Information about psychoses

What symptoms are there?

The core symptoms of a psychosis are roughly divided up into four categories:
1. Positive Symptoms, 2. Negative Symptoms, 3. Cognitive Symptoms (Thought Disorders) and 4. So-called Ego-disorders

Listed below are some of the typical symptoms that are experienced by persons afflicted.

Symptoms: What is experienced by the person afflicted

Positive symptoms


Explanation of the symptoms: Hearing, seeing, feeling, tasting or smelling things that do not really exist

How you can experience it

  • The most frequent form of hallucination is the hearing of voices.
  • Many persons perceive these voices above all in the first few days as agreeable and not as alarming.
  • Others can hear voices that say terrible or negative things or issue commands.


Explanation of the symptoms:Absolute conviction about things that cannot be true.

How you can experience it

  • The idea that other people would plot against you, attempt to harm or persecute you
  • Conviction that you are being watched through the television set
  • Conviction that you are a famous personality
  • Conviction that the television set is broadcasting signals or messages to youCurious or obsessive religious ideas

Negative symptoms

Lack of drive

How you can experience it

  • You can lose interest in all aspects of life.
  • Energy dwindles and dealing with even the simplest tasks causes difficulties, e.g. getting up in the morning or tidying up the house or apartment.

Social withdrawal

How you can experience it

  • You lose interest in friends and would most like to spend time alone; at the same time, you frequently perceive an intensive feeling of isolation.

Lack of concentration

  • You have great problems reading a book, remembering anything or noticing something new.

Cognitive symptoms

Thought disorders

How you can experience it

  • Incoherent / scatterbrained thought which leads to confusion / befuddlement and loss of concentration

Speech and thought impoverishment

How you can experience it

  • You begin by saying something and yet mid-sentence you forget what you wanted to say.
  • Thinking through things takes too much effort and appears too difficult.

Ego disorder

Depersonalization/ Derealization

How you can experience it

  • Persons, items and surroundings appear unreal, strange, spatially altered, above all your own person.

Thought deprivation, broadcast and insertion

How you can experience it

  • Thoughts are perceived as influenced from outside, as made, steered, controlled, inserted or imposed; feelings that other people know what you are thinking or that thoughts can be "extracted"

Symptoms: How they appear to relatives

Experiences of heterosuggestion

Explanation of the symptoms: Persons afflicted often report the experience that their sensation, their thoughts and actions are controlled or steered from outside.


Subjective description by the persons afflicted

  • “Other persons can read my thoughts.”
  • “What I think is not from me, but is controlled from outside.”
  • “I must sometimes do what I don’t want to do.”
  • “My actions are influenced by other persons / powers.”

How the symptoms appear to relatives

  • The changes in the person afflicted thereby occurring are first of all incomprehensible and strange. As relative you can in the first instance not know what is going on in the person afflicted. You notice a clear change however.

Subjective description by the relatives

  • “He often behaves so strange that we do not even recognize him.”
  • “He does not say anything anymore.”
  • “Sometimes, he looks as though we have done something to him.”

Unusual sensory perceptions

Explanation of the symptoms: Persons afflicted often report anxiety-provoking, adversely affecting or unusual experiences. Often, by this, they mean the hearing of voices or noises, more rarely also the seeing, smelling or tasting or certain things. The term hallucination is used in this connection if these sensory perceptions are not based on an external source of stimulus. You hear something without any noise being made. You see something on a white wall.


Subjective description by the persons afflicted

  • “I can hear noises, voices or conversations although I am alone in a quiet room. Other persons say that they hear nothing. I am sure however.”
  • “In many rooms there is a bad smell like of poisonous gases.”

How the symptoms appear to the relatives

  • Hallucinations are as a rule initially not recognizable as such by relatives. They experience for example that the person afflicted gives the impression of being absent and unconcentrated. Frequently therefore conflicts arise between persons afflicted and relatives: The person afflicted naturally assumes that his / her perceptions are “correct”. However, they are only real for him / her alone. For all others, they do not exist. The relatives do not know therefore what the person afflicted is talking about and why he / she sometimes is behaving so strange. This leads to disputes therefore.

Subjective description by the relatives

  • “Sometimes he interrupts the conversation and turns away as though he had heard something.”
  • “She looks around in the room as though she is looking for something"

Convictions regarding unusual facts and circumstances

Explanation of the symptoms: Persons afflicted often report convictions which they hold with great certainty and which have unusual or alarming contents. Convictions that are not based on facts but which are adhered to nonetheless are referred to as delusional. Persons afflicted quite often report after a successful stabilization that they “got caught up” in many convictions and could no longer easily assess which of these convictions really corresponds to reality.

Subjective description by the persons afflicted

  • “I am the victim of unjustified persecution. I know that there are persons who have it in for me and do not leave me in peace.”
  • "I have extraordinary abilities which distinguish me from other persons”
  • “I am responsible for the happiness of all people on this planet.”

How the symptoms appear to the relatives

  • Delusional convictions of a person afflicted are a great problem for the relatives. They can in no sense comprehend these convictions; they feel hurt and misunderstood, to some extent even threatened.

Subjective description by the relatives

  • “He reproaches us and demands to be left in peace."
  • “Sometimes he even becomes aggressive; this then makes us very afraid.”
  • “She is often so absent, then again condescending and does quite extraordinary things.”
  • “Often, he imagines that he is something special.”
  • “We don’t understand her anymore.”

Changes in the thought process

Explanation of the symptoms: The manner of thinking can change in connection with the acute phase of the disorder. Persons afflicted often report disruptions in the through process and concentration difficulties.

Subjective description by the persons afflicted

  • “Sometimes I cannot think a thought to the end.”
  • “Sometimes I jump from one topic to the next.”
  • “I cannot concentrate for long sometimes.”
  • “I have too many thoughts at the same time in my head.”

How the symptoms appear to the relatives

  • In routine daily activities this change is often highly visible.

Subjective description by the relatives

  • “You can no longer carry out a longer coherent conversation with him.”
  • “She no longer even listens correctly.”
  • “He is deaf in both ears.”
  • “Everything is confused in his thinking.”
  • “She can no longer deal with her duties; she always interrupts and never comes to the end.”

Change in drive

Explanation of the symptoms: Persons afflicted very frequently find it very difficult to pull themselves together, start the day as planned and take on duties and responsibilities. This can go so far that entire days are spent in bed without this leading to any interest to become more active again.

Subjective description by the persons afflicted

  • “I find it very difficult to get out of bed in the morning. Mostly I just stay in bed then.”
  • “I cannot cope with many of my duties.”
  • “Sometimes I don’t feel like washing myself.”
  • “I have lost interest somewhat in getting in contact with other people.”

How the symptoms appear to the relatives

  • For the relatives these changes result in great stress. Their ill family member neglects his / her duties in the household, sometimes gives the impression of being unkempt, does not pursue any regular activity and “hangs around the house aimlessly”.

Subjective description by the persons afflicted

  • “She doesn’t seem to care very much about her work.”
  • “His room is totally untidy; he no longer gets involved in the house work."
  • “Being seen with her in public is embarrassing.”
  • “He just withdraws into his room.”

Change in feelings

Explanation of the symptoms: Persons afflicted mostly experience a clear change in their feelings in connection with a psychotic episode. Feelings which they have hardly known until then frequently develop. Other feelings are absent suddenly. Sometimes, the experience of feelings is not in line with situations experienced. Quite often suicidal thoughts develop.

Subjective description by the persons afflicted

  • “I am more frequently anxious, but also more frequently aggressive.”
  • “Sometimes I don’t even feel anything anymore.”
  • “My feelings are sometimes quite different than what corresponds to the situation.”
  • “I am more frequently depressed than I used to be.”
  • “Frequently, I am irritated.”
  • “Occasionally, I think about killing myself.”

How the symptoms appear to the relatives

  • Relatives experience that they no longer know their family member very well. The personality appears to have changed.

Subjective description by the persons afflicted

  • “She no longer has any confidence.”
  • ”He is sometimes like a automaton, but then there are also times when he goes ballistic.”
  • “Sometimes she laughs in such a funny way when she is sad.”
  • “She is always pessimistic.”
  • “His moroseness is depressing, more and more frequently he talks about suicide”.

(Source: Extract from the book: Schizophren? Orientierung für Betoffene und Angehörige. Klingberg/ Mayenberger/ Blaumann. Weinheim: Beltz-Verlag 2005, Germany)


Moreover, so-called psychosis-associated symptoms occur:

1. Aggressiveness, irritation, animosity, inner restlessness, tension, psychomotor disorder. These symptoms develop in the event of delusions of persecution, threatening misinterpretation of one’s surroundings and the feeling of being controlled and manipulated from the outside. Furthermore, these modes of behaviour can develop as a reaction to insulting, threatening or commenting voices.

2. Behaviour injuring oneself or outside parties. Behaviour injuring oneself in persons afflicted by a psychotic disorder is expressed on the one hand by putting oneself into situations that could be dangerous, e.g. by provoking punch-ups on the other hand however also through self-injuring forms of behaviour such as cutting one’s forearm with sharp objects.



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