Guide
Guide
|
Reference
17 Reality Distortion and Psychosis-Spectrum Experiences
17.1 Summary
- Experiences where perception, belief, or thought content departs from shared reality or is held with reduced insight.
17.2 Patient-Language Phrases
- “I hear voices when no one is there.”
- “People are watching or sending me messages.”
- “My thoughts don’t feel like my own.”
- “Things feel unreal or distorted.”
17.3 Core Features
- Hallucinations or perceptual distortions.
- Fixed or unusual beliefs held with high conviction.
- Disorganized thought or behavior.
- Reduced ability to test reality.
17.4 Boundary Markers
- What it is: persistent or recurrent reality-distorting experiences with reduced insight.
- What it is not: culturally normative beliefs, grief-related phenomena, or transient misperceptions tied to sleep loss or substances.
17.5 Quick Structure
- Variants / Spectrum
- Auditory, visual, or tactile hallucinations.
- Delusional themes (persecution, grandiosity, reference).
- Thought insertion, withdrawal, or broadcasting.
- Disorganization or catatonia-like states.
- Insight continuum from intact to minimal.
- Severity (0-4)
- 0: No reality-distortion symptoms.
- 1: Mild, intermittent, with intact insight.
- 2: Moderate, recurring, impacts function.
- 3: Severe, persistent, with impaired insight or safety concerns.
- 4: Extreme, disabling or unsafe.
- Time-course
- Acute onset.
- Episodic with remissions.
- Chronic persistence with exacerbations.
- Progressive functional decline.
- Functional impact
- Work/school: disorganization or reduced performance.
- Relationships: mistrust, withdrawal, or conflict.
- Self-care: neglected routines or safety concerns.
- Developmental expression
- Adolescence: new onset with functional change.
- Adulthood: episodic or persistent patterns.
- Late life: new onset warrants medical workup.
- Cultural/context notes
- Assess beliefs within cultural, spiritual, or community context.
- Language and meaning may shape symptom description.