Dear Therapist:

I have a friend at work that was acting strangely and my coworkers are saying he "snapped." I am not sure what this means. Someone said this means he has psychosis. What is the meaning of psychosis? Is this something that can happen suddenly to someone without warning? I myself have gone to therapy in the past for anxiety and baruch Hashem I am doing very well but I am worried about something like this happening to me. I think more information would be reassuring to me and I am grateful for the Yated for providing us with such a valuable resource.

 

Response:

You say that you worry that you might develop psychosis. However, you didn’t discuss any cause for this concern.

Have you had any psychotic symptoms? Essentially, psychosis is a break with reality. This can take the form of delusions, or beliefs that are clearly not real (like believing—without reason—that the FBI is following you). People with psychosis might hallucinate. Technically, hallucinations can affect any of the five senses, but psychotic hallucinations are associated with seeing or hearing things that do not exist. If you have had hallucinations or persistent delusions, there is cause for concern.

Although there are symptoms that can be precursors for psychosis, it is important to remember that these can also be symptoms of other, often less severe, disorders. They can also be symptoms of issues that are unrelated to mental health diagnoses (like lack of sleep). Additionally, within reasonable limits some may be normal (like some social withdrawal after a traumatic event).

According to the National Institute of Mental Health:

Behavioral warning signs for psychosis include:

  • Suspiciousness, paranoid ideas, or uneasiness with others
  • Trouble thinking clearly and logically
  • Withdrawing socially and spending a lot more time alone
  • Unusual or overly intense ideas, strange feelings, or a lack of feelings
  • Decline in self-care or personal hygiene
  • Disruption of sleep, including difficulty falling asleep and reduced sleep time
  • Difficulty telling reality from fantasy
  • Confused speech or trouble communicating
  • Sudden drop in grades or job performance

Psychosis is uncommon. Psychosis without prior signs is even less common. Psychosis that can lead to extreme problems (like harming oneself or others) is uncommon as well. Although the above warning signs can be signs of numerous issues unrelated to psychosis, they are often indications that there is a problem of some sort that should be addressed.

When we hear that someone “snapped” or had a “nervous breakdown,” this doesn’t necessarily mean that they had a break with reality or that they have experienced a psychotic episode. Since these are not official, clinical terms, they can be defined in numerous and often conflicting ways. If someone becomes deeply depressed, they can be said to have had a breakdown. If someone with high anxiety begins yelling at others, people may say that they have snapped.

Remember that there are very many reasons that people can act in an unusual manner. If you know someone who is exhibiting troubling symptoms, something should certainly be done to help them. If you begin having symptoms, you should reach out for help. However, if there is no particular reason to believe that you are developing psychosis, it is unlikely that you are.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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