How to Help Someone in a Psychotic Episode

Help someone in a psychotic episode

Psychotic episodes can be frightening for everyone. It’s also completely normal to feel unprepared. To support someone with psychosis, it helps to understand what these issues really are about, as opposed to what the general public often believes.

The word “psychosis” describes conditions that affect the mind, causing loss of contact with reality. This break from reality is a psychotic episode. During a psychotic episode, a person may experience delusions and hallucinations, among other issues. They may suddenly say they can hear voices, withdraw socially, or even violently lash out.

Because many people don’t know how to respond to these behaviors, they feel helpless and the stress and fear start to pile up. Learning how to communicate with someone with psychosis is key to both their—and your—mental health.

Recognizing the Signs of a Psychotic Episode

The typical image of a psychotic episode is a loud and dramatic event. Some episodes can be quite intense, but many are more subtle. Sometimes the only evident symptom is a slight behavioral change.

Plus, studies indicate that psychotic events are far more common than most people realize. As many as 5–10 percent of people will have a psychotic episode in their lifetime. For these reasons, it’s essential to learn and recognize both the obvious and less prominent signs of a psychotic episode.

In general, psychosis symptoms fall into one of three categories. Positive symptoms include delusions and hallucinations, while negative ones involve a loss of function. The third category entails changes in thoughts and behaviors.

Early Warning Signs

Typically, people with psychosis will show cognitive and behavioral changes first. Some of the biggest warning signs include:

  • Suspiciousness of other people
  • Paranoia
  • Uneasiness around others
  • Social isolation and spending more time alone
  • Confused speech and difficulty talking

Some of the other early signs are less obvious. For example, grades or job performance may suddenly worsen without a clear cause. A person may begin to express new ideas that are intense or unusual. In some cases, they may describe feeling strange or even seem to have no feelings at all.


Delusions are fixed, false beliefs. Even if they seem obviously unrealistic, the person experiencing them will continue to believe the delusions. They can vary dramatically, but persecutory delusions—where a person feels someone is out to get them—are among the most common. Some other types of delusions include:

  • Referential delusions: a person feels that things they hear or see refer to them
  • Grandiose delusions: a person has grand or self-inflating, yet unrealistic, views of themself
  • Erotomanic delusions: a person feels that someone is in love with them
  • Nihilistic delusions: a person believes that a major catastrophe is about to occur


Hallucinations are experiences that lack the proper trigger or stimulus to produce such a sensation. An example of this is smelling an odor that has no origin or seeing an animal that isn’t actually there. While most people think of hallucinations as purely visual or auditory, they may involve any of the senses. In fact, they may involve multiple senses at once. In contrast with delusions, people who hear auditory hallucinations describe them as occurring outside of their heads.

Loss of Function

Someone experiencing any of the other symptoms of psychosis may also have difficulty functioning overall. It’s common to lose the ability to initiate or participate in activities like hobbies or going to work. Some people notice a drop in their ability to feel pleasure, as well as a loss of motivation. These issues often overlap with the symptoms of conditions like depression and anxiety.

What Not To Say When Someone Is Psychotic

The way you respond to someone with psychosis can play a major role in your relationship with them and even affect the severity of their symptoms. Because psychotic episodes can vary so much, it’s often easier to focus on what not to say—bearing in mind the following….

Nobody Is at Fault

Understand that neither you nor the person going through the episode is at fault. The situation is an adjustment for everyone and most people have little preparation for it. Don’t try to assign blame or hold anyone responsible for the psychosis, especially the person experiencing it.

The Delusions and Hallucinations Are Real

To people with psychosis, the delusions are real, no matter how unrealistic they seem to you. Avoid laughing at, diminishing, or ignoring their thoughts. Never call them or their behavior crazy or stupid and avoid challenging delusions too directly. Beyond these tips, remember that your mental health matters, too. You don’t need to continue any conversation that you feel is distressing or confusing.

They’re Not Lazy

Labeling a person with psychosis as lazy is not only harmful but inaccurate as well. Their behavior is a symptom, not disobedience or intentional slacking. Don’t argue about tasks, chores, or responsibilities, and avoid overwhelming them with too many instructions. Also, don’t bring up how they used to feel or act. This can add additional negative feelings about how they’ve changed, aggravating their symptoms. Even if a person doesn’t show any emotion, they still have feelings.

How To Deal With Someone Having a Psychotic Episode

When it comes to knowing how to support someone with psychosis, the most important part is to focus on the emotion and themes of the conversation. Be on their side and don’t challenge them head-on. While they may say or describe things that aren’t realistic, you’ll often find threads of reality that you can follow.

An Example of Psychotic Thoughts

Imagine that your loved one tells you that a car is monitoring them. It parks on their street and every time they leave, a car drives by to track their habits. They claim the car follows them everywhere they drive.

Don’t dismiss these thoughts as unrealistic. However, remember that you should never encourage their psychosis. Instead, recognize their feelings. Let them know that you empathize with how scary these things feel. Ask if there’s anything you can do to help. Doing so will make it clear that you’re here to help and that they are free to reach out to you.

Keeping in Touch

People with psychosis often withdraw from social situations. Without pressing them to interact, you should always remain in contact. Simply letting them know that you’re there whenever they need you can be a major relief.

Handling Aggression

It’s a fact that sometimes psychotic episodes involve aggression and even violence. Remember that while a person may be directing their anger and aggression at you, it’s not necessarily a personal attack. Usually, they are a bigger risk to themselves than to you. Listen to them and attempt to understand why they are upset. Try to use a calm voice and a neutral facial expression.

Ultimately, take any threats or violent actions seriously. Your safety is as important as theirs, so leave the room or house quickly if things begin to escalate. Give them time to cool off.

Plan for the Future

One of the most important parts of helping someone with psychosis is building a plan for the future. You may be able to help manage a person’s psychotic episodes for a short period, but it is a heavy responsibility to carry and there’s only so much you can do. People with psychosis have medical conditions and need professional help.

Studies show that it’s common for people with psychotic symptoms to go without treatment for an entire year. Reducing this period will not only be better for their recovery but will also save you and the other members of their support network a significant amount of stress.

Involve the individual in the treatment plan. Their specific goals and needs will drive the path to recovery and giving them an active role will help them combat feelings of paranoia. It’s typical for people to reject treatment. You should still reach out to specialists so they can help guide you on the best path for you and your loved one.

Restore provides comprehensive, personalized care to those with psychosis, ensuring they receive the most effective treatment possible. Contact us today to learn more about how we can help with psychotic episodes and other mental health issues.