Unravelling the Intersection: Dissociative Mood, Psychosis, and Paranoia Among People with ADHD and PTSD

Mental health disorders such as Attention Deficit Hyperactivity Disorder (ADHD) and Post-Traumatic Stress Disorder (PTSD) continue to impact the lives of many people across the globe. ADHD and PTSD, although distinct disorders, often co-occur and share certain symptoms including issues with attention, impulsivity, and emotional regulation (American Psychiatric Association, 2013). This article aims to evaluate the occurrence of dissociative mood, psychosis, and paranoia among people with ADHD and PTSD, focusing on these symptoms' complexity and their impact on those afflicted.

 

Dissociation: A State of Disconnect

Dissociation, a term coined to describe a state of altered consciousness, memory, identity, or perception of the environment, is commonly associated with PTSD but less so with ADHD (Mayo Clinic, 2020). These symptoms often manifest as a psychological defence mechanism in response to overwhelmingly stressful or traumatic situations (van der Kolk, 2014).

 

Whilst individuals with ADHD can experience periods of dissociation, often described as "zoning out," it does not typically resemble the severe dissociative episodes associated with PTSD (Barkley, 2014). For people with PTSD, dissociation occurs more frequently due to repeated exposure to severe trauma (Mayou, Ehlers & Bryant, 2002).

 

Psychosis: A Distorted Reality

Psychotic symptoms, including delusions of grandeur and hallucinations, are not typically associated with ADHD or PTSD (American Psychiatric Association, 2013). However, in extreme cases, these disorders may precipitate brief episodes of psychosis, particularly under severe stress or trauma (Friedman & Resick, 2006).

 

The nature of these delusions can often be grandiose in nature, where the individual might believe they possess superior qualities or have been "chosen to save the world" (APA, 2013). However, these symptoms are more common in conditions such as schizophrenia or bipolar disorder (Kendler, Gallagher, Abelson & Kessler, 1996).

 

Paranoia: Fear and Suspicion

Paranoia, characterised by an intense, irrational suspicion or fear of others, is not a core symptom of either ADHD or PTSD, but can occur (APA, 2013). In individuals with PTSD, a heightened threat perception can lead to paranoid thoughts, given the underlying association with trauma involving harm by others (Perkonigg, Kessler, Storz & Wittchen, 2000).

 

The Intersection of ADHD, PTSD and Complex Symptoms

While each disorder manifests uniquely, they often intersect in certain areas. For instance, ADHD can increase the risk of trauma exposure, leading to PTSD, which in turn amplifies ADHD symptoms (Daviss, 2008). This interplay could potentially exacerbate symptoms such as dissociation, paranoia, and, in rare cases, psychosis.

 

Understanding this interplay is crucial for providing comprehensive psychiatric evaluation and treatment. Cognitive-behavioural therapy, Eye Movement Desensitization and Reprocessing (EMDR) for trauma, and medication management can all play a role in managing these complex cases (National Institute for Health and Care Excellence, 2018).

 

Dissociation, mood disorders, and psychotic episodes are complex psychological phenomena that can affect people with various mental health conditions, including Attention Deficit Hyperactivity Disorder (ADHD) and Post-Traumatic Stress Disorder (PTSD). While it's important to note that not everyone with ADHD or PTSD will experience these symptoms, there can be some overlap due to shared underlying factors such as stress, trauma, and neurobiological changes.

 

Dissociative States

Dissociation can be seen as a psychological defense mechanism that is triggered when individuals confront overwhelmingly stressful or traumatic situations. It's a state in which one's consciousness, memory, identity, or perception of the environment is disrupted. This can involve feelings of detachment from one's body or reality, or the inability to recall key personal information that would not typically be lost with ordinary forgetfulness.

While people with ADHD may experience forms of dissociation, it's not a common symptom. For example, they might "zone out" or become deeply engrossed in a task to the point where they lose awareness of their surroundings. However, in PTSD, dissociation can be more common, especially in those with a history of severe or repeated trauma.

 

Episodes of Psychosis

Psychosis is characterized by a disconnection from reality and can include symptoms like hallucinations (seeing or hearing things that others don't), delusions (strong beliefs in things that are not true or unlikely to be true), and disorganized thought or speech.

 

Delusions of grandeur, where the person believes they possess superior qualities or powers, or the notion of being "chosen to save the world," are not typical symptoms of ADHD or PTSD. However, they can occur in the context of severe mental health conditions like bipolar disorder or schizophrenia. In some cases, extreme stress or trauma might precipitate brief psychotic episodes, especially if the individual has a predisposition to such conditions.

 

Paranoid Behaviour

Paranoid behaviour involves intense, irrational suspicions or fear of others. People with this kind of behaviour may feel persecuted or believe in conspiracies. Although it's not a core symptom of ADHD or PTSD, it can occur, especially if the person has experienced trauma involving betrayal or harm by others. In PTSD, hyperarousal and a heightened threat perception can lead to paranoid thoughts.

 

The Intersection of ADHD, PTSD, and these Symptoms

The intersection of ADHD, PTSD, and symptoms like dissociation, episodes of psychosis, and paranoid behaviour is complex. ADHD and PTSD are separate disorders, each with its own diagnostic criteria. However, they share common elements, like difficulties with attention, impulsivity, and emotional regulation. These shared features can compound and amplify symptoms.

Moreover, trauma, which is at the heart of PTSD, can lead to a wide array of symptoms including dissociation, paranoia, and in extreme cases, episodes of psychosis. Similarly, individuals with ADHD who have a high degree of impulsivity and difficulty with emotional regulation may find themselves in more risk-prone situations, increasing the chance of trauma and subsequent PTSD.

It's also worth mentioning that comorbidity is common in psychiatric conditions. An individual might not just have ADHD or PTSD, but they could also have additional conditions like anxiety disorders, depression, bipolar disorder, or personality disorders, which could further complicate their symptom profile.

It's crucial for these individuals to receive comprehensive psychiatric evaluation and treatment that address all of their co-occurring conditions. Cognitive-behavioral therapy, EMDR for trauma, medication management, and lifestyle interventions can all play a crucial role in managing these complex cases. Regular follow-up with mental health professionals is important to adjust treatment plans as needed, ensure the effectiveness of the intervention, and monitor for any new or worsening symptoms.

Please remember that while these conditions can be challenging, help is available, and recovery is possible. Mental health conditions are not a choice or a moral failing—they are medical conditions that can be treated.

Dissociation in ADHD

Dissociation is not a commonly discussed symptom in relation to ADHD in the scientific literature. ADHD primarily involves symptoms of inattention, hyperactivity, and impulsivity. However, a person with ADHD may "zone out" or become deeply engrossed in a task, which could potentially be considered a form of dissociation. But this is distinct from the kind of severe dissociation often seen in disorders like dissociative identity disorder or severe PTSD. Some studies showed that with diagnosed people with ADHD alone, 10% of them experienced dissociative mood, which can be a cause of developing some psychotic symptoms.

 

Dissociation in PTSD

Dissociative symptoms are much more common in PTSD. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), experiencing dissociative reactions in which the individual feels or acts as if the traumatic event(s) were recurring (this can include a sense of reliving the experience, illusions, hallucinations, and dissociative flashbacks) is one of the criteria for PTSD.

According to some studies, dissociative symptoms occur in approximately 15% to 30% of patients with PTSD. Additionally, the DSM-5 now recognizes a subtype of PTSD known as "Dissociative Subtype of PTSD," which is diagnosed when the individual experiences high levels of depersonalization (feeling detached or disconnected from oneself, observing oneself from an outside perspective) and derealization (experiencing the world as unreal, dreamlike, distant, or distorted) in addition to the standard PTSD symptoms.

 

Psychosis in ADHD and PTSD

Psychotic symptoms are not typical in ADHD and are not included in the diagnostic criteria. While psychotic symptoms could potentially occur in someone with ADHD, this is likely to be relatively rare and would suggest the possibility of an additional diagnosis such as a psychotic disorder.

As for PTSD, some research suggests that individuals with PTSD have a higher risk of experiencing psychotic symptoms compared to the general population, although the prevalence can vary widely depending on the study. Some studies suggest that approximately 30-40% of patients with PTSD may experience at least some psychotic symptoms. However, these symptoms are usually transient and not as severe or persistent as those seen in primary psychotic disorders such as schizophrenia.

If you or someone you know is experiencing symptoms of dissociation or psychosis, it's important to seek professional help. These can be signs of serious mental health conditions that require treatment.

It's important to note that individual experiences can vary widely, and these numbers are rough estimates. The manifestation of these conditions can differ greatly based on a number of factors, including individual characteristics, the presence of comorbid conditions, the severity and nature of any experienced trauma, and more.

 

Possible dissociative episodes in adjustment disorder

Adjustment disorder is a stress-related condition that arises when an individual struggles to cope with or adjust to a significant life change or stressor. Although dissociation is not typically a primary symptom of adjustment disorder, it can occur, particularly if the stressor or change is exceptionally severe or traumatic.

 

Dissociation in the context of adjustment disorder can manifest as feelings of detachment, disconnectedness, or being "outside" one's body. People may report a sense of the world seeming unreal or dreamlike, or they may have gaps in memory pertaining to the stressful or traumatic event. These experiences are often a psychological defense mechanism that helps individuals cope with extreme stress or emotional pain.

However, it's crucial to note that if an individual is experiencing significant dissociative symptoms, they may have a different or additional diagnosis beyond adjustment disorder, such as PTSD or a dissociative disorder. It's always important to seek professional help when facing mental health challenges, as accurate diagnosis is key to effective treatment (American Psychiatric Association, 2013).

 

Conclusion

While understanding these complex psychiatric conditions remains challenging, it is important to remember that help is available, and recovery is possible. A comprehensive, individual-centred approach that recognises the complex interplay of these conditions and associated symptoms will be crucial for ensuring optimal patient outcomes.

Dr Robert Becker, Mental Health Specialist, Psychiatric Assessor

References:

 

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). APA.

 

Barkley, R. A. (2014). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. Guilford Publications.

 

Daviss, W. B. (2008). A review of co-morbid depression in pediatric PTSD: Recommendations for future research. Journal of Child and Adolescent Psychopharmacology, 18(6), 565-575.

 

Friedman, M. J., & Resick, P. A. (2006). PTSD and related disorders in adults. The Oxford Handbook of Anxiety and Related Disorders.

 

Kendler, K. S., Gallagher, T. J., Abelson, J. M., & Kessler, R. C. (1996). Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Archives of General Psychiatry, 53(11), 1022-1031.

 

Mayo Clinic. (2020). Dissociative disorders. Retrieved from https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-20355215

 

Mayou, R., Ehlers, A., & Bryant, B. (2002). Posttraumatic stress disorder after motor vehicle accidents: 3-year follow-up of a prospective longitudinal study. Behaviour Research and Therapy, 40(6), 665-675.

 

National Institute for Health and Care Excellence. (2018). Post-traumatic stress disorder. Retrieved from https://www.nice.org.uk/guidance/ng116

 

Perkonigg, A., Kessler, R. C., Storz, S., & Wittchen, H. U. (2000). Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica, 101(1), 46-59.

 

van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.