Traumatic loss and psychosis – reconceptualisingthe role of trauma in psychosis

Literature suggests that the occurrence of psychological trauma (PT) fromvariousnegativelifeexperiences beyond events mentioned in the DSM-criterion A, receives little to no attention whencomorbid with psychosis. In fact, despite research indicating the intricate interplay between PTand psychosis, and the need for trauma-focused interventions (TFI), there continue to be mixedviews on whether treating PT would worsen psychosis, with many practitioners hesitating toinitiate treatment for this reason. This study, therefore, aimed to understand patient perspectiveson the role of PT in psychosis and related treatment options. A qualitative exploratory approachwas adopted using in-depth interviews with individuals experiencing psychosis. The GlobalAssessment of Functioning (GAF)scale was administered on a predetermined maximum variationsample resulting in two groups of participants- those with moderate-mild disability (GAF 54–80;n = 10) and those experiencing moderate-severe disability (GAF 41–57; n = 10). With the formergroup, a semi-structured interview schedule was used, while with the latter, owing to multiplesymptoms and difficulty in cognitive processing, astructured interview schedule was used. Resultsfrom interpretative phenomenological analysis (IPA) indicated that traumatic loss was central toexperienced PT, but received no attention; this often contributed to the psychotic experience and/or depression, through maintenance factors such as cognitive distortions and attenuated affectiveresponses. Further, the experience of loss seems to be more consequential to trauma-relatedsymptoms than the event itself. Participants opined strongly the need for TFI and the role of it inpromoting recovery from psychosis.