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Understanding and Treating Early Psychosis in Young Adults

Est. reading time: 6 mins
Posted Under: For Families, Interviews

Clinically Reviewed by: Amanda Fialk, PhD, LCSW, LICSW


Early psychosis and first-episode psychotic events can be frightening, confusing, and stressful — for the person experiencing it as well as their family members and loved ones. An episode can occur out of nowhere and to seemingly healthy individuals living normal lives.

In today’s blog post, Amanda Fialk, PhD, LCSW, LICSW, Partner and Chief Clinical Officer at The Dorm shares some essential information on treating young adults with psychosis and psychotic disorders, including how it manifests as a trauma to a young adult and their community. Fortunately, The Dorm helps treat psychotic disorders through a holistic and integrative care process and as part of our community, we see impressive outcome results. 

What is a psychotic break?

Studies predict that between 15 and 100 people out of 100,000 develop psychosis each year. A psychotic break refers to an episode of psychosis and typically the first onset of psychotic symptoms for an individual. These symptoms may include delusional thoughts and beliefs, auditory and visual hallucinations, disorganized speech and paranoia, and difficulties recognizing reality. A psychotic break may impact individuals who, prior to the first episode, were living productive and fulfilling lives. In this way, first-episode psychosis can be viewed as a trauma, not only for the individual experiencing the symptoms but for the entire family system.

During early psychosis, it is vital to connect with the right treatment quickly. Doing so can be life-changing and radically alter a person’s prognosis. While it can be difficult to tell the difference between the early warning signs of psychosis and typical teen or young adult problematic behavior, getting a professional assessment is key.

When do psychotic breaks first present?

For many individuals (both men and women), the late teens and early 20s is when psychosis first presents. While it can start at any age, young adults are at an increased risk due to continuing brain development and pubescent hormonal changes. 

It was once thought that the brain didn’t change much after early childhood, but findings now indicate that the brain continues to undergo profound changes into the early 20s. This malleability means that being exposed to different influences in your social environment through your teenage years can have a notable impact on the way that your brain develops. Research also indicates that shifting hormones may play a role, especially in symptom progression for adolescents who are already experiencing adjustment problems.

What are the warning signs of a first psychotic break?

Withdrawal is usually the first sign of psychosis. A teenager or young adult, often someone who has had no prior emotional or behavioral issues, will begin to be less interested with what’s going on around them. Rather than focusing on friends, family, school, work, and other activities, they become preoccupied with what’s going on internally, increasingly fixated on disturbing ideas that are gaining momentum.

Other warning signs include:

  • Hearing, seeing, tasting, or believing things that others don’t 
  • Suspiciousness or extreme uneasiness with others
  • Delusions, hallucinations, and/or intellectual impairment
  • Strong and inappropriate emotions or no emotions at all
  • Withdrawal from family or friends
  • A sudden decline in self-care
  • Trouble thinking clearly or concentrating
  • Heightened agitation or anxiety
  • Hypochondria
  • Insomnia
  • Physical immobility

Can a psychotic break lead to schizoaffective disorder or schizophrenia? 

To start, it’s important to understand that both schizoaffective disorder and schizophrenia are classified as psychotic disorders according to the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Therefore, a first psychotic break can mark the onset of either diagnosis. 

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Note that schizoaffective disorders and schizophrenia are different disorders with their own diagnostic criteria and treatment. For instance, a person with schizoaffective disorder will exhibit the same symptoms as schizophrenia (i.e. delusions and hallucinations), but they will also exhibit symptoms of mania (bipolar type schizoaffective disorder) or depression (depressive type schizoaffective disorder) in order for it to be classified as schizoaffective.

Many people also wonder how a psychotic disorder is different from a nervous breakdown. A nervous breakdown (also called a mental breakdown) refers to a perceived crisis in someone’s mental or emotional health. It is not a diagnosis but rather a signal that someone is overwhelmed with stress and pressure, limiting their ability to effectively utilize coping skills. Nervous or mental breakdowns typically build over time. Healing, then, is gradual and requires professional help. While a nervous or mental breakdown does not exclude the possibility of psychosis, a psychotic break refers specifically to an episode of psychosis.

What are the risk factors for psychosis?

Although we are still learning about how and why psychosis develops, it is thought to be triggered by a mix of genetics (indicated by family history) and life stressors during critical stages of brain development, including through adolescence and the early 20s. The most common cause of psychosis, however, is a psychiatric disorder: schizophrenia or, less often, bipolar disorder or severe depression. Psychosis can recur episodically with these illnesses.

Risk factors that may contribute to the development of psychosis include stressors such as physical illness, substance use (specifically marijuana, hallucinogens, and stimulants) as well as psychological or physical trauma.

If psychosis is related to schizophrenia and/or bipolar disorder, these conditions have a much higher rate of inheritance. If someone has a first-degree relative (like a parent or sibling) with one of those disorders, they are at a much greater risk of developing it themselves.

If you or your loved one are experiencing early psychosis, it’s imperative to act quickly and connect the struggling individual with the right treatment. In fact, evidence shows that treatment after the initial episode can dramatically reduce the number and intensity of future recurrences by as much as 50 percent and prevent much of the disability associated with a psychotic illness.

The Dorm follows a holistic and integrative care process when treating young adults with psychotic disorders and early psychosis

The most successful treatment plans respect the complexity of symptoms that come with psychosis and our third-party validated research outcomes demonstrate that this approach is effective. We see the greatest mental health outcomes when there is an intensive evaluation period and when treatment plans are comprehensively customized to the individual.

Our Research Outcomes Related to Psychosis & Cognition

At The Dorm, our approach to treating young adults diagnosed with psychotic disorders includes:


At both the individual and group level, education serves to support, validate, and empower our clients.


People struggling with psychotic symptoms often feel isolated and marginalized. They can disengage socially and stop participating in meaningful life and leisure activities. While we recognize the healing power of being part of a supportive community, we are also empathetic to the challenges of doing so for someone with a psychotic disorder. We help our young adult clients develop social skills (individually and in a group setting) and re-enter community socialization through groups at The Dorm Clubhouse.

Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT)

We offer individual and group CBT and DBT to help individuals who are diagnosed with psychotic disorders modify negative thoughts, behaviors, and emotional responses associated with psychological distress and symptoms of their illness. Clients learn to communicate through words instead of behavior, develop emotional regulation skills enabling them to tolerate previously overwhelming feelings, learn adaptive functioning, and develop an enhanced understanding of themselves and their motivations.

Family Therapy/Parent Therapy

Familial-based psychological counseling helps family members process the emotional impact of having a loved one diagnosed with a psychotic disorder. In family therapy/parent therapy, clients discuss the benefits and risks of medication as well as possible symptoms and the meaning of those symptoms. We also explore how to communicate and lay firm but loving boundaries with a family member diagnosed with a psychotic disorder.

Life Skills Therapy

Individuals who are diagnosed with psychotic disorders may struggle to maintain basic activities of daily living.  For example, cooking, cleaning, sleep/wake cycles, medication compliance, personal hygiene, and budgeting are often compromised. Our therapists provide comprehensive individual and group-based life skills therapy and training, both in the home and at the Clubhouse.

Holistic Services

At The Dorm, we believe in harnessing the power of alternative and holistic approaches during the treatment of psychotic disorders. Yoga, meditation, mindfulness, and other forms of exercise are offered at both the individual and group level to help with symptom management, stress relief, and individual confidence.


Medication plays a key role in the treatment of psychotic disorders, which is why we offer to consult psychiatric services to our clients if it’s required. Consulting psychiatrists respond to a patient’s preferences and concerns and educate patients about the benefits and risks of medications. We also work closely with outside treating psychiatrists to help ensure medication is being utilized effectively and optimally.

“The Dorm helped me not only to find myself again, but also to discover a whole new world of hope and possibilities. I will be forever grateful for its collective love, support, and guidance.”

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