Trauma and Psychosis Pathways

Trauma is increasingly recognised as a critical antecedent to the development and exacerbation of psychotic experiences. Exposure to adverse events, particularly during sensitive developmental periods, can dysregulate stress circuits, alter memory processing and heighten perceptual sensitivity to threat. These neurobiological and cognitive alterations may manifest as hallucinations, delusional beliefs or disorganised thought. Moreover, complex trauma—characterised by repeated interpersonal harm—can engender enduring disturbances in self‐concept and emotion regulation, fuelling a cycle of hyperarousal, dissociative states and anomalous perceptions. Pathways from trauma to psychosis often involve interactions among genetic vulnerability, dysregulated hypothalamic–pituitary–adrenal axis function and maladaptive appraisals of threat. Recognition of these pathways has prompted an integrative framework whereby early identification of trauma‐related symptoms, targeted psychosocial interventions and trauma‐informed care converge to mitigate progression to overt psychotic disorder.

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Trauma and Psychosis Pathways publication trend

The graph below shows the total number of articles in trauma and psychosis pathways across all publications each year (not limited to Nature Index journals).

Technical terms

Complex PTSD: A syndrome characterised by core post‐traumatic stress symptoms alongside disturbances in self‐organisation such as affect dysregulation and negative self‐concept, often arising from prolonged or repeated trauma.

Eye Movement Desensitisation and Reprocessing (EMDR): A trauma‐focused therapy that uses guided eye movements to facilitate processing of distressing memories and reduce associated symptoms.

Dissociation: A psychological process involving a disconnection between thoughts, identity, consciousness and memory, which can contribute to the emergence of psychotic‐like experiences.

Hypervigilance: Heightened sensory sensitivity and vigilance to potential threat, frequently observed in traumatised individuals and implicated in perceptual anomalies.

Psychotic symptoms: Clinical features including hallucinations, delusions and disorganised thinking that reflect a break from shared reality.

References

1. Associations between post-traumatic stress disorders and psychotic symptom severity in adult survivors of developmental trauma: a multisite cross-sectional study in the UK and South Korea. The Lancet Psychiatry (2023).
2. Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings.. Psychological Medicine (2023).
3. Trauma measures for use with psychosis populations: A systematic review of psychometric properties using COSMIN. Psychiatry Research (2023).