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Psychotic symptoms and insight


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More specifically, delusions and hallucinations.

Can you have insight that a delusion can't be true?

Example: (I suppose I'm not sure if this would actually a delusion or not, but there you go.) I believe based on anecdotal evidence that if I'm hoping for something or desperately need something (like a new home) I won't be permitted to have it until I completely give up all hope and fall into despair. Recently, we have been searching for an apartment. With every application/search I would have hope. Then one house had bedrooms too small for our bed. I fell apart. Just complete despair. As soon as that happened I was rewarded by being approved for the next apartment we looked at. Now, from a logical standpoint, it's hard to believe that someone is in control of my life in that way. What makes me so special? However, I can't shake the feeling. After I applied, I hoped, and I would get so angry with myself for it because I knew that I would be punished for it. Even now that we got the apartment, I'm terrified at the excitement I feel because I'm sure I'll be punished for being happy. Again, logically this can't be true. If I know that it can't be true, even though I believe it, is it still a delusion (if it ever was to begin with)? 

Example 2: The other day, I saw things moving that couldn't move (words on a book and my leg hair stubble). Does the fact that I knew they couldn't be real mean that they weren't hallucinations?

On a related note, do delusions and hallucinations necessarily mean psychosis?

I know no one here is a medical professional. I'm just looking for others' experiences. 

I put this here because I have a bipolar spectrum diagnosis rather than a schizophrenia spectrum or other psychosis disorder. I hope that's okay.

ETA: My tdoc knows about example 2, and I am going to try to remember to tell him about example 1 tomorrow when I see him. I'm just afraid to ask him these questions because I might have to hear that I do have psychotic features, and that's been my biggest fear since diagnosis.

Edited by chantho
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I can't speak as a medical professional (tdoc or pdoc), but from what I know about psychology, I believe you have a cognitive bias with respect to example one. You're basically ascribing a random force to a string of events. Gamblers are known to have this fallacy with respect to a string of wins. They call it the "hot hands" bias. They believe that when they're on a streak of wins, the streak will continue. However, each bet they make is an independent event. Going back to your apartment search, each apartment you look at is an independent event. It's just random chance.

Humans have evolved to use heuristics, or mental short cuts, to help them deal with all the information they are bombarded with on a daily basis. Sometimes that process goes haywire. Having a MI on top of all this creates distorted thinking and compounds the problem.

The second example seems more like a hallucination. I would definitely talk to your tdoc about that. I don't think it matters if you believe they're real or not.

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this might not be helpful in the context of a mood disorder, but your question (re: example 1) reminds me of my experience with OCD. with OCD you can have anywhere from super clear insight (i.e. I know the house won't burn down if I don't check the stove) to absent insight (i.e. I am certain the house will burn down). my insight waxes and wanes, but when it's closer to the "absent" end of the spectrum I have believed, for example, that since I was careless with turning off my phone it has sent naked pictures of me (that I have not taken) to everyone on my contact list. (now my insight is better, but I still won't go near my phone without being fully clothed.) I know this is kind of a wild example, but for me it's a lot like knowing something cannot possibly be true but believing it anyway. during my mood episodes all of this intensifies and it becomes quite difficult to parse out what is OCD and what is bipolar. 

anyway, sorry to hear you're struggling with these symptoms and I hope you manage to figure things out with your tdoc soon. 

Edited by aura
clarification
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The answer is yes. I do, very much so. Things can catch me by surprise of course, but for the most part I can eventually identify when my mind is skewed. The way I have done this is by accepting that when I'm ill, my mind can't be trusted. Not even a little. So, I turn to outside sources, closely observing people I know deeply and trust just as deeply (in non crazy times). Even if I don't feel like trusting them and am scared to do so, I force myself and I watch them reacting towards my actions and words. This is pivotal in identifying the real from the fake.

At these times I rely heavily on my husband to confirm what he is saying to me. If I hear something strange come out of his mouth, I tell him that. So, for instance, I once had a delusion that my husband was holding me prisoner. When i realised this was a delusion, based on his distressed behaviour and worried actions (why would a kidnapper be so worried?), I started to tell him exactly what I heard and thought. A lot didn't match up and it made him realise what was going on and it made me realise it too. It was particularly difficult and confusing for everyone as the hallucination words were intermixed with the real ones. So, after all that, if I told him I heard him saying if it seemed weird. He either said yes or no to confirm or deny it. This went on for quite some time, but I kept that forced trust regardless of my delusional mistrust and he became a lifeline of sorts.

It's truly and utterly miserable, though, to come to the realisation that I really am delusional and hallucinating. I can't make any of it stop once that magic switch of self awareness turns on. I find things easier in crazy denial land because I maybe terrified of the delusions themselves (believing in them) but at least I'm not also terrified of myself. Instead, I have to bear with all this until I'm stabilised again. I also never completely disbelieve things my psychosis feeds me even though I fight back with logic. That little nugget of doubt stays lodged until the very last, always nagging and questioning from the back of my mind. During psychosis, awareness is a lot like keeping your head above the ground in quicksand.

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I'm not a doctor, but I play one on TV...

#1 does sound a bit like a persecutory delusion, but only if you imagine there's a being that's doing the punishing or rewarding and only if have no rationale about it not being real. When I get paranoid delusions, they're always about people breaking into my home to get me. I get physically scared and will even do things like check closets and under the bed. It consumes me and the feelings are so intense that I cannot rationalize them away. sitting here now, well and medicated, it's almost comical to think about.

#2 one of the ways I can gauge if I'm not well is that I'll see "tricks of light". I wouldn't call them hallucinations, but it's almost like my brain misinterprets, just for a moment, what's there -- especially during movement. Technically they *are* hallucinations. You don't have to be delusional about a hallucination, but sometimes hallucinations and delusions coexist.

Please don't be afraid of a Dx of psychotic features. Because being diagnosed is the first step to getting well. And being diagnosed doesn't change you as a person, after all. Everyone, and I mean everyone, has some struggle in their life.....we're just lucky enough to be dealing with mental health disorders :)

Good luck.

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For your example 2, the movie "Beautiful Mind" comes to my mind. At the end of the movie, Russel Crow's character keeps seeing those imaginary people (the little girl, and his roommate), but he just ignores them as he had learned to do. But to the viewer, they were still hallucinations, even though he, at that moment, was strong enough to ignore them in his Schizophrenia.

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I'm not sure if you hare having delusions or not. But I can speak from my own experience that you can have a little insight and still be psychotic. My insight varies from time to time. Sometimes I can see past it and sometimes I can't. I have learned to put it aside if people tell me I'm being delusional or paranoid. Once and a great while I can do this. It isn't easy though. It consumes me and becomes all I can think about. Everything points to it being completely true. Tdoc helps me reality check and so does my husband. I really tend to fully believe paranoid events though. It's just the nature of the beast.

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I'm not sure if you hare having delusions or not. But I can speak from my own experience that you can have a little insight and still be psychotic. My insight varies from time to time. Sometimes I can see past it and sometimes I can't. I have learned to put it aside if people tell me I'm being delusional or paranoid. Once and a great while I can do this. It isn't easy though. It consumes me and becomes all I can think about. Everything points to it being completely true. Tdoc helps me reality check and so does my husband. I really tend to fully believe paranoid events though. It's just the nature of the beast.

Yes. I'm the same. It's amazing how much of the day can be consumed by paranoid delusions.

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You can have insight and still be hallucinating and delusional. For me, delusions are harder to shake, but I know they are delusions. But I had delusions about my hallucinations last time I had an episode, and I still knew they weren't real.

I don't like the sound of that punitive delusion.

Thanks for the explanation of a "hot hand" Sam78, I wasn't familiar with it.

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Thanks everyone. I did talk to my tdoc about it. He basically said a dumbed-down version of what Sam78 said (thank goodness because I'm dumb). He said that bipolar 2 can have psychotic features now according to the DSM-V. I didn't know that. So it sounds like I'm keeping my diagnosis, but adding a modifier of sorts.

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