You’ve probably heard the word before, but maybe only in passing - in a movie, on the news, or used as a punchline or a warning. “Psychosis” tends to conjure images that are dramatic and extreme. But when it starts to touch your life, those images don’t match what you’re actually seeing.
What you’re noticing might be small; a shift in your child’s thinking, a change in how they interact. Something feels off, but it doesn’t feel like a crisis, at least not yet. That’s often how psychosis begins.
So what is it, really? Not a diagnosis, a label, or a permanent identity. Just a signal that something in the brain isn’t processing reality the way it usually does.
Psychosis is a symptom, not a sentence
There’s a reason the word psychosis brings up fear. In pop culture, it’s used interchangeably with “crazy,” or worse. We imagine people who are out of control, dangerous, or broken beyond repair. But in clinical reality, psychosis isn’t any of those things.
The truth is, the lifetime prevalence of psychosis (of all types) is more common than people realize, with large population-based studies reporting rates near 3% when all psychotic disorders are included. And when it starts in adolescence or early adulthood, the outcomes depend heavily on how early it’s recognized and treated.
Psychosis is a symptom. It’s the brain’s way of signaling that something is off in how it’s interpreting the world. And just like a fever can be part of many different illnesses, psychosis can appear in a range of mental health conditions, like schizophrenia, schizoaffective disorder, bipolar disorder, major depression, and even in medical conditions like Alzheimer’s.
That doesn’t mean your teen has one of those diagnoses. It means they’re having experiences, like hallucinations, unusual thoughts, or disorganized thinking, that suggest something in the brain is misfiring. These experiences are real to them, even if they don’t align with objective reality.
What’s going on in the brain?
Think of the brain as a network of neighborhoods. Each one has its own job: hearing, vision, memory, emotional regulation, social awareness, and more. And all of these regions are constantly in conversation with one another. In a healthy brain, those signals are coordinated and balanced. In psychosis, that communication gets scrambled.
One part of the brain might send out a signal that another part misinterprets. The system is still online, but it’s glitching. That’s why someone in the early stages of psychosis might hear a voice that isn’t there, or become convinced that a friend is secretly watching them, or start speaking in a way that feels disjointed or confusing.
These aren’t behaviors someone can “snap out of.” They’re the result of real neurological disruption.
What parents might notice
Psychosis doesn’t usually begin with a dramatic break; more often, it creeps in slowly. You might notice your teen withdrawing from friends, seeming emotionally flat, or acting out in ways that don’t quite fit the situation. Their thinking might start to seem off, or they might talk about things that don’t make much sense.
Here are six early signs that could suggest the start of psychosis:
- Hearing or seeing things others don’t
- Believing things that seem out of step with reality
- Becoming unusually suspicious or paranoid
- Speaking in a way that feels disorganized, hard to follow, or a reduction in content and output
- Pulling away from people or activities they used to enjoy
- Neglecting basic needs like hygiene, sleep, or eating
You don’t need to see all of these signs, and you don’t need to panic if you do. But if something feels off, especially if it’s new or getting worse, it’s worth paying attention.
Why psychosis can be hard to detect
One of the cruelest parts of early psychosis is that it doesn’t always look alarming, at least not at first. Your teen might still be going to school, showing up at dinner, having mostly normal conversations. But in the background, they might be struggling with thoughts or perceptions that feel scary or confusing.
And often, they won’t tell you. Not because they’re hiding it, but because they may not fully realize that something is wrong. This lack of insight is common, and it’s part of why so many families don’t realize what’s happening until the situation becomes more severe.
Think of it like this: If your child said they saw a monster in their room, you might assume it was a dream or an overactive imagination. You wouldn’t jump to conclusions. But if those types of comments keep happening - if the “monster” becomes a theme, or your teen starts acting as though they live in a different reality - it’s time to look deeper.
How do you know when to consider assessment and treatment for psychosis?
There’s no single test, no bright line that tells us for sure. But mental health professionals look at a few key things:
- Is this experience causing distress or dysfunction?
- Is it persistent or getting worse over time?
- Is it interfering with daily life, relationships, or self-care?
If the answer is yes, it’s time to seek support. Not because your child is broken, but because they can be helped and the symptoms can be better managed.
Psychosis can sound like a scary word, but early action can make all the difference. You don’t need to be sure, and you don’t need a diagnosis - you just need to be curious and open.
The sooner we intervene, the better the chances your teen has to recover, stay on track, and live a full and healthy life.
If something about the behavior of your teen or young adult child has you concerned, even if you’re not sure what it means, you don’t have to figure it out alone. Reach out to California OnTrack at Pand Health to connect with a clinician who understands early psychosis in teens and young adults. Whether you’re looking for answers, want to ask questions, or are ready to schedule a confidential evaluation, we’re here to help.
