Types of Trauma Exposures Predict Specific Psychosis Symptoms

A new study explores the role that types of cumulative exposures to trauma have on the development of specific psychotic symptoms.

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Lifetime experiences of cumulative trauma are related to the severity of psychotic symptoms, according to a new study published in the Archives of Psychiatric Nursing. Whereas previous studies on psychosis and trauma have highlighted how specific traumatic events predict psychotic symptoms, the current study focused on associations between psychosis and cumulative trauma as a whole.

The study was led by Mohamed A. Zoromba of the College of Nursing at Prince Sattam Bin Abdulaziz University in Saudi Arabia. The research team comprised individuals from psychiatry and nursing departments in universities across Egypt and Saudi Arabia. They found that exposure to total cumulative trauma was a predictor of hallucinations, disorganized speech, abnormal psychomotor behavior, depression, and mania.

The researchers also found that certain types of cumulative traumas are linked to an increased risk for specific psychotic symptoms. For example, “attachment trauma,” related to early childhood experiences like abandonment, was connected to hallucinations, abnormal psychomotor behavior, and mania.

The researchers also offered an interpretation of how exposure to cumulative trauma may predict psychosis:

ā€œExposure to accumulated trauma experiences accompanied with ineffective coping modalities may affect the interpretations of the human mind to daily life events or stressors, which may enhance the separation of the integrated components of the human mind, namely, intellect, affect, and behavior, leading to the emergence of psychotic symptoms.ā€

As a result, the researchers emphasize the need for a more holistic, trauma-informed, and person-centered approach to understanding and treating psychotic symptoms.

Experiences of trauma are diverse and complex in nature and range from isolated events to continuous, ongoing, and lifelong traumas, referred to as ā€œcumulative trauma.ā€

A comprehensive and developmental framework for understanding trauma has recently been introduced. It highlights the complexity of traumatic experiences and offers a more multifaceted understanding of cumulative experiences of trauma.

Zoromba and colleagues outline this framework, which includes:

  • ā€œ(1) attachment traumas (e.g., abandonment of a child by parents);
  • (2) identity traumas, including personal identity trauma (e.g., rape, sexual or physical abuse, incest, and other betrayal traumas that violate oneā€™s autonomy), collective identity or shared trauma (e.g., slavery, discrimination, and targeted genocide), and role identity or self-actualization trauma (e.g., business failure, loss of life savings, sudden termination of employment, failure or dropping out of college or school);
  • (3) interdependence, trauma that is secondary or indirect (e.g., viewing violence, exposure to media-related violence, or therapist compassion fatigue); and
  • (4) trauma that involves physical survival (e.g., assault and combat, life-threatening accident, or major natural disaster).ā€

Although the impact of traumatic experiences on mental health has long been studied, there remains a lack of research and understanding regarding how trauma, especially cumulative trauma, contributes to the later development of psychotic symptoms and how that may shift cross-culturally. Subsequently, there is also uncertainty related to treatment outcomes for ā€œpsychosis-related trauma.ā€ To date, much of the research surrounding psychosis and trauma has focused on single traumatic events or indirect associations between childhood trauma and later psychosis in adulthood.

In the current study, the researchers attempt to fill this gap by investigating the relationship between psychosis and cumulative trauma. Participants were recruited from an outpatient clinic associated with Mansoura University Hospital in Egypt. Overall, 76 patients ranging from ages 18 to 30 years old with a diagnosis of psychosis with no comorbid physical issues or substance abuse participated in the study. Participants largely consisted of single or divorced (51.3%) men (56.6%) who were less than 25 years old (52.6%), unemployed (59.2%), with some level of basic education (44.7%), and resided in rural areas (53.9%).

Rating scales assessing cumulative trauma and psychosis symptom severity were conducted with the participants and then were examined via statistical analysis.

The majority of participants endorsed experiencing hallucinations, delusions, impaired cognition, disorganized speech, and ā€œnegativeā€ symptoms, such as blunted affect. Over one-third of participants experienced abnormal psychomotor behavior and depression, and slightly more than a quarter (27.6%) experienced mania.

Contrary to the biomedical model, which emphasizes the role that biology and genetics play in the cause of psychosis (despite there being a lack of research evidence to support this claim), Zoromba and colleagues found that most (71.1%) participants did not have a family history of psychosis.

Participants with the highest levels of total cumulative trauma were found to be primarily female, 18 to 25 years old, resided in rural areas, unemployed, had small families (less than 5 family members), had been experiencing symptoms for less than 2 years, had no history of psychosis in their families, were diagnosed with schizoaffective disorders, and were previously hospitalized.

The findings aligned with other research that implicates trauma as a contributing factor to the later development of psychosis. For example, another study found that over half of its participants had experienced sexual or physical abuse prior to the onset of schizophrenia, whereas another study using two large community samples found that experiencing two or more types of traumas was significantly associated with later development of psychosis.

These research studies are similar to Zoromba and colleagueā€™s conclusions that there were significant connections found between cumulative trauma and psychotic symptoms like hallucinations, disorganized speech, and abnormal psychomotor behavior, as well as depression and mania.

Moreover, the researchers found connections between specific types of trauma and psychotic symptoms, which is also supported by previous research. For instance, attachment trauma was associated with delusions, abnormal psychomotor behavior, and mania. Collective identity trauma was a significant predictor of hallucinations and abnormal psychomotor behavior. Survival trauma was connected to disorganized speech, whereas exposure to secondary trauma predicted symptoms such as hallucinations, disorganized speech, abnormal psychomotor behavior, depression, and mania.

Major limitations of the study include a lack of a control group and concerns related to generalizability. Future research will need to be conducted cross-culturally to determine whether its findings can be generalized across populations.

The work conducted by the researchers adds to a growing body of literature that emphasizes the role that trauma, rather than biology, plays in the development of psychosis. In Nicaragua, external factors, such as trauma and conflict, have long been attributed to the development of psychosis. Looking at the research literature, a recent study found connections between childhood trauma and psychosis. Others have found specific connections between certain types of trauma as well as gender and psychosis.

The relationship between trauma and psychosis indicates that treatment beyond antipsychotic drugs, which have been shown to have negative side effects, including causing damage to the brain and leading to worse outcomes, is needed. Trauma therapies offer one path forward in addressing underlying issues.

 

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Zoromba, M. A., EL-Gazar, H. E., Rashed Elkalla, I. H., Amr, M., Ibrahim, N. (2024). Association between cumulative trauma and severity of psychotic symptoms among patients experiencing psychosis, Archives of Psychiatric Nursing, 51, 54-61. https://doi.org/10.1016/j.apnu.2024.05.008. (Link)

 

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28 COMMENTS

  1. Psychosis exists on a spectrum. The experience of complete abandonment of objective and subjective reality, on the other hand, is catatonia. The reality of psychosis is that it is based on attachments and meaning that does not work on a social level. Until we realize we are all kind of psychotic, we will never get it through our heads that ā€œpsychosisā€ is not fundamentally different than any other mental health disorder. If I believe that I lose weight by eating carrots, I will lose weight. But itā€™s not the carrots, itā€™s the intention set by consuming carrots and the physiologic trigger that I give myself by eating them. That idea alone, is psychotic, in that it is not solely based in an objective reality, but the idea is harmless, and more importantly, leaves me harmless to others. At its core, what we are dealing with when we say clinical psychosis, is actually a communication disorder. We need to see it that way. We need to help people learn to communicate and the importance of communication faculties on our safety and success. (Ability to thrive)

    But as long as we believe Jesus was not just another dude having a manic episode in a time where we didnā€™t know any better, the fundamental nature of our society in the West will be off kilter for true integration of human psyche experiences. We also put so much weight on free will driven narratives that we create the conditions for psychosis in the first place. When we collectively attach to a broader reality with our language expression and become more precise, psychosis will end on its own. The individual sufferer just needs to understand the nature of the world they live in and how to communicate within it while being patient and tolerant for the world to catch up. Thatā€™s the game.

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    • I concur entirely with Franklin’s comments above. The research under discussion seems to rely on encounters with a limited number of individuals experiencing psychosis, with researchers attempting to generalize these experiences inappropriately. This type of scaling in psychiatry can be particularly harmful, as it tends to exclude the observerā€™s influence from the analysis, thereby disregarding the subjective nature of observing patients (it is one way diagnosing when there are two people). Moreover, psychosis is not solely triggered by trauma; it can also arise from extreme euphoria or extreme sleeplessness, and those engaging with psychedelics may be experiencing a form of controlled psychosis. The full implications of these phenomena are not yet understood. Although some insights exist, they are often suppressed or unacknowledged or denied for expression. This issue is intricately linked to language and communication as well as consciousness. As Franklin rightly points out, we all exist on a spectrum, yet there is a growing concern that our current understanding may soon prove inadequate, potentially leading to significant repercussions.

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    • I don’t think that one can say that “clinical psychosis” is linked to insufficient communication faculties. I have communication faculties on a very high level. When I experienced severe psychosis, I was in a situation where I could not openly talk about my feelings and experiences. Not because I was lacking communication skills, but because I was afraid of angering the person whose behaviour traumatized me. Power dynamics are crucially important and feeling powerless is one of the most terrifying experiences.

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  3. If you want to understand how experiences of violence and oppression are linked to the devolopment of chronic psychic ailments you have to understand two things.

    First, the key element that decides whether they go into a process of deteriorating mental health after having experienced violence is the capability to grief. If there is adequate support and understanding to assist a person to work through, feel, interpret, grief and let go of experienced harm then a person will go back to a balanced mental health. If such an environment is lacking or grieving is even blocked by the people around the hurt person and the only way for them “to move on” is by repressing the reality of their harmful experiences, psychological instabilities and chronic problems will develop.

    Secondly, what kind of psychic issues (which of the crises styles like depression, mania, delusion, ect. and which one(! – not several) of the so called personality disorders) a person will develop depends on their personality style and neither on the characteristics nor on the amount of the harm they have experienced.

    Personality styles are probably genetic or develop extremely early on in child development. They will develop with or without a child being a target of severe oppression and neglect or not. The amount of violence and oppression together with the amount of deprivation from adequate support and/or disenfranchised grief are the determining factors of the resulting psychological health levels.

    The reason why traumapsychotherapy doesn’t work is because it understands neither the first nor the second reason for the development of chronic problems of psycholgical health in the aftermath of violence and oppression.

    Typically, by taking away the expertise to find a way through the crisis away from the hurt person, psychotherapy is often rather a means of blocking the natural capability of grieving harm and loss in a client. It thus adds to the deterioration of the psychological health level of the person instead of helping to recover it.

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    • I would just add that the societal narratives matter a lot in the context of what trauma even is.

      FGM – Female genitalia mutilation is a real thing that has been going on for a long time in some countries. If someone came and cut my genitals off in the West, I would be destroyed mentally by this. But in a culture where there is a ceremony to it, and a nod of approval, itā€™s not as traumatic to the psyche. Because the society is conditioned to award it. Resistance can be more destructive to oneā€™s psyche because they are outcasted.

      The nature of the experience matters far less than its social relevance. And thatā€™s not broadly specified. And itā€™s often the source of trauma where the mind projects fears and things that are related or could be loosely related.

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    • “Typically, by taking away the expertise to find a way through the crisis away from the hurt person, psychotherapy is often rather a means of blocking the natural capability of grieving harm and loss in a client. It thus adds to the deterioration of the psychological health of the person instead of helping to recover from it.”

      I think this speaks to how much the power imbalance in psychotherapy (can) insidiously disempower clients to one extent or another. And feeling disempowered (unsafe) is probably what causes most people to drift into psychosis in the first place.

      The psychotherapy set-up is crazy: DSM labels, power imbalance, and a therapist’s agenda together (can) foster the unhealthy relational dynamic known as infantilization (unreasonable dependency) which imo is another form of psychosis (descent into unreality).

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    • Lina, I don’t think personality styles determine the type of mental health issues one can have. The same person can respond in a different way to difficult or traumatizing situations depending on all kinds of factors. At the age of 27 I was very depressed when someone I loved ended contact with me; at the age of 32 I became psychotic when I felt rejected by someone I loved; later I never became psychotic again, though I faced many difficult situations.

      Moreover, we can have various mental health issues at the same time, e.g. I sometimes had mania when I was psychotic.

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  5. why are we not searching for a physical cause of this illness? Late stage infections can go into the central nervous system and cause psychosis. Autoimmune encephalitis and other Autoimmune co ditions cause psychosis by immune system attacking the brain.

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    • Yep. There’s most definitely a (woefully under-researched) phenomenon called, “Covid Psychosis.” Just stands to reason that if the brain is infected and inflamed in anyway (viral, bacterial, parasitic, etc.), you’re likely to have a serious psych reaction.

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  6. Hello Ashley, Great report and a nod to the common sense of the research. I wonder if anyone reading this has the capacity to do research on Se-REM and hospitalized patients. There is a need for an easier way to treat trauma. The world is literally awash in it with terrible consequences. For those who are interested in a way to bring treatment to thousands of sufferers, you can view my podcast on: https://lockedupliving.podbean.com. It explains how REM brain state can treat nearly all trauma. Se-REM.com has not been used in a hospital setting, so there is a need for research that could justify its implementation. Once adopted, it will change mental health treatment. It downloads at: Se-REM.com.

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  7. I can’t stop writing and igniting because I was being torn apart, the walls were balking, and then the whole Universe appeared within but I was nothing at all besides it. And I want to curl up into a foetal position and then explode like a nuclear bomb, as we all do. That is the force of nature through the form of the father, the mind, which we try and plot out with thought. Mind is beyond thought and is blue. Mother is green. I want to turn pitch black and flood existence like an oil slick. She cried with all the agony of the Universe, and then the sky cracked like an egg. It shattered into glass daggers the thickness and weight of a judges hammer slamming down on your world. These are your black knives glittering under the black sun you created. The golden sun burns the black sun whose rays are killing lines destroying the Universe. Can you see the human being screeching through the headlines, deadlines, killing lines.

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  8. You can’t destroy the world with the songs of black children. But it is nature who shoots the world with black songs. Covid was her creation to make you use less oil, as was inflation, as was Russia, Ukraine, and so was the Israeli division between you and Saudi Arabia, anything to keep your greedy mits off that black oil. You may have plundered Iraq if you hadn’t already done so. Now they isolate you with obviously evil leaders who talk of America first or Brexit or building other walls and then they isolate you and therethrough possess you and cannibalize you. The rich will pitch you against each other and then stimulate mutual destruction and desert you. They have the wealth to abandon for better climes, but the Earth won’t maintain them. She goes or they go, and with her goes the truth. Black oil we drink you. Eclipse>No-One. Zero. I am that.

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  9. They aren’t symptoms: they are creative communications from The Mother, which is our feelings, our nature. Ordinarily they express themselves through the ordinary socially conditioned channels of thought and conditioned action, and they all call themselves ‘me’ even though they are very different, for example one being angry, one yearning for something beyond all this, one being lustful, one being envious energies, and they negotiate with the brain through words and physical action in order to get their needs realized, their needs being beyond words and beyond the limits of social conditioning. Invariably they have to make do with social palliatives to thir real needs and when the frustrated needs pile up, and the trauma of social experience exaccerbates and exaggerates and distorts and perverts their needs, their needs can no longer be expressed through the socially conditioned avenues of thought and conditioned life activity, so they build up and express themselves involntarily through imaginative form. Yes, they play tricks on the brain and create dillusions, but this is not pathalogical: it’s an emergency reorganization of psychological existence in order to prevent the complex truth of being from uncontrollably expressing itself to the brain, which would destroy the brain out of irredemable shock, and instead to create a different, illusory reality thereby creating the possibility of self-healing through this emergency reconfigeration of reality. But delusion isn’t necessary if the brain understands what’s going on, which means observe and understand, not interpret, and then the brain can allow the free creative movements of spirit. This turns, say, a paranoid psychosis into something more remeniscent of a mescaline or mushroom trip, or a spiritual experience, or an adventure into consciousness. And then this consciousness can liberate itself and tell the brain what it is. And it is the whole consciousness of humanity, which is part of the whole consciousness of the Earth (Mother) and sky (Father), and we are the whole universe in me, and therefore the Universe can reveal itself to all and speak to all. We can all have universal cosmic consciousness if we realize we are the Universe and the easiest way to do that is to become Mother Nature. Just play with your dogs till you become dogs: just play with your children till you become children. Just take every psychadelic drug you can like your life depended on it: anything to get out of that factory consciousness and into the infinity of cosmic, colourful, powerful existence. Or get a McJob. Or become successful, i.e. a happy self-fattening computer brained pig. So what if we go mad trying? They call me psychotic but we all know it is an insane society that diagnosed me. Do we all know what a psychosis is? You do now because the psychosis told you. And by the way, don’t judge vices. It’s Mother Nature who sometimes needs a cigarrette and a glass of wine. It’s Mother Nature that sometimes needs to check out on smack, all sunk in a door way. We’ve been living at her expense you know. She’s exhausted. No wonder she might check out from time to time. We checked out on her after all.

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