Shadow People.. What's the Deal?
Who are the shadow people & why are they visiting all of my adolescent pts
Psychosis… a condition characterized by a loss of contact with reality, often accompanied by hallucinations and delusions. Symptoms of psychosis can include hearing voices, seeing things that aren't there, having false beliefs, and disordered thinking. It is a symptom of several mental disorders, including schizophrenia, bipolar disorder, and severe depression.
With the definition of psychosis given it is obvious, yet still important to understand that psychosis is in and of itself a symptom, NOT a disease or specific condition. For the purpose of this post we will be talking more about hallucinations, & save the conversation related to delusions for another day.
Soooo. Hallucinations, they can be easily summarized as perceptual disturbances. Auditory hallucinations are by and large the most common form of hallucinations. Visual hallucinations often occur in the context of substance use (think methamphetamine intoxication or alcohol w/d). In fact, visual hallucinations in the traditional sense (ie excess dopamine in mesolimbic pathway) are unlikely to occur without some sort of recent substance abuse. We also know that early onset schizophrenia and similar disorders are very rare in children and adolescents.
Wait, what? Then how come all of these kids keep talking about shadow people..? One unfortunate common denominator in adolescent pts who describe seeing “shadow people” is this: a history of trauma. Typically, what we find when we dig in & ask for a better picture of what the patient is experiencing, they will describe seeing shadows & shadow people in their peripheral vision. Sometimes words fail to accurately describe what a person feels. This is one of those times. Adolescents who describe visualizing shadow people are typically experiencing an inappropriate activation of their fight or flight response. As a result, they experience anxiety, are a bit on edge & experience visual disturbances. In the general sense… this could be passed off as psychosis. However, the treatment algorithm calls for an entirely different response.
If you are reading this & thinking to yourself… “oh wait! is that why the zyprexa isn’t working for my patient?'“ Don’t worry, you’re not alone. This is a common mistake. Instead of jumping to a potent second generation antipsychotic consider utilizing propranolol, which works to reduce the overactivation of the fight or flight response and as a result will decrease the incidence that your patient visualizes the “shadow people.”
Food for thought, obviously some children and adolescents may be the exception to the rule and will truly benefit from the utilization of antipsychotic medication. But, common things are common and epidemiology rates tell us that organic psychosis is extremely rare in children. Trauma, unfortunately.. is not :(