It can be both. Sometimes they can just come out of nowhere, sometimes they are triggered by something. Triggers for a psychotic episode differ from person to person, and they also differ from episode to episode.
Here are some common triggers for a psychotic episode:
- Changes in the environment (breakups, going back to school, changing jobs, having a fight with someone, moving, etc)
- Changes in the season
- Changes to the therapeutic regimen
- Medications no longer working
- Changes in hormones (people who menstruate note that their psychosis often coordinates with their menstrual cycle, for example, and people who are pregnant or have just given birth are often at risk for having a psychotic episode - bipolar individuals are especially susceptible to post-partum psychosis. This doesn’t mean that the hormone cycles of AMAB people can’t contribute just as much to psychotic episodes, just that more is known and reported on about AFAB peoples’ hormone cycle, for whatever reason, likely because more is known in general about the hormone cycles of AFAB people.)
- A “bad anniversary” coming up for someone who has prior abuse
- Going on vacation or a similar break in routine
- Accomplishing something that was very looked forward to (even positive things can cause psychotic episodes, unfortunately)
- Long episodes of bad weather or even long episodes of good weather (some people with psychosis are very sensitive to sunlight - I’m one of them, and if there are many days with strong sunlight, I’m more likely to have a psychotic episode. Similarly, I’m also sensitive to winter. I have many of my psychotic episodes during summer and winter because of the extreme weather, and I know others who are the same.)
There are plenty of other triggers - these are just ones that I know, but the list of triggers is as unique as the person with psychosis and there might be ones that I haven’t even thought of. Some people may have a psychotic episode triggered by a certain sound, a certain texture, a certain memory. It doesn’t take much to push someone over the edge, especially if they aren’t medicated, aren’t medicated enough, are in transition with their medications, or are having trouble with their medications.
The other thing is that sometimes you don’t realize what triggered a psychotic episode until long after the episode had ended. It took my family months to figure out all the different triggers for my long psychotic episode last year, because it was such a massive one and there were so many different ones combined that it genuinely took several people the good part of a year to tease apart all the different strands to see all the different factors that went into it.
You can’t always see them coming, unfortunately, or you’d be able to prevent every single one, and life doesn’t always work like that, which is a damn shame, because psychotic episodes are scary as hell for everyone involved, not the least the person experiencing them. (Trust me - if you’re scared by witnessing them, the person going through it is scared times a million.)
So while knowing a person with psychosis’s triggers is very helpful, it can’t always prevent a psychotic episode, because you can’t always prevent those things from occurring. We can’t prevent bad weather, we can’t prevent stress, we can’t prevent life changes, and so on. And sometimes a cloudy day may make me have a psychotic episode (I have some cloud-related delusions), and sometimes it won’t. Sometimes stress will make me hallucinate, sometimes it won’t. It’s so very complicated. Which is why psychosis is such a challenging disorder to treat, and such a challenging disorder to have.
I hope that answered your question, at least in part. I’m always willing to answer questions about psychosis, because people need to know more about this disorder. There’s so much bullshit and misinformation about there, and as someone with psychosis, who’s pretty stable, and who is capable of dispelling that bullshit, I want to do as much as I can to get good, reliable information out there. Always feel free to ask me any questions you may have about it and I’ll do my best to answer.
just a note that antipsychotic medications often make you more susceptible to heat, which is probably why it’s so common to be adverse to sunlight.
also i usually get psychotic when i am tired. it’s different for everyone.