Anxiety, or generalized anxiety disorder (GAD), can cause persistent and excessive worry that can manifest into physical symptoms, such as fatigue, muscle tension, and sleeping troubles. And, for some people, it can become so intense that they feel like losing their minds, and they begin to say things like “I feel like I’m going crazy” or “Am I crazy?”
If you have constant fears that you’re losing touch with reality, you might think you’re experiencing psychosis. According to Tracie Zinman-Ibrahim, LMFT, CST, a therapist at NOCD, psychosis is a “disconnection from the shared reality of others, paranoid thinking, or delusions of grandeur.” It is often associated with various mental health conditions, including anxiety.
If you believe you could be experiencing anxiety psychosis, know that your concerns are valid, and there’s treatment available that can help.
Can anxiety cause psychotic episodes?
Do scientists believe that anxiety can actually lead to psychosis? Not quite. “Having anxiety or an anxiety disorder is not going to make you psychotic,” says Zinman-Ibrahim. “Anxiety can make you confused, upset, and depressed, but not necessarily psychotic.”
A research study found that having an anxiety or depressive disorder does not influence whether or not someone will develop psychosis.
However, both anxiety and psychosis may share some similar symptoms, such as:
- Difficulty thinking and concentrating
- Social withdrawal
- Sleeping troubles
- Having a sense of impending danger, panic, or doom
While anxiety doesn’t directly cause psychosis, a small research study discovered that people with psychotic disorders often also have symptoms of anxiety disorders.
Also, there is one possible link between particularly severe anxiety and episodes of psychosis. Research revealed that people who had persistent, high levels of anxiety during their childhood and adolescent years can have a higher risk of developing psychosis later on.
But, for the most part, anxiety typically isn’t able to cause episodes of psychosis. However, some mental health disorders can make you worry that you’re going through a psychotic episode, or that you’re having hallucinations or delusions.
Having anxiety or an anxiety disorder is not going to make you psychotic,” says Zinman-Ibrahim. “Anxiety can make you confused, upset, and depressed, but not necessarily psychotic.
Why am I so worried that I’m developing psychosis?
A possible reason as to why you think you’re having anxiety with delusions is obsessive-compulsive disorder (OCD). OCD is a condition characterized by intrusive thoughts, images, urges, sensations, and/or feelings (obsessions) accompanied by mental and physical actions done to feel better or more certain (compulsions). OCD has several subtypes or themes that can impact your daily life—and one common theme is your mental health and grasp on reality.
Zinman-Ibrahim explains that OCD often causes a fear of psychosis, often during periods of intense anxiety. “Fear of being psychotic is a common OCD presentation,” she says. “In both of my OCD support groups, we’ve had multiple conversations where people shared things like, ‘I think I might be hearing something,’ ‘I’m going to lose control and do stuff that is harmful,’ or ‘Oh gosh, I’m losing my memory.’”
She also adds that OCD symptoms are often misdiagnosed as symptoms of psychosis. “For instance, magical thinking, which is where you think if you do a ritual, that somehow it is going to protect you from something, could be seen as delusional thinking—but it could also just be OCD,” she says.
What actually causes psychosis?
While anxiety has not been shown to cause psychosis, there are several mental health conditions can cause symptoms of psychosis, including:
Severe depression
Severe depression, or major depressive disorder, may cause delusions or hallucinations during depressive episodes. But, like anxiety, having severe depression doesn’t necessarily mean you have psychosis. “You can have a very deep depression that borders on psychotic features, but that’s not quite the same as you becoming psychotic,” says Zinman-Ibrahim. “You’re just having extra symptoms of depression.”
Schizophrenia
Schizophrenia is a chronic mental health disorder that can affect how you think, feel, and behave. Zinman-Ibrahim explains that people with psychotic disorders like schizophrenia may experience hallucinations and delusional beliefs that indicate psychosis.
Bipolar disorder
Bipolar disorder is another mental health disorder that may cause psychosis. It can cause extreme and unusual shifts in your mood, concentration, energy, and activity levels. Research reveals that symptoms of psychosis are very prevalent in people with bipolar disorder, with more than half experiencing psychotic mood episodes at some point in their lives.
Getting help to manage psychotic symptoms
Now that we have a clearer understanding of the relationship between anxiety and psychosis, let’s explore what treatment looks like for a fear of being psychotic versus mental disorders that can actually cause psychosis.
Before recommending a treatment, Zinman-Ibrahim says that it’s important to identify where the fear of psychosis is coming from. “We would assess you to make sure we understand what’s causing your symptoms, whether it’s anxiety, OCD, or a psychotic disorder like schizophrenia,” she says. “If you had a psychotic disorder, we would refer you to a specialist who can assess that and recommend treatment.”
Treatment for OCD or anxiety
If you’re suffering from anxiety or have OCD focused on a fear of psychosis, Zinman-Ibrahim recommends a combination of Exposure and Response Prevention (ERP) therapy and Acceptance and Commitment Therapy (ACT).
ERP, which is the gold standard treatment for OCD, comprises two components: careful exposure to fear and uncertaintyresponse prevention techniques to resist engaging in compulsions. “The purpose of ERP is to expose ourselves to either the possibility or idea of a fear coming true or facing a very specific fear,” she explains. “We’re going to face our fears a little bit at a time, then we’re going to learn how to react in a way that does not engage or feed into the OCD and make it worse.”
This specialized therapy may be done in combination with ACT, which “helps us learn things like mindfulness, unhooking from the distress we feel from being triggered, understanding how to choose your personal values, and letting those guide you, as opposed to living by OCD fears,” says Zinman-Ibrahim.
If your OCD obsessions focus on a fear of psychosis, an exposure exercise might involve reading about others who have experienced psychotic episodes, or simply saying “I might have a psychotic break one day” out loud. To learn how to manage your anxiety and uncertainty, you’d then resist the urge to respond with compulsions, such as reaching out to a loved one for reassurance, or “testing” your grasp on reality to feel better.
Treatment for psychotic disorders
For psychosis tied to disorders like schizophrenia and bipolar disorder, Zinman-Ibrahim recommends visiting a licensed psychiatrist for proper diagnosis and treatment. She also explains that because these conditions are believed to be associated with chemical imbalances, treatment will often involve a mixture of therapy and medication (mood stabilizers and antipsychotics) to manage symptoms of psychosis.
Regardless of what the source of your fears about psychosis are, a proper assessment and treatment from a licensed mental health professional is necessary to help manage your mental health condition. If you have anxiety or OCD, working with a therapist specializing in ERP can get you on the path to recovery.
We can help you get your life back from OCD, anxiety, or both. Book a free call.
