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I've seen this answered by people who have never had psychosis, but I'm interested in a more knowledgeable answer.

I've had hallucinations etc in my life, but I've also had times when I had a fantasy that was so HUGELY compelling that I could not stop thinking of it. During these times, I would create more time alone each day so I could "act out" my part in this fantasy, even to (silently if need be) mouthing my side of the "dialogue" and acting out what I could act out in a closed, private room. I was aware this was not "real" but early on I was compelled to act it out anyway, and then soon I would find that the fantasy began to color my sense of reality and they began to blur together until I was totally lost in what now felt like reality but was not totally.

When these get started, they can last for months. In my young adulthood they could last for years. I've learned that the earlier I stop this, the easier it is to get rid of. However, its very "tempting" when it first shows up, and at a minimum it usually takes me 2 to several days to realize I'm not hanging onto reality and about to go down a bad path.

Did that start as fantasy and become psychotic delusion? Or was it delusion from the start?

If its not delusion at the beginning (or even at the end) then what is it?

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I think the difference for me is that when a fantasy becomes real to me, then it is a delusion.  When you cross from knowing it is not real (fantasy) to thinking it is (delusion), I think that is part of the difference between fantasies and delusions.  This is a guess though from doing a quick google about it.

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I'm really interested in the replies too. You just described me. It hasn't been as bad for me since I started writing - the fantasy largely stays on paper. I still act it out in my head though. As a kid/teenager I'd do exactly what you're describing.

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I'm curious too about the pressured feeling that I can't not do this acting out when it gets going, and the inability to get it out of my thoughts before it blurs with my reality.

Does it count then as "intrusive thoughts", or...?

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Here's some quick info I pulled up this morning. NOT that I believe Wikipedia is a great fount of perfect knowledge, but it's often got the basics (as long as it isn't a contentious topic).

 

Here is a link to "Intrusive Thoughts". It says in part:

 

 

Intrusive thoughts are unwelcome involuntary thoughts, images, or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to manage or eliminate.[1] When they are associated with obsessive-compulsive disorder (OCD), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD,[2]posttraumatic stress disorder, other anxiety disorders, eating disorders, or psychosis.[3] Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and they can be divided into three categories: "inappropriate aggressive thoughts, inappropriate sexual thoughts, or blasphemous religious thoughts".[4]

 

It's unfortunate the article doesn't go beyond simply mentioning that intrusive memories "may also be associated with" psychosis. And the article also didn't mention anything about feeling compelled to "act out" fantasy. It spends a lot of time talking about OCD, and I can see that some of the compulsions I've had (all the time when I was a child and teen, but less and less as I get older) could have an OCD "flavor" to them. But reading more about OCD makes it seem unlikely that I have actual, full-on OCD because it doesn't involve the delusions, acting out, etc. (though it's also possible I'm not understanding the full breadth of OCD, of course, since I'm just a casual reader and not a professional). For example, I don't have "rituals" that help make the intrusive thoughts better or less overwhelming. The only "fix" for me is to simply and repeatedly break myself from the fantasy and not allow myself to go back there until it fades away (until the next time).

 

One thing I do have - and which the article only mentions briefly - is what was very severe PTSD from the time I was a small child. Even as a 6 or 7 year old, I had extreme depersonalization, derealization, fugue states, etc., and I still can have them as an adult if I'm triggered. However, my "intrusive thoughts" are not obviously related to my triggers or past abuse events, for example.

 

So I've learned something - but not what I was actually needing to know.

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Have you ever been talking to someone and imagined the horrible act of beating the living crap out of them, or kissing them (opposite sex or same sex), or randomly stepping in front of a buss for no reason? Or anything like that that is generally unaccepted? Those are intrusive thoughts. They are thoughts that pop into your head out of the blue and generally scare the person having them. In OCD this becomes extreme and the only way to ward off the thoughts is by doing things (rituals) so they don't happen (even though you know they probably won't happen anyway).

That's the gist of it. I don't have diagnosable OCD, but I do have the basic components like these thoughts. I remember when I would have these thoughts at work about me bashing sweet old customers with store signs...kinda freaked me out. I would never do that but the thought wouldn't leave my mind and until I realized it was a symptom of OCD, I was horrified.

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Yes, I've had stuff like that. Worse when I was younger. But I never felt I had to do some ritual to make the thoughts stop or to save myself or someone else from them. I just held on until it went away, or I left the scene, or I just lost it.

Those times felt totally different than the fantasy that turns into delusion, though. So does that mean the fantasy --> delusion is not intrusive thoughts, even though I / we feel compelled beyond our control to act them out?

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I can relate to what apokalypz describes.  I think that the intrusive thoughts are different from delusions.  Idk how to describe what I am thinking though, but did google things and came up with this:

 

According to Wikipedia, a delusion is:

 

 

A delusion is a belief held with strong conviction despite superior evidence to the contrary.[1] As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, or other effects of perception.

 

http://en.wikipedia.org/wiki/Delusion

 

 

Intrusive thoughts are unwelcome involuntary thoughts, images, or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to manage or eliminate

 

http://en.wikipedia.org/wiki/Intrusive_thoughts

 

From the link above:

 

 

The intrusive thoughts that occur in a schizophrenic episode differ from the obsessional thoughts that occur with OCD or depression in that the intrusive thoughts of schizophrenics are false or delusional beliefs (i.e. held by the schizophrenic individual to be real and not doubted, as is typically the case with intrusive thoughts) .

 

I still don't quite understand the difference though, now that I read this.  I'm sorry ... I thought I could explain it more.

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Perhapse the problem is with our motivation. It's seen as a negative symptom, though that seems to only be half of the picture. I was thinking that our motivation system just rolls dice. So we are motivated to act out fantasy which turns I to obsession and finally delusion.

So we are motivated to do things that others are not motivated to do and we're not motivated to do the things that others are.

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What you describe in your first post sounds a lot like a delusion to me. When you start acting on it and acting as though it were real, I believe it starts to become a delusion. When you start isolating yourself, and become unsure as to whether it's real or not, I think it's a delusion. I think however that there is a difference between a full blown psychotic delusion and simply, "delusional thinking" or "delusion-like" thoughts. It sounds like quasi-psychosis to me. Like, it's on the borderline between psychosis and not psychosis. Sort of reminds me of the difference between frank psychosis and psychotic personality organization. 

 

I am not well read on this kind of stuff, but you've intrigued me!

 

It is possible however, to have a rich fantasy life. But the key to me if that you started isolating yourself and ignoring reality. 

 

Have you ever thought to ask a pdoc about this?

Edited by Parapluie
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I'm enjoying all your thoughts and discussion. Intriguing stuff. Parapluie, I've gotten different answers from different pdocs about this, when they've bothered to answer. Mostly once they knew I have hallucinations sometimes, they stopped caring to investigate more.

But I want to understand myself as much as possible, as that is how I've found more peace and even courage over time.

Interestingly enough, I had one of these try to start last night, so as I was putting on the brakes to keep it from advancing I "studied" it more. It really felt nothing like a daydream. Instead, it had a bad sense to it somehow. Like I could sense the difference between my "clear mind" and my "crazy mind", and at that moment it was like I was in the doorway between them, facing towards but not actually in "crazy".

It also felt like a temptation, like it was promising escape into something MUCH more exciting - and in this case.it felt like the temptation of mania, sort of. Though my acting out fantasies rarely comes with physical mania (my delusions can, though).

Sorry - don't know if any of this helped or not.

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I'm really interested that most people have said that it starts out like a fantasy because mine are usually different.  It starts out with a random thought that seems truer than true, and then as I think about it, more other things become skewed to fit around it.  It actually seems more real when it first begins, then I am sometimes able to consider the possibility that it's false.  I don't know, maybe it is kind of like the compulsive fantasy concept because it definitely becomes more fleshed out with time.

Edited by evilnessness
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