Women and Psychosis: A Guide for Women and Their Families
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The term “psychosis” refers to a state of mind during which thinking, reasoning and mood are disrupted in major ways.
Many factors can play a role in the onset of psychosis, including high fever, a drug reaction, neurological illness (an illness
of the brain, such as epilepsy), and family history of psychosis. Often the cause is unknown, and the illness appears to come
“out of the blue.”
During a period of psychosis, a woman may be convinced that her partner is cheating on her, even if this is not true. She
may read meaning into her partner’s gestures, tone and actions that are based on her worst fears, not on reality. A woman
having a psychotic episode may hear a voice in her head confirming her fears, which she takes as proof that her beliefs are
true. It is difficult to change such fixed beliefs, even though there is evidence that contradicts them.
Sometimes psychotic convictions (called delusions) stem from a mood disruption. If a woman is very depressed, for example,
she may feel unlovable; this may lead her to believe (falsely) that she is being abandoned, discriminated against or attacked.
This also happens to men. Typically, women’s delusions focus on relationships; the false belief that a partner is cheating
on her is a common delusion in women experiencing psychosis. Men’s delusions tend to involve issues such as terrorist plots,
spiritual concerns and computer espionage.
Early in a psychotic episode, it is difficult to determine the underlying cause of psychotic symptoms. And symptoms change
over time, making diagnosis even harder. There is no “objective” test for psychosis. The diagnosis is a clinical opinion based
- what the woman (and her family) report
- what seems to have triggered the problem
- the duration of symptoms
- changes in symptoms
- how much the symptoms interfere with everyday function
- family history.
Women are as likely as men to develop psychosis. While psychosis arising from drug use is less common in women than in men,
psychosis associated with mood fluctuation is more common in women than in men.
When women are diagnosed with schizophrenia, they tend to have fewer “negative” symptoms (things that are “taken away” when
the person becomes ill) than men do. The negative symptoms (e.g., loss of pleasure or motivation) are often the ones on which
the diagnosis of schizophrenia is made. Yet women rarely show these symptoms, making a diagnosis of schizophrenia in women
more difficult. On the other hand, mood symptoms, especially depression, are common in women even when the illness turns out,
in the end, to be schizophrenia rather than a depressive psychosis. Symptoms of depression include crying easily, feeling
guilty and losing hope. When mood symptoms and cognitive symptoms (e.g., loss of reasoning ability) occur at the same time,
accurate diagnosis is even harder.
Psychotic illnesses first affect women at a later age than men and are often triggered by events. Women tend to be vulnerable
in their early twenties, and the trigger is often a relationship failure. Men tend to be vulnerable in their late teens, and
the trigger may be alcohol and other drug use.
The later start to illness gives women the advantage of having more schooling behind them when they first get ill. They also
have more relationship and work experience, which helps with recovery. Women generally respond better to treatments for psychosis
than men do. Women seem to do well with relatively low drug doses. In general, women tend to be more open to talking about
their experiences and, therefore, do better than men with psychosocial treatments. This is good news for women.
However, women go through times when the risk of relapse is high (e.g., premenstrual, childbirth and postpartum periods, and
menopause). This suggests that women’s hormones may affect their resistance to psychosis. Other risk factors for women include
poverty, immigration, substance use, domestic abuse, sexual exploitation and single parenthood. Thyroid drugs and steroid
drugs (used more by women than by men) are also risk factors.
Psychotic symptoms occur in many medical and neurological illnesses. Different types of psychosis may need specific treatment.
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Schizophrenia is characterized by three clusters of symptoms.
The first cluster is “positive” symptoms — symptoms that are “added on” when the person becomes ill. Positive symptoms include
hallucinations (disorders of perception, e.g., hearing, seeing, tasting, smelling or feeling something that isn’t really there)
and delusions (fixed beliefs not based in fact).
The second cluster is “negative” symptoms — things that are “taken away” when the person becomes ill. Negative symptoms include
loss of pleasure, motivation and initiative, feeling apathetic, showing little emotion and avoiding social contact.
The third cluster is cognitive symptoms — these include loss of memory, reasoning and calculating abilities.
For a person to be diagnosed with schizophrenia, these three clusters of symptoms must have lasted for at least six months,
and must interfere with the person’s ability to function. Schizophrenia is a long-lasting illness. Remissions (periods when
a person has no symptoms) occur, but the person needs to continue treatment even during a remission to prevent relapse (the
return of symptoms).
This term is used for symptoms of schizophrenia that have not yet lasted for six months. Schizophreniform disorder may disappear
on its own or may develop into a longer-lasting illness.
Bipolar disorder (manic depression)
Bipolar disorder is a mood illness that alternates between periods of depression and periods of elation. At times, both poles
of this illness (depression and elation) may be accompanied by psychotic symptoms. For example, when depressed, people may
hear voices in their heads putting them down. When elated, they may believe they have special powers and can do amazing things,
without evidence to support these beliefs. In contrast to schizophrenia, when people are in remission from bipolar illness
they can resume their lives as before.
This term refers to illnesses where symptoms of both schizophrenia and mood disturbance are present. The two kinds of symptoms
either appear at the same time or alternate.
Depressionwith psychotic features
Unipolar depression (depression without elation) can be accompanied by psychotic symptoms. Depression is much more common
in women than in men.
Drug use can elicit psychotic symptoms. Some of the drugs that trigger psychosis are marijuana, cocaine, LSD, amphetamines
and ecstasy. Once the effects of the drugs wear off, the symptoms of psychosis will usually go away. If they do not go away,
the drugs may have triggered a longer-lasting illness. Drug-induced psychosis is more common in men than in women.
Brief psychotic disorder
This term refers to psychotic symptoms that last less than a month. These short-lasting psychoses are more common in women
than in men.
A delusional disorder is a long-lasting illness in which delusions (usually one elaborate delusion) are prominent, but in
which there are no hallucinations. An example of an elaborate delusion is a person believing that a song she wrote has been
stolen by a popular band, and that this band has made millions of dollars on the song. The person devotes her life to “setting
the record straight” and, in so doing, neglects everything else in her life. A delusional disorder may not prevent normal
functioning in some areas of life, but it strains relationships.
Post-traumatic stress disorder (PTSD)
This term refers to non-psychotic symptoms that follow a traumatic experience such as a violent assault. The affected person
relives the event, is preoccupied with it, avoids situations associated with it and may have flashbacks (visual and auditory
recollections of the event) that are impossible to distinguish from the hallucinations of a psychotic illness. More women
than men develop PTSD symptoms when exposed to a traumatic event.
Psychiatric diagnoses are not objective (no blood test or X-ray confirms the diagnosis). To help your doctor make an accurate
diagnosis, it is important to be as thorough as possible when telling your doctor what you are experiencing. Let him or her
know what you have been thinking and feeling. If you have been using alcohol or other drugs, you need to tell your doctor
how much and how recently. If you have been traumatized, either as a child or as an adult, tell your doctor. You also need
to discuss any family history of mental health problems openly.
It may be distressing or confusing to talk to a health care professional, especially when you are not well. The symptoms of
illness may interfere with your ability to express yourself. Your doctor or other members of your health care team may ask
for your consent to speak to your family or close friends. Family and friends can give information about what they have observed
that may help with the diagnosis.
The more information your doctor has, the more likely he or she is to make the most accurate diagnosis.