The Northern Ireland Trauma-Psychosis Research Network
In December 2010 a group of researchers from Northern Ireland held an inaugural meeting to establish the first Northern Ireland Trauma-Psychosis Research Network. Motivated by a shared contribution to a growing literature, championing the aetiological significance of psychological trauma in the onset and maintenance of psychosis, researchers from the University of Ulster and the Queen’s University of Belfast decided to establish a research hub, to disseminate, communicate, and facilitate trauma-psychosis based research emanating from the province.
Psychosis is responsible for some of the most distressing and debilitating of psychological experiences. It is often conceptualised and contextualised in terms of complex and ambiguous psychiatric diagnoses such as ‘schizophrenia’, ‘paranoid schizophrenia’, ‘manic depression’ and ‘bipolar depressive disorder’. While our understanding of psychosis, i.e. what ‘it’ is, who has ‘it’, what causes ‘it’, what influences ‘it’s’ expression, and what eradicates ‘it’, is extraordinarily weak, We do know a little about those who experience it.
We know that individuals who experience psychosis can endure frightening, and disturbing hallucinatory and delusional experiences; they can experience wide fluctuations in mood; and they may be highly susceptible to a wide range of severe health and social related problems. Their experiences, often, expose them to a world which may seem alien to many around them and, often, these experiences can culminate in suicide, debilitation, or early mortality. We also know that many individuals who experience psychosis have endured severe psychological and interpersonal trauma, especially in early childhood. We know that the severity of psychosis and the implications for those unfortunate enough to suffer from it is worsened, quite dramatically in many cases, in those who have endured such experiences of trauma. We know that many individuals reporting trauma have earlier first admissions, receive hospital care more frequently and for longer periods of time, are medicated more, have higher rates of attempted suicide, and experience greater symptom severity. The greater the severity of the trauma the higher the likelihood of developing a psychotic disorder in adulthood and the more severe the disorder is likely to be.
We know that in many cases individuals diagnosed with a psychotic disorder are rarely asked whether they have experienced trauma. We know that for many, the content of their hallucinations and context of their delusions are trauma based. We know that many individuals with a psychosis related diagnosis also have a trauma related diagnosis such as post traumatic stress disorder (PTSD) and that the symptoms of these disorders seem to overlap. We also know that psychosis is a highly heterogeneous construct and that it is not only comorbid with PTSD but with a wide array of other psychiatric disorders also. We know that alternative risk factors for psychosis, such as cannabis consumption, are highly influenced by trauma history and that the age of onset of trauma and cannabis consumption significantly influences the probability of psychosis diagnosis. We also know that psychosis is not limited to clinical or diagnostic extremes but can be found throughout the general population along a continuum of symptom severity. We know that the risks associated with clinical psychosis, such as traumatic experience, are also associated with subclinical experiences and that many individuals who experience sub-clinical psychosis seek help from sources other than psychiatric services.
While our understanding of psychosis is weak, our ability to explore, reconceptualise, and reconceive is strong. Trauma has become central to many investigating psychosis, and for the members of the Northern Ireland Trauma Psychosis Research Network, trauma has become the key ingredient to understanding this complex and elusive concept.