Psychotic experiences in the general population
Psychosis is a set of symptoms characterized by the presence of delusions, hallucinations, and disorganized thinking , among others, and is considered a mental disorder because it causes distress and interference in the daily lives of people who have it. It is estimated that 3% of the world's population will have a psychotic disorder throughout their lives (Përäla et al., 2007).
Traditionally, psychosis had been defined within a categorical classification, that is, you either have psychosis or you don't. Or what is the same, you either have a mental disorder or you don't. Today we know that this is not the case, that is, psychosis is a continuum that goes from the existence of psychotic experiences in the general population (non-clinical) to the presence of a mental disorder that requires treatment.
In the last thirty years, it has been studied whether symptoms of psychosis can exist in other conditions outside of mental disorder, as has been observed in other disorders such as depression. The results indicate that psychotic experiences are common in the general population and their presence is not necessarily associated with having a mental disorder. According to several studies, the average prevalence of psychotic experiences in the general population is 8.4% . In contrast, the prevalence of psychotic experiences with clinical relevance, that is, cases in which a psychotic disorder is present, is 1.5 % (van Os et al., 2008). This means that most people who have these experiences do not have any mental health problems.
Psychotic experiences are common in the general population and their presence is not necessarily associated with having a mental disorder.
The highest incidence of psychotic experiences is between childhood and late adolescence , and there is a decline in older ages (Fonseca-Pedrero et al., 2008). For 80% of people with psychotic experiences, these are transient (Linscott & Van Os., 2013; McGrath et al., 2015), while 20% have them repetitively. In the latter cases, the likelihood of developing distress and, therefore, a psychotic disorder is higher (Calkins et al., 2017).
Hallucinations and delusional ideas
Regarding hallucinations , 12.4% of adolescents and 12.7% of children assessed have had them at some point in their lives (Maijer et al., 2018). That is, they have had visual, auditory, tactile, olfactory or gustatory experiences without stimuli that justify them. Something very similar happens with delusions . The number of people who have them without experiencing discomfort is much higher than the number of people who have psychotic disorders. There are studies that have found a frequency of up to 28% of these thoughts (Bebbington et al., 2013). Some examples of questions to assess whether people have these thoughts are: “Do you think it is better for people not to know many things about you in case they can use them against you?”; “When you are in a public place and you see people talking, you often think they are talking about you”; "In this last year you have sometimes felt that people were against you."
After a certain amount of psychotic experiences, a person may be more likely to develop a psychotic disorder (or other mental disorders), especially if risk factors such as stressful events or substance use are added.
The development of psychosis, therefore, could follow a model very similar to that of other medical conditions. For example, blood pressure, which can fluctuate naturally, but above certain values the person has high blood pressure, a factor that increases the risk of suffering from cardiovascular disease (van Os., 2003). In the case of psychosis, after a certain amount of psychotic experiences a person may be more likely to develop a psychotic disorder (or other mental disorders), especially if factors such as stressful or traumatic life events, consumption of toxic substances or having a genetic predisposition are added (van Os, 2003; Yung et al., 2006; Nelson et al., 2012).
Factors that increase the risk of having a psychosis
In conclusion, having hallucinations or delusions is much more common than initially thought. Not all people who have them will develop a psychotic disorder. However, it is important to observe if these experiences are repeated regularly and, above all, if they cause discomfort and difficulties in daily life. In this case, it is highly recommended to seek specialized help, since psychotic disorders often have a good prognosis if treated early . The general practitioner can request a consultation with the mental health team in the area.
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