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Key Takeaways
- Psychosis is a collection of symptoms often associated with psychotic conditions like schizophrenia spectrum disorders. It can also be associated with other mental health conditions, neurological disorders and physical health conditions.
- During acute psychosis, individuals typically experience hallucinations, delusions and confused thinking or communication.
- Autism and psychosis can co-occur, and it can be difficult for autistic individuals to find tailored support that is responsive to psychotic symptoms and their interactions with autistic traits.
- Psychosis can be treated effectively with medication and psychotherapy. Accommodations for daily activities can also be incredibly supportive for individuals dealing with psychosis.
When most people think of psychosis, they think of schizophrenia—not autism. However, psychosis can be associated with several different diagnoses. Although psychosis is not a symptom of autism, it’s more common for autistic individuals to experience psychosis at some point during their lives than it is for neurotypicals.
Psychosis often involves hallucinations and delusions, where an individual perceives things that are not there or believes things that are untrue, respectively. These experiences can feel very real and quite frightening. However, many forms of support can help people thrive while reducing, managing or eliminating symptoms of psychosis.
What is autism?
Autism spectrum disorder is considered a neurodevelopmental disorder, meaning it affects the development of an individual’s brain and nervous system. Autism is associated with a number of traits, including differences in:
- Communication and social styles
- Information processing, including sensory processing
- Repeated behaviors, adherence to routines, and focused interests
The autism spectrum is diverse, and each autistic individual may need different types and levels of support. Each autistic person can also experience a different combination of autistic traits at varying intensities, often called a “spiky” profile.
Social and communication differences
Autistic individuals tend to interpret social cues differently than others, often finding neurotypical social norms and communication styles non-intuitive. Autistic people tend to communicate in ways that neurotypical individuals may not expect. For example, they often use more direct, literal communication styles.
Cognitive and sensory processing
Autistic people tend to think and process information differently than neurotypical individuals. They are more likely to exhibit bottom-up, detail-driven thinking. They also process sensory inputs differently and may experience heightened or decreased sensitivity to certain stimuli. These differences can affect how an autistic person processes verbal information, further affecting their communication and social cognition.
Repeated behaviors and limited interests
Many autistic individuals strongly favor repetition and sameness, and they can find it distressing when routines or expected plans are disrupted. They may stick to limited routines and often repeat the same behaviors, such as stims, which they do to self-soothe. It’s also common for autistic individuals to have special interests, which can occupy a great deal of their time and attention.
What is psychosis?
Psychosis occurs when a person experiences some level of disconnect from reality. People experiencing psychosis can have a difficult time discerning between reality and their own perception.
Symptoms of psychosis
The main symptoms associated with psychosis are:
- Hallucinations
- Delusions
- Confused or disorganized thinking and communication
- Changes in behaviors and feelings
Hallucinations and delusions are symptoms of acute psychosis. Hallucinations are false perceptions, meaning a person perceives something that’s not actually there. Hallucinations can affect any sensory modality. They can be:
- Visual (seeing)
- Auditory (hearing)
- Tactile (feeling)
- Olfactory (smelling)
- Gustatory (tasting)
Delusions are false beliefs or deeply held convictions in something that isn’t true. For example, an individual with delusions may believe that they are being targeted or surveilled. Or, they may strongly believe that they have special abilities. Like other symptoms of psychosis, delusions are often stigmatized and made light of in popular media. However, for the people experiencing them, they are very real and often incredibly frightening.
People experiencing acute psychosis also often think and communicate in ways that others may perceive as disorganized or confused. They may have a difficult time focusing, thinking clearly or processing information. During a psychotic episode, an individual may also struggle to follow conversations or speak in a way that is confusing or does not make sense to others.
Additionally, a range of changes to behaviors and feelings can accompany psychosis. Some of these changes can include:
- Withdrawing from friends and loved ones
- Atypical or unusually intense feelings
- Absence of feelings
- Low energy or motivation
- Loss of interest in activities the individual normally enjoys
- Anxiety
- Sleep disturbances, like difficulty falling asleep or sleeping continuously
- Overall difficulty with functioning and performing activities of daily living
These symptoms are sometimes called “negative symptoms,” because they reflect a loss or decrease in a person’s typical energy, mood and functioning. They often show up before acute symptoms of psychosis like hallucinations or delusions.
Who can experience psychosis?
Psychosis is not a diagnosis in and of itself. Rather, it’s a cluster of symptoms that may be connected to several diagnoses. When most people hear the term “psychosis,” they typically think of psychotic disorders like schizophrenia. However, symptoms of psychosis can emerge in individuals with a variety of other diagnoses.
In addition to psychotic disorders—diagnoses like schizophrenia, schizoaffective disorder or schizotypal personality disorder—psychosis can accompany other mental health conditions or scenarios, including:
- Bipolar disorder
- Severe depression
- Substance or medication-induced psychotic disorder
- Trauma
- Postpartum psychosis
- Severe sleep deprivation
Psychosis symptoms can come with a number of neurological diagnoses and physical health conditions, including:
- Parkinson’s disease
- Alzheimer’s disease
- Traumatic brain injuries
- Stroke
- Multiple sclerosis
- Lyme disease
- Lupus
- Addison’s disease
- Cushing’s disease
How long does psychosis last?
Because psychosis can emerge in relation to many different conditions, people have widely varied experiences with psychotic symptoms. Some individuals may only ever experience one psychotic episode and have mild symptoms moving forward or none at all. Others may have recurring psychotic episodes with limited or no symptoms in between episodes. Other people may experience continuous psychotic symptoms.
Psychotic episodes can vary greatly in length, and their duration often depends on the individual as well as any external factors that may be triggering the symptoms.
How common is psychosis?
Psychosis is somewhat common; it is estimated that as many as 5.8% of people will experience a psychotic episode during their lifetime. Of these individuals, around 25% will never have another psychotic episode.
What is the difference between autism and psychosis?
Autism and psychosis entail very different experiences, but they share some key features, such as differences in communication and thinking styles. Because of their similarities, autism was initially proposed in 1911 as a symptom of childhood-onset schizophrenia. By the 1970s, however, the two diagnoses had come to be seen as separate conditions.
Autistic individuals and those experiencing psychosis both tend to inhabit internal worlds that may look and feel different from others. The most defining difference between the two is that a person experiencing psychosis’ inner world separates from reality. In contrast, an autistic individual retains contact with reality but may exhibit different ways of understanding and interacting with it.
Autistic traits and behaviors also diverge from symptoms of psychosis. For example, individuals with psychosis may not necessarily exhibit repeated behaviors, and autistic individuals do not typically experience hallucinations or delusions (unless they are experiencing psychosis).
Another key difference between autism and psychosis lies in how they are categorized. Autism is considered a neurodevelopmental disorder, meaning it affects the development of the brain and nervous system. Signs of neurodevelopmental conditions like autism typically emerge during early childhood and last throughout a person’s lifetime.
Psychosis, on the other hand, is a cluster of symptoms that may be connected to a mental illness, neurological condition or physical condition. Psychosis often emerges during early adulthood, between a person’s teenage years and mid-20s, although it can onset in younger or older individuals. The symptoms of psychosis are often treatable and, for some, can go into remission with treatment.
Co-occurrence of autism and psychosis
Autism and psychosis are known to co-occur, though their rate of co-occurrence has been debated. Researchers have estimated that between about 9% and 35% of autistic individuals may exhibit some psychotic symptoms.
Autistic individuals who experience psychotic symptoms or have a psychotic disorder can face unique challenges in accessing support. Autistic traits and behaviors, like differences in information processing and social intuition, can interact with psychotic symptoms such as confused thinking and communication. This interplay can present heightened challenges in navigating a world that stigmatizes and fails to accommodate either condition.
Despite the clear need for support, many autistic individuals may find that clinicians falsely attribute symptoms of psychosis to their autism, and do not refer them for appropriate follow-up to treat psychotic symptoms. This can lead to autistic people with psychosis going without the support they need, often until their psychotic symptoms progress much further.
Support for autistic individuals experiencing psychosis
Despite the barriers to support that many autistic individuals with psychosis encounter, numerous interventions are effective at improving quality of life and reducing symptoms of psychosis.
Psychotherapy
Psychotherapy, AKA “talk therapy,” is the primary intervention offered for autistic individuals seeking support. It has also been shown to be effective at improving outcomes for individuals experiencing psychosis.
Cognitive behavioral therapy (CBT) is a type of psychotherapy popularly used to treat mental health conditions and support autistic individuals. Research shows CBT can reduce psychotic symptoms and improve day-to-day functioning in people with psychosis.
CBT works by helping individuals recognize unhelpful patterns of thinking and behavior and gradually replace them with more supportive alternatives. For autistic individuals, this can be incredibly helpful in addressing issues related to co-occurring anxiety and depression, and can also support the development of skills that help the person advocate for their needs.
Some providers specialize in cognitive behavioral therapy for psychosis (CBTp), which is tailored to address symptoms of psychosis. CBTp can be particularly helpful in managing and reducing these symptoms and supporting positive mental health outcomes.
Medication
Prescription medication is also a common intervention for individuals experiencing psychotic symptoms. Antipsychotic medications, such as aripiprazole (Abilify) or risperidone (Risperdal), are effective at reducing symptoms of psychosis. They work by blocking dopamine receptors, which may play a role in these symptoms.
Antipsychotics are also sometimes prescribed for autistic individuals struggling with intense emotions and strong responses to stimuli, so their effect on autistic people has been studied at some length. However, research has not focused on their efficacy in specifically treating psychosis symptoms in autistic people.
If you are autistic and considering medication for psychosis, it’s best—when possible—to work with a psychiatrist who has experience with autistic patients. Many autistic individuals struggle to identify and describe feelings in their bodies, and it is important to see a clinician who can work with you to effectively monitor changes in your symptoms as well as any potential side effects of medication.
Accommodations and social supports
Accommodations, often in the workplace or educational settings, are a major avenue for support for autistic individuals. The same can be true for individuals with psychosis. Accommodations are tailored to an individual’s own experiences and needs. Some workplace accommodations that can benefit autistic individuals with psychosis include:
- A private or semi-private workspace
- Sensory accommodations
- Changing the location of the individual’s workstation
- A modified or flexible schedule
- Flexible break times during shifts
- Remote work options
How Prosper Health can support
Are you autistic and unsure if you are experiencing symptoms of psychosis? Or, do you have a history of psychosis and find yourself wondering about pursuing an autism diagnosis? Prosper Health’s clinicians support autistic adults through a diverse range of experiences, regardless of where they are in their mental health journeys.
Prosper Health offers telehealth therapy that is covered by insurance. Prosper Health therapists are experienced in working with autistic adults and specialize in supporting them through common challenges. If you deal with psychosis and are autistic, or believe you may be, Prosper’s therapists can give you the support you are looking for.
With support that recognizes and responds to the full scope of your experiences, you can make strides towards your personal goals and truly thrive.
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