Episode 364: PTSD with Psychosis & Body Dysmorphia Cured by Loss

Hello, friends! I hope you’re treating yourselves well. In this episode, I dive into two compelling listener questions that touch on complex emotional states and mental health diagnoses.

First up, we discuss what it means to be diagnosed with PTSD with “schizophrenic episodes.” If you’ve ever been confused by mental health jargon or diagnoses, this segment will provide some clarity. We’ll break down the DSM criteria for PTSD and explore the possibility of psychotic symptoms within the framework of trauma.

Our second question is a deeply emotional one. It’s about the sudden disappearance of body dysmorphia and low self-esteem following the death of an abusive parent. Can such a significant life event dramatically shift one’s self-image? We’ll delve into the complexities of grief, closure, and self-perception in this intriguing discussion.

As always, your engagement keeps this show going. Send your questions to duffthepsych@gmail.com for a chance to be featured in future episodes. For full show notes, head to duffthepsych.com/episode364.

Question 1:

I’ve been in therapy for a little while now and I was recently diagnosed with ptsd with schizophrenic episodes. My therapist didn’t go into detail of what that means. If u could help me understand I would really appreciate it. My therapist said that it developed over time from not dealing with my childhood trauma. If u could do an episode on understanding this so I can take the proper steps to get the help I need thank u. Also I love your episodes on understanding different mental health problems it has really helped me with my mental health and how to talk to my therapist.


Thank you for writing in and taking the initiative to get help for your deep-seated issues. Your question about being diagnosed with PTSD with “schizophrenic episodes” is a compelling one that warrants a detailed response. One thing I’d like to clarify right off the bat is that it’s okay to ask your therapist for more explanation. Often, professionals can forget that the terms and acronyms we throw around aren’t common knowledge. That’s part of the reason why I started the Hardcore Self Help series.

Understanding your diagnosis is critical, and you shouldn’t hesitate to seek clarification. I usually ask my clients what their understanding of a diagnosis is and, if needed, go through the criteria with them to make sure we’re on the same page. For your situation, let’s first dive into what PTSD, or Posttraumatic Stress Disorder, actually means according to the DSM criteria. PTSD encompasses a range of symptoms from intrusive memories and avoidance to altered mood and reactivity.

The term “schizophrenic episodes” isn’t technically accurate. What your therapist might be referring to are symptoms of psychosis, a break from reality that can manifest as delusions or hallucinations. However, experiencing temporary psychosis is different from having schizophrenia, which is a specific type of psychotic disorder. If your therapist is indicating that you have PTSD with psychotic symptoms, it adds a layer of complexity to your diagnosis. The symptoms of PTSD and psychosis can sometimes overlap, making it challenging to differentiate between the two. For example, vivid flashbacks in PTSD can feel a lot like hallucinations.

This brings us to another point you mentioned: your therapist said your condition developed from unresolved childhood trauma. Trauma can build up over time, especially if you’ve been avoiding dealing with it. This avoidance can lead to additional traumatizing experiences and may be affecting your current mental state. However, trauma reactions are not one-size-fits-all. Some people manage to cope without extreme symptoms or psychosis.

It’s also worth mentioning Complex PTSD (CPTSD), a term used to describe traumatic reactions usually stemming from prolonged, repeated trauma. While not yet recognized in the DSM, it’s acknowledged by many professionals and could be relevant to your situation. People with CPTSD often struggle with emotional regulation and relationships, mainly because the prolonged trauma affects their world view and integrates into their personality.

In summary, you have every right to ask your therapist for more details. Mental health is complex, and not all therapists are equally equipped to handle every condition. If you find that your current therapist isn’t meeting your needs, particularly when it comes to understanding and treating complex or severe symptoms, you might consider seeking one who specializes in trauma.

Question 2:

Hello & as always thank you for all that you do. I’ve been listening to your podcast for about 6 years now and I can honestly say it’s helped so much. I’ve also recommended it to people and even listened to the fuck anxiety audiobook with my 12 year old son & it helped him a lot.

My question today is this : can the passing of an abusive relative be enough to cure body dysmorphia and pathologically low self esteem? I have always had body dysmorphia. It is extreme to the point where when I looked in the mirror I would see this wrinkled obese troll looking person. It has been this way since I was a little girl but it got significantly worse in adulthood. For reference, I am 32. About 6 weeks ago, my father passed away. He was an addict and rejected me in my adult life for the past 15 years or so. When i was young he would go back and forth between being a decent father and being abusive. I am conflicted because ever since his funeral, it’s like my body dysmorphia is gone completely. I don’t understand it, and if you told me that someone waved a magic wand in front of me while I was sleeping I would believe it. My fundamental understanding used to be that I was a disgusting creature who was unintelligent and a bad person. Now I feel so confident. When I catch my reflection in the mirror, I double check because I feel like I’m seeing someone else- somebody very attractive and accomplished and worthy of life. I like to write and when I read something I’ve written I feel proud of it and want to show it off. How has my self image changed so much just from the loss of someone I’ve been estranged from for 15 years? Any advice or thoughts are appreciated!


First and foremost, I’m truly honored that you’ve been a longtime listener and even shared one of my books with your son. Hearing that my work has had a positive impact on your life is incredibly rewarding. Your question about the sudden disappearance of your body dysmorphia symptoms after the passing of your father is both interesting and complex. I’m thrilled to hear that you’re feeling more confident and happier with yourself, and you definitely deserve to feel this way.

Body dysmorphia isn’t merely dissatisfaction with one’s appearance; it’s an intense, distressing preoccupation with perceived flaws that often aren’t noticeable to others. From what you’ve described, you’ve battled with this for a substantial part of your life, and I’m genuinely sorry that you’ve had to endure it. The fluctuating relationship you had with your father—a relationship that oscillated between support and abuse—likely contributed to your low self-esteem and distrust in yourself and others. Such an unstable emotional foundation can indeed lead to severe psychological issues.

The concept of grief is complicated. While you might be experiencing a form of grief for your father, it’s more likely that you’re feeling closure for the version of yourself that wasn’t allowed to flourish. The absence of your father might have lifted a longstanding emotional burden that has allowed you to see yourself more clearly. While grief and self-image are fluid and subject to change, the way you’re feeling now serves as evidence that you’re capable of positive self-regard. Even if you find yourself in a less positive state in the future, remember that you’ve felt worthy before and can feel that way again.

I understand that being relieved or even “happy” about the death of a family member can be unsettling. I felt a similar sense of relief when my grandmother passed away, so I can relate to those complex emotions. Now might be an excellent time for you to document your feelings. Consider writing down or recording your thoughts to capture this newfound self-esteem and confidence. These could serve as helpful reminders in the future.

Given the complexity of your feelings, this might also be a prime time to seek therapy. You’ll be entering the therapeutic relationship not in crisis but with a sense of curiosity and a desire for deeper understanding. It’s a unique opportunity to capitalize on your current emotional state, explore it further, and perhaps even solidify these positive feelings for the long term.

In conclusion, thank you for sharing your question. I’m delighted that you’re seeing yourself in a new light, and I hope this state of clarity and self-acceptance continues for you.

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