworth
I wish I had signs to look for before my son got ill. I could have helped stop the progress of this disease. He still hasn't received the right medications and he's been diagnosed for 7 years!

MAR, 29, 2017 08:34:49 PM
Marilyn gerber
Please explain how body trauma re motor vehicle accident can cause ptsd?!

MAR, 29, 2017 08:23:48 PM
Julie Pitts
I have had PTSD since the age of five according to the symptoms. So my first real Therapist informed me. It was true I had textbook PTSD at 5. I sought counseling in my mid-twenties. I did very well and after two years of therapy I had the tools I needed for dealing with PTSD and actually did very well. Then my husband left the military and I went back to my hometown where most of the trauma happened to me. I was still doing well and miraculously after fifteen years of trying to conceive and carry a child to terrm I finally got pregnant and had a beautiful healthy daughter. At my six-week checkup my Obstetrician stated matter of factly you have Post Partum depression. We had not really spoken so it must have been my body language. My daughter was in her car seat and this doctor eas saying she wanted to put me on an SSRI. I was breast feeding and on the advice of my Pediatrician it was either take the medicine and quit breastfeeding or keep breastfeeding and try diet and exercise for the depression. I had waited 15 years to be a mother in every way and I chose to keep breastfeeding. It was the wrong choice. My mind was truthfully already having problems with psychosis, things like I had a dreaded fear I was so inept as a mother if I bathed my daughter I would drown her. No thoughts of WANTING to drown her but FEAR that I would. I always bathed my daughter with my husband present. Things slid into where I was living a double life by the time my daughter was two. A major negative relationship ended and I had not only ideations of suicide I had bought rope and picked a spot. that day I went to theraoy with my husband and she told me either go to the hospital and self admit or the sheffiff will come to your house put you in handcuffs in front of your daughter and I will have court ordered you into a hospital. My husband took me to the hospital. That was 2001. I went through treatment for psychosis for the next twelve years. I was diagnosed with not only Post Partum Psychosis/Psychosis, Major Depressive Disorder, Dissociative Identity Disorder, PTSD, Anxiety Disorder, Panic Disorder, Seasonal Affective Disorder and Dysthymia. In 2013 in a desperaate attempt to put my life and family back together I had 8 treatments of ECT. It was a very difficult choice to make but I decided it would be better than living on 11 medications that made me a Zombie and that I could not afford. I did months of research and decided the benefits outweighed the risks. After the first three treatments I demanded to be released from the hospital because of confusion and being disoriented. But the clarity of thought it gave me back I chose to have 5 more treatments. FOR ME it was the best choice I ever made. Unfortunately I was one of those people that lost memories permanently. But by the next year I had been able to get off 8 medications. I am still on a medication for depression, anxiety, and a sleep disorder. But I have had a wonderful life. A life I enjoy. I was just existing on medication, but now I have a life. I see my psychiatrist every 90 days and I see a therapist every 2 weeks and sometimes more often if I am working on a major life issue. I still have trouble with PTSD. The flashbacks began to be sneaky and present as dreams and catch me off guard. I couldn't use the tools I needed while asleep. So for a time I had to work on that. And that is why I still need my medications and to see the therapist.

MAR, 29, 2017 08:11:26 PM
Jennifer M Carrano
I was diagnosed with bipolar 1 over 20 years ago. I have always answered "no" to the question "do you hear or see things that others do not?" I have always been aware of my increasing stress levels because I become what I have termed 'squirrely'. Now I realize that my difficulty understanding basic conversations, changes in vision (like flashes of light), and onset of paranoia could all be symptoms and/or warning signs of psychosis. This is very enlightening. I thought that because I wasnt hearing voices telling me to hurt people or seeing bugs crawling under my skin that I wasnt hallucinating. I wonder why my doctors never recognised what I was telling them for what it actually was- psychosis. Thanks for this article. I'll discuss my revelations with my doctor.

MAR, 29, 2017 07:19:50 PM
Mary Lewis
My son in law needs help,he blames all his problems on my daughter.He thinks everyone that ISN'T traditional Catholic is going to hell.My daughter does all that he commands of her.He has nothing to do with his family and wants my daughter to have nothing to do with.her family.I have done all I can for them and he hates me.Personally I DON'T care as long as he stops verbally abusing my daughter.It is bad they have a 5 year old son and now a baby girl.He screams and yells has put his fist through the wall more than once.She WON'T let me talk to him this is very upsetting.Several times when visiting me Dominic DOESN'T want to return home.I tell her to call 911 he has her upset and crying too often.What can be done when my daughter puts up with thin behavior,what about her children,it is very upsetting to her son.Thanks

MAR, 29, 2017 07:06:38 PM
Thank you for your description of the descent into psychosis. Our daughter had a severe psychotic episode and was hospitalized. It was a very traumatic event for the whole family...her slow steady decline and her hospitalization. Her brain needed a recovery period afterwards and 2 years later, she is back to her happy, stable self with the right meds.

MAR, 29, 2017 06:02:49 PM
All family and friends need to be aware of this description. As parents we did not know what was happening to our son. We thought depression because that is a common thing. We never thought schizophrenia. We spent years not doing the right things for our son.

MAR, 27, 2017 03:24:29 PM
Denise Connelly
I am very interested in this medication treatment, but I am very afraid of the side effects and I know my daughter would hate the constant venipuncture sticks needed to monitor for a drop in whte blood counts.

MAR, 27, 2017 03:21:39 PM
Denise Connelly
Interesting article,. my daughter suffers from Schizo affective disorder, and has a intellectual disability. Most of the time she seems happy especially when he is talking to the other she says are constantly around her. She is actually angry and combative when they are not around. I thought this comes from a chemical imbalance on neuro transmitters (Dopamine and serotonin. How does stress actually change tour body's chemistry?

MAR, 26, 2017 07:51:08 AM
My son, 21, is in the psych. unit now after a "psychotic" break after heavy use of alcohol, Adderall, and marijuana while on spring break. He left for the trip but it feels like he never came home. This is the first time I came to this sight. Thank you, to read Mr. Larrauri continued to pursue his education has given me a glimmer of hope for my son.

MAR, 26, 2017 02:07:44 AM
edith lewis
My daughter is having signs of phycosis. She is not suicidle. She is isolating herself from everyone. She quit her job of 9 years because she thinks they are at her. She is a model employee. She got help I 2010, 2012. I have been trying to get her to talk to a professional she won't. I need some advice on what to do next.

MAR, 24, 2017 05:00:31 AM
Great article!

MAR, 22, 2017 03:15:28 AM
walt stawicki
PTSD sufferers do "listen to their body." It lies.

MAR, 20, 2017 08:05:30 PM
Lizanne Corbit
I so appreciate the thoughtfulness of this piece. There is a lot of taboo and misunderstandings surrounding things like psychosis. I love that you gave early warning signs and an explanation of causes. This is one of those things that people typically know very little about and that only exacerbates the negativity surrounding it. Openly discussing and working towards understanding is so huge.

MAR, 20, 2017 07:57:28 PM
Mrs. Garrett is my sister, I'm mentally ill myself. That was an interesting article. Thank you

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