Lately I've been trying to preserve the last tatters of my mental health. I've been noting how intertwined adverse life experiences and psychotic-spectrum symptoms are.
"Adverse events involving trauma, loss, stress, and disempowerment have a central etiological role in psychosis." and experiences of loss, stress, adversity, abuse, and disempowerment are central to shaping psychotic experiences [1].
It is important to shift the clinical emphasis towards personal, recovery-oriented goals and the "alleviation of traumatic responses, emotional vulnerabilities, and psychosocial and interpersonal conflict"
There is cumulative behavioural sensitisation - exposure to psychosocial stress— such as adverse life events, trauma, or discriminatory experiences— may progressively increase the behavioural and biological response to subsequent exposures
Increased traumas also dramatically increase the risk for developing substance use, depression, and suicidality
The formation of psychotic experiences is complex and likely to be the result of the interplay between stress, cognitive, and affective processes [2]. There is elevated emotional reactivity to stressors and trauma appears to predict conversion to psychosis and adversity may lead to the formation of negative schemas of the self, others, and the surrounding environment which worsens symptoms. Persecutory voices were often associated with humiliating events and events impairing to self-esteem.
Stress-induced emotional and cognitive changes may result in anomalous experiences such as experiences of aberrant novelty and salience in vulnerable individuals.
As individuals seek to explain these experiences, biased cognitive processes (such as enhanced threat anticipation) then result in the appraisal of anomalous experiences as uncontrollable, threatening, externally caused or attributable, which, ultimately, lead to abnormal beliefs and hallucinations becoming symptomatic. Hypersensitive threat processing (including social-rank threats linked with shame and stigmatisation and/or that originating from traumatic experience) can severely impair emotional regulation and reduce affiliation capacities.
Maladaptive behaviors (e.g., non-suicidal self-injury, suicidal behaviors, aggression), poor coping skills, and impaired emotional regulation may also arise out of stressful and traumatic experiences, increasing one’s risk for developing mood and anxiety disorders [3]
[1] Social Adversity in the Etiology of Psychosis: A Review of the Evidence
[2] The Role of Trauma and Stressful Life Events Among Individuals at Clinical High Risk for Psychosis: A Review
[3] Modeling the Interplay Between Psychological Processes and Adverse, Stressful Contexts and Experiences in Pathways to Psychosis: An Experience Sampling Study
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