What Is a Psychotic Break?

31 March, 2021
This article has been written and endorsed by la psicóloga Laura Ruiz Mitjana
A psychotic break implies a break with reality, a decompensation. Find out more about this phenomenon through our article.

What is a psychotic break? It could be said, broadly speaking, that people who don’t manifest a mental disorder of a psychotic type live their lives out in a continuum. This means that they have an adequate contact with reality, and can differentiate what is real from what is not.

But what about people with psychotic disorders? Or with those who are exposed to very traumatic or stressful situations? Their continuum of reality can be broken, and this is when we speak of a psychotic break.

So, when someone suffers from a psychotic break, there’s a break from reality, and the person stops having contact with reality. They no longer know what is real and what isn’t. It’s in this context that hallucinations, delusions, symptoms of agitation, and even violence can appear.

Experts call this a “decompensation” (that is, the patient has decompensated or has flared). What does a psychotic break entail though? Are there warning signs that allow us to anticipate it? In which disorders are they more frequent than in schizophrenia for example? We’ll reveal all right here.

What is a psychotic break?

A psychotic break can be difficult to control.
Psychotic breaks can significantly affect several different aspects of life.

A psychotic break is a temporary break from reality, that is, a loss of contact with everything that’s real. This means that during this episode, the person can’t distinguish whether what’s happening is real or not.

The affected person can develop significant paranoid thoughts, which can turn into delusions, as well as hallucinations of different kinds.

It’s advisable to treat the psychotic outbreak with drugs, as well as to request psychological help as quickly as possible. If they don’t, then they’re putting their life at risk and even those around them too. Also, it’s during these “breaks” that antipsychotic drugs are at their most effective (not before or after the outbreak).

When do they occur?

Psychotic outbreaks appear in psychotic disorders, such as schizophrenia, schizophreniform disorder or brief psychotic disorder, among others. However, they can also appear in isolation in people who don’t suffer from any psychotic disorder.

In this sense, traumatic or very stressful situations can trigger symptoms.

It’s also believed that there are people who manifest a certain genetic predisposition to suffer from them. If certain environmental factors are added to that individual vulnerability (for example, the stressors already mentioned), then the appearance of the outbreak is more likely.

Warning signs of a psychotic break

There are some signs that may indicate the imminent appearance of a psychotic outbreak (this is what we call “prodromal”, in the prodromal phase of schizophrenia, as we’ll see later). What are some of these signs?

  • The person begins to isolate themselves from their social life in some way.
  • Changes appear in that person’s routine, as well as in the way they behave or dress (they may abandon hygiene, for example).
  • They begin to display disorganized, weird, extravagant, and unusual behavior, etc.
  • The person may begin to have strange illogical ideas that don’t seem to relate to reality in any way.

Psychotic breaks in schizophrenia

In schizophrenia, the appearance of a psychotic break is frequent; when the person has one, we usually say that they have “decompensated”.

Thus, the psychotic break is part of the “positive” symptoms of this psychotic disorder, as they usually include hallucinations and delusions.

Let’s have a look at the three types of symptoms that appear in schizophrenia:

  • Positive: These are the symptoms that imply the appearance of some type of phenomenon, and include hallucinations, delusions, disorganized thoughts, etc. They aren’t “positive” in the usual sense of the word.
  • Negative: These imply the “deactivation” of some area of our life, and include affective flattening (also known as emotional blunting), little or no communication, disconnection with their surroundings…
  • Cognitive: Decreased attention and memory, impaired executive functions, slow thinking, etc.

On the other hand, for the diagnosis of schizophrenia, according to the DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders ), at least two of the following symptoms must appear:

  • Delusions
  • Hallucinations
  • Disorganized language
  • Catatonic or very disorganized behavior
  • Negative symptoms

What we mean here is that there must be a specific symptom that would trigger a proper psychotic break. People with schizophrenia, which is a chronic disorder, manifest different outbreaks throughout their lives. However, with adequate psychiatric and psychological monitoring they can be prevented.

Phases of schizophrenia

Schizophrenia follows a fairly heterogeneous course. However, four stages or phases of it have been defined in order for us to better understand how patients with this disorder usually evolve. Where would the psychotic break be found within these phases? Let’s have a look:

  • Premorbid phase: In this phase, the patient doesn’t show symptoms of schizophrenia, and their functioning is normal.
  • Prodromal phase: In this phase, the first prodromes appear, that is, signs of the disease, although not exact symptoms as such. Thus, the person may experience a slight change in behavior, an alteration in mood, a little strange behavior, etc.
  • Acute phase: It’s in this phase when the psychotic break appears. That is, the patient has decompensated. In this phase, antipsychotics are more effective than ever.
  • Residual phase: This is the post-outbreak or post-crisis phase, the one that occurs after the outbreak. It’s divided into two: the initial recovery phase (when there’s a partial remission of symptoms) and the late recovery phase (when the person is already functioning normally).

The psychotic outbreak in other disorders

Psychotic breaks require treatment.
Psychological therapy, along with drug support, is necessary in order for these patients to experience improvement.

The psychotic break can also appear in other disorders of the psychotic spectrum. This is the case in schizoaffective disorders, delusional disorders, brief psychotic disorders, and shared psychotic disorders.

Schizoaffective disorder

This is categorized as such in the DSM-5 and is characterized by an uninterrupted pattern during which a major depressive episode (including depressed mood) or a manic episode has appeared, together with symptoms of criterion A of schizophrenia (that is, the appearance of delusions, hallucinations, etc.).

As we can see here, mood symptoms are combined with psychotic symptoms. Therefore, a person with this disorder can also suffer from a psychotic break when they decompensate.

Delusional disorder

People with delusional disorder, another psychotic spectrum disorder, can also have a psychotic break. Because of this, delusional disorder is also typified as such in DSM-5.

In order to be diagnosed, the person must manifest one or more delusions with a duration of 1 month or more.

As we have seen, delusions are part of the “positive”, or “active” symptoms of the psychotic spectrum, and suffering one of them abruptly can trigger a psychotic break.

Brief psychotic disorder

Brief Psychotic Disorder is short-lived. It lasts at least a day, but less than a month, and the person returns to the level of activity they had before the outbreak; they’ll return to normal, as such. This implies the presence of at least one of the following symptoms:

  • Delusions
  • Hallucinations
  • Disorganized language
  • Very disorganized or catatonic behavior

When a person suffers from a psychotic break that lasts at least a day, they can already be diagnosed with a brief psychotic disorder.

Of course, the symptoms mustn’t be due to another underlying problem (for example, depression, bipolar disorder with psychotic symptoms, schizophrenia, etc.) or to the direct physiological effects of a substance or a medical illness.

Shared psychotic disorder

This condition (also called folie a deux ) implies a delusion shared by two people. That’s to say, there is an “influential” person, who usually has a diagnosis of schizophrenia or depression, who “transfers” his delusion to another “influenced” person (the second person is the one who suffers from the shared psychotic disorder).

This diagnosis has been removed in the latest version of the DSM (DSM-5), but some authors still affirm its existence. In this case, the two people could manifest the psychotic break through their delirium.

Psychotic breakouts are complex and varied

As you have been able to see throughout the article, these alterations and changes can be due to a wide variety of problems. They’re peculiar and sometimes difficult to identify.

To avoid the progression of aggressive symptoms and behavior that could put the lives of one or more people at risk, timely psychological and psychiatric therapy is necessary.

  • American Psychiatric Association -APA- (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid. Panamericana.
  • American Psychiatric Association -APA- (2000). DSM-IV-TR. Diagnostic and statistical manual of mental disorders (4thEdition Reviewed). Washington, DC: Author.
  • Belloch, A., Sandín, B. y Ramos, F. (2010). Manual de Psicopatología. Volumen II. Madrid: McGraw-Hill.
  • OMS: CIE-10. (1992). Trastornos Mentales y del Comportamiento. Décima Revisión de la Clasificación Internacional de las Enfermedades. Descripciones Clínicas y pautas para el diagnóstico. Organización Mundial de la Salud, Ginebra.
  • Sims, A. (2002). Symptoms in the mind: An introduction to descriptive psychopathology (3rd ed.). Edinburgh: Elsevier Science Ltd.