10 Signs Someone You Love May Be Losing Touch With Reality

When people think of psychosis, they often imagine someone in a full-blown state of delusion—hearing voices, seeing things that aren’t there, or believing the government is tracking their every move.

These extreme examples dominate popular culture, but psychosis isn’t always so dramatic. Indeed, it often starts in ways that are elusive and easy to overlook, especially in people you see regularly.

Below are 10 subtle signs that someone may be drifting from reality. It’s important to note that while no single symptom confirms psychosis, a combination of these could be a cause for concern.

1. Persistent Negative Thoughts

A consistently negative outlook might just be pessimism, which is not a psychological disorder. But if your loved one is persistently down on themselves, the world, or the future, and these thoughts seem detached from reality, it could be more than just pessimism.

Persistent negative thoughts that seem "out of character" could and often do signal depression. But in rarer cases, it may also be an early sign of psychosis, especially when it’s accompanied by irrational or delusional thinking. Delusional thinking involves a mental disconnect from the reality most people share, which can cause confusion over what is real and skepticism about other people's intentions.

2. Overwhelming Fear

While everyone experiences anxiety from time to time, if your loved one suffers from chronic and intense anxiety—particularly when unfounded—that could signal a psychological disorder. While it's most likely an anxiety disorder, it could also be an early sign of psychosis.

In both anxiety and psychotic disorders, the anxiety might manifest as persistent worry about things that others find trivial or extreme nervousness in social settings and social withdrawal. Fear that others are judging or plotting against them is a more reliable sign of a psychotic disorder than an anxiety disorder.

3. Obsessive Health Concerns

Excessive worry about physical health, particularly bodily health, can in some cases be an indicator of mild psychosis.

Mental health professionals classify hypochondria—the belief that one is suffering from severe illness despite medical reassurance—as an anxiety disorder primarily involving worry and rumination.

But in rare cases, a preoccupation with health can reflect a distorted perception of reality. An example of this is somatic type delusional disorder, a mental illness that involves a false belief about bodily functions, such as a bad mouth odor or a parasitic infection.

Another example of a somatic delusion is body dysmorphia, a condition where a person is preoccupied with flaws in their appearance that are unnoticeable by others.

People with somatic delusional disorder do not typically present with other psychotic symptoms such as paranoia or incoherent thoughts or speech.

4. Sudden Mood Swings

Unpredictable mood swings, particularly those that seem disproportionate to the situation, are most likely a sign of a hormonal imbalance, due to puberty, menopause, or a medical condition like a thyroid disorder or premenstrual syndrome.

But if other explanations have been ruled out, extreme mood swings could indicate the onset of a psychotic episode.

For example, if your loved one shifts from calm to enraged with little provocation or becomes inexplicably euphoric, this might be an early sign of bipolar disorder, a condition that causes unusual shifts in a person’s mood, energy levels, and focus.

Bipolar type I—one of three types—is defined by a pattern of depressive episodes and manic episodes. While bipolar mania often involves a euphoric, high-energy state, it can also present with psychotic symptoms, such as grandiose ideas or erratic thoughts and behavior.

5. Restless Energy

Restlessness, often manifesting as an inability to sit still or rapid, pressured speech, can indicate bipolar mania, which is most common in bipolar I.

While bipolar mania can present in a variety of ways, it is often coupled with a feeling of being jumpy or wired and having excessive energy.

This heightened energy might initially seem like enthusiasm, but when paired with racing thoughts or impulsive actions, it could signal something more concerning.

The person may take on too many projects or engage in risky behaviors without considering the consequences.

6. Disrupted Sleep Patterns

Frequent disturbances in sleep—such as insomnia, waking up frequently during the night, or sleeping too much—can be more than just a minor inconvenience or due to a natural transition like menopause.

Persistent sleep disruptions often indicate an underlying health problem, including psychological issues. While not a reliable sign of a psychotic disorder on its own, it can be an indication in combination with several other symptoms.

It should be noted that when our sleep patterns deteriorate due to persistent sleep disruptions, this can cause irritability, disorientation, and distorted perception and cognition, which could erroneously be mistaken for a psychotic disorder.

7. Subtle Paranoia

Paranoia doesn’t always manifest as extreme distrust of everyone around you. It can begin with subtle suspicions—perhaps you believe that others are talking behind your back or that your neighbors are spying on you.

Even if these thoughts aren’t entirely outlandish, when they persist without evidence, they may point to deeper issues of a psychotic nature.

If mild paranoia intensifies, it can lead to more serious delusional beliefs and detachment from reality.

8. Inconsistent Trust Levels

Inconsistent levels of trust in different people commonly reflect a history of abuse or past relationship problems.

But in some cases, inconsistent trust can be a sign of a psychotic disorder, especially when grounded in unfounded suspicion or their levels of trust seem misplaced.

For example, your loved one might become overly suspicious of you or their close friends or family while placing undue trust in strangers or casual acquaintances.

This inconsistency of trust can be disorienting for people around them and lead to them becoming isolated as they push away those who genuinely care for them.

9. Rigid Routines

A strong need for order and predictability can sometimes mask deeper psychological issues. If your loved one rigidly adheres to routines, avoids new experiences, and becomes anxious at the thought of change, they might be displaying early signs of psychosis.

This need for control often stems from an underlying fear of losing touch with reality, leading to an overly simplistic or repetitive lifestyle.

10. Emotional Detachment

A noticeable decline in emotional responsiveness, often referred to as a "flat affect," can be a subtle but significant sign of psychosis.

For instance, your loved one might seem indifferent to events that would normally elicit a strong emotional response, or they may be unreceptive to how others feel.

This lack of empathy can strain relationships and further isolate them from their support network.

Recognizing the Signs

Psychosis can run in families, and those with a family history of the condition are at a higher risk of developing it themselves. However, psychosis doesn’t always follow a predictable path, and the symptoms can vary widely from person to person.

If someone you love is showing multiple signs of mild psychosis, it may be time to seek professional help.

Early intervention can make a significant difference, potentially preventing the progression of symptoms and helping your loved one maintain a higher quality of life.