Anxiety: Fearing Psychosis 

There appears to be a really strong theme, common to most anxiety sufferers, around the fear of psychotic illness. Over the last few year I have had countless conversations with anxiety sufferers along the same lines and thought it was sensible to write something along about it directly. I do want to begin though with a general word of encouragement to genuine sufferers of psychotic illness who may read this post. Please know that this content is aimed at helping anxiety sufferers overcome a variety of misconceptions around certain symptom profiles. It is not my intention to further fuel the stigma or fear of psychotic illness.

For the anxiety sufferer, physiological and emotional changes can emerge very quickly. New sensations and discordant emotions can be very unsettling. A hypersensitive limbic system can create an almost endless list of foreign sensations in the body, all of which provoke further anxiety and hence further symptoms. lists over 100 of the most common anxiety symptoms but even these are not exhaustive. One of the issues an anxiety sufferer experiences is not a loss of contact with reality but a hyperawareness of their reality. This means that even the smallest changes in their body or mind become a cause for fresh concern.

Making sense of all of these changes inevitably leads an anxiety sufferer to work through a huge list of possible physical illnesses. Most commonly, heart disease, brain tumors, cancer, hyperthyroidism, MS, early onset Parkinson’s disease, and HIV Aids. At the end of the medical list is a recognition that if it isn’t physical, it must be mental. Because of the anxiety sufferers propensity to catastrophize their symptoms, they typically fear those illnesses which are most stigmatized and misunderstood: psychotic illnesses. Life can then become an endless quest to prove that they do not have these illnesses, which in turn proves to keep the fear alive.

The reality of diagnosis for a serious and enduring psychotic illness is complex and the responsibility of psychiatric professionals. It involved looking at a very broad spectrum of symptoms; both positive and negative. Interestingly, hallucinations and delusions are not always evident in psychosis. Many psychiatrists trust the ‘flat’ or ‘negative’ affect symptoms more than the ‘positive’ or ‘active’ symptoms to make a diagnosis. Of course anxiety sufferers tend to fear ‘clear signs’ that they are losing touch with reality. Something that is in itself a paradox, since it would be impossible to judge yourself as losing touch with reality if you really were.

At the same time, when an anxiety sufferer experiences something through their senses that they are not sure really happened, they tend to see it as concrete proof that they are becoming psychotic. Common experiences in this group include: Hearing your name called in the street, hearing beeps, pops and whistles. Hearing your phone ring when it is not ringing. Hearing domestic appliances running when they are off. Hearing music or chatter in fans and hairdryers. Seeing things out of the corner of your eyes (peripheral vision): bugs, light flashes, or even people. Seeing faces in mirrors, computer screens or reflections. Hearing voices or music when you are falling asleep or waking up (hypnagogic). Thinking you recognize faces of people in a crowd. Feelings of déjà vu. Frequently mishearing what people are saying.

On paper all of these experiences sound very concerning. However, they are actually very common in the general population. Ask any friend if they have ever though someone was calling their name when there was actually no one there and you will see just how normal this sort of experience is. Dr Fred Penzel (WSPS) makes a very helpful distinction between these experiences and true hallucinations. He calls these sensory illusions Dysperceptions, a common and harmless sensory experience seen in anxiety and most prominently OCD style disorders. Dyspeceptions are transitory, perceived as being strange, and are rarely complex. They are not the same as hallucinations in that they are believed to be sensory anomalies, not concrete events by the individual experiencing them. 

Why am I experiencing dysperceptions?


There are many reasons why you may be experiencing dysperceptions, very often the cause is a combination of the following issues:

Being in an anxious state heightens all of your senses. Hearing, seeing, smell, touch and taste are all supercharged. Because anxiety makes us alert, that alertness means we will most likely misperceive any stimulation that we receive.

Mild Sensory dysperceptions are a common and harmless phenomena in the general population but their significance is over estimated by those suffering from anxiety.

Our brains run their own ‘noise cancelling’ mechanism that tends to filter out those sounds which are not pertinent to us. This is why people can sleep perfectly whilst living next to noisy train lines and under flight paths. Their brains simply edit out the noise. However, an anxious brain tends to ‘hear’ everything, making is subject to misreading stimulus as meaningful.

Our brains commonly ‘fill in the gaps’ in our perceptions. For example the sound of a car breaking may be at the same frequency as your mobile ring tone. Your brain immediately fills in the rest and you reach for your phone to answer the call, except your phone hasn’t rung. (Selective Soft Sound Sensitivity Syndrome is worth looking at for a deeper explanation)

With visual dysperceptions the imagination also comes into play. Many anxiety sufferers see things that ‘could be mistaken’ for something else. Their imagination then develops the picture. Then within a similar setting they recall the memory of this image and replay it again. In this way a coat on the backseat of the car seen in the rear view mirror becomes a person. Having removed the coat subsequent glances in the rear view mirror seen to suggest a  person is seated there.

Anxiety typically diminishes people’s confidence in their senses. As a result they tend to double or triple check. The result of this doubt is not assurance but even more uncertainty. As a result people enter a hypervigilant state where they experience even more dysperceptions and subsequently more anxiety.  

How can I deal with my fear of psychosis?


The first thing to do here is recognize that no amount of information gathering will provide an answer to the threat you fear. Stop searching the internet for diagnostic lists for psychotic illness or online tests. They will reassure you only for a few moments before your doubts reappear.

Exposure and Response Prevention is the best treatment for this sort of fear. Rather than trying to convince yourself that you are no psychotic, welcome the possibility. “I may be psychotic, everyone is a little bit anyway. I can live a long and fulfilling life with a psychotic illness. It is ok to have strange experiences…..” It will feel frightening at first but actually accepting these possibilities deeply diminishes anxiety and restores a balanced perspective.

Talking to an experienced mental healthcare provider about your fears can often help, but don’t become reliant on their reassurances. Your GP may also offer to prescribe you an anti-anxiety medication (SSRI) that can help you manage your fears more easily.

Accept that human sensory experiences are much more diverse than you imagine. Recognize that most people experience dysperceptions on an occasional basis, more commonly when they are anxious. Some people even hear complex voices and yet are not classified as suffering psychotic illness. (See Voice Hearers Network)

Meet people who do suffer from psychotic illness. You will be pleasantly surprised by how lovely and ‘normal’ they are. This is because, for the majority of people who do suffer from psychosis, modern drug therapy controls their symptoms really well. You might not have their illness, but you can acknowledge that if you did, it clearly wouldn’t be the catastrophe you imagined.

Pray that God would increase your assurance in his plan for your life. Try to rest in the knowledge that whatever happens to you, he will never leave you. He cares for you.


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