Complex Trauma, Psychosis and COVID-19: A Case Report

Main Article Content

Marlon Edu Saavedra-Delgado Francisco Valdés la Vallina-Alvarado Katherine Mawcinitt-Backmann Christian Gabriel Toledo-Lozano


Background: Complex trauma is a variant of post-traumatic stress disorder (PTSD), adding symptoms of affect dysregulation, difficulty in relationships, and negative self-perception. Its neurobiology is closely linked to the pro-inflammatory alterations by the disruption of the hypothalamic-pituitary-adrenal axis, which are also described in psychosis, and neuropsychiatric symptoms of the SARS-CoV-2 virus infection.  

Aim: To present a case that illustrates the clinical and neurobiological overlap between COVID-19, psychosis, and complex trauma.

Case presentation: A 24-year-old female who initially presented dissociative symptoms evolving into a psychotic episode, after suffering from COVID-19 disease, in whom a history of abuse was later clarified. The clinical case is reviewed, performing a free search of articles for the discussion of clinical and pathophysiological challenges.

Conclusion: Trauma is one of the greatest determinants in mental health, and is associated with several clinical spectra, being necessary to open the phenomenological and physiological debate to understand the sum of effects in patients who present with severe mental illness.

Keywords: post-traumatic stress disorder (PTSD), complex trauma, psychosis, psychotic disorder, SARS-CoV-2, COVID-19

Article Details

How to Cite
SAAVEDRA-DELGADO, Marlon Edu et al. Complex Trauma, Psychosis and COVID-19: A Case Report. Medical Research Archives, [S.l.], v. 11, n. 1, jan. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 22 apr. 2024. doi:
Case Reports


1. WHO. ICD-11 Reference Guide. World Health Organization. Published 2020. Accessed November 10, 2022.
2. Bryant RA. The Current Evidence for Acute Stress Disorder. Curr Psychiatry Rep. 2018;20(12). doi:10.1007/S11920-018-0976-X
3. Briere J, Scott C. Complex Trauma in Adolescents and Adults: Effects and Treatment. Psychiatr Clin North Am. 2015;38(3):515-527. doi:10.1016/J.PSC.2015.05.004
4. Courtois CA. Complex trauma, complex reactions: Assessment and treatment. Psychotherapy. 2004;41(4):412-425. doi:10.1037/0033-3204.41.4.412
5. Cloitre M. ICD-11 complex post-traumatic stress disorder: simplifying diagnosis in trauma populations. Br J Psychiatry. 2020;216(3):129-131. doi:10.1192/BJP.2020.43
6. The American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. American Psychiatric Association; 2013. doi:10.1176/APPI.BOOKS.9780890425596
7. Newman E, Riggs DS, Roth S. Thematic resolution, PTSD, and complex PTSD: the relationship between meaning and trauma-related diagnoses. J Trauma Stress. 1997;10(2):197-213. doi:10.1023/A:1024873911644
8. Alessi EJ, Hutchison C, Kahn S. Understanding COVID-19 through a Complex Trauma Lens: Implications for Effective Psychosocial Responses. Soc Work. 2021;67(1):79-87. doi:10.1093/SW/SWAB045
9. Cénat JM, Dalexis RD. The Complex Trauma Spectrum During the COVID-19 Pandemic: A Threat for Children and Adolescents’ Physical and Mental Health. Psychiatry Res. 2020;293. doi:10.1016/J.PSYCHRES.2020.113473
10. Javakhishvili JD, Ardino V, Bragesjö M, Kazlauskas E, Olff M, Schäfer I. Trauma-informed responses in addressing public mental health consequences of the COVID-19 pandemic: position paper of the European Society for Traumatic Stress Studies (ESTSS). 2020;11(1):1780782. doi:10.1080/20008198.2020.1780782
11. de Sousa Moreira JL, Barbosa SMB, Vieira JG, et al. The psychiatric and neuropsychiatric repercussions associated with severe infections of COVID-19 and other coronaviruses. Prog Neuropsychopharmacol Biol Psychiatry. 2021;106. doi:10.1016/J.PNPBP.2020.110159
12. Pallanti S, Grassi E, Makris N, Gasic GP, Hollander E. Neurocovid-19: A clinical neuroscience-based approach to reduce SARS-CoV-2 related mental health sequelae. J Psychiatr Res. 2020;130:215-217. doi:10.1016/J.JPSYCHIRES.2020.08.008
13. Sinanovi O, Mufti M, Sinanovi S. COVID-19 Pandemia: Neuropsychiatric Comorbidity and Consequences. Psychiatr Danub. 2020;32(2):236-244. doi:10.24869/PSYD.2020.236
14. Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. 2020;12(1). doi:10.1186/S13195-020-00640-3
15. Clouden TA. Dissociative Amnesia and Dissociative Fugue in a 20-Year-Old Woman With Schizoaffective Disorder and Post-Traumatic Stress Disorder. Cureus. 2020;12(5). doi:10.7759/CUREUS.8289
16. Smith CM, Komisar JR, Mourad A, Kincaid BR. COVID-19-associated brief psychotic disorder. BMJ Case Rep. 2020;13(8). doi:10.1136/BCR-2020-236940
17. Varatharaj A, Thomas N, Ellul MA, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020;7(10):875-882. doi:10.1016/S2215-0366(20)30287-X
18. Poyraz BÇ, Poyraz CA, Olgun Y, et al. Psychiatric morbidity and protracted symptoms after COVID-19. Psychiatry Res. 2021;295. doi:10.1016/J.PSYCHRES.2020.113604
19. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th Ed. (DSM-5). American Psychiatric Publishing, Inc..; 2013. doi:10.1176/APPI.BOOKS.9780890425596
20. O’Donnell ML, Greene T. Understanding the mental health impacts of COVID-19 through a trauma lens. Eur J Psychotraumatol. 2021;12(1). doi:10.1080/20008198.2021.1982502
21. Cloitre M, Stolbach BC, Herman JL, et al. A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. J Trauma Stress. 2009;22(5):399-408. doi:10.1002/JTS.20444
22. Pérez-Balaguer A, Solari-Heresmann LM, Gil-Benito E, Sanz-Aranguez B, Gayubo-Moreo L. The impact of the COVID-19 pandemic on the development of acute and transient psychotic disorders. European Psychiatry. 2021;64(Suppl 1):S258. doi:10.1192/J.EURPSY.2021.693
23. Al-Busaidi S, Al Huseini S, Al-Shehhi R, Zishan AA, Moghadas M, Al-Adawi S. COVID-19 Induced New-onset Psychosis: A Case Report from Oman. Oman Med J. 2021;36(5). doi:10.5001/OMJ.2022.25
24. Lanier CG, Lewis SA, Patel PD, Ahmed AM, Lewis PO. An Unusual Case of COVID-19 Presenting as Acute Psychosis. J Pharm Pract. 2022;35(3):488-491. doi:10.1177/0897190020977721
25. Desai S, Sheikh B, Belzie L. New-Onset Psychosis Following COVID-19 Infection. Published online 2021. doi:10.7759/cureus.17904
26. Smith CM, Gilbert EB, Riordan PA, et al. COVID-19-associated psychosis: A systematic review of case reports. Gen Hosp Psychiatry. 2021;73:163-8343. doi:10.1016/j.genhosppsych.2021.10.003
27. Doufik J, Ouhmou M, Bouraoua I, Laaraj H, Mouhadi K, Rammouz I. Les accès psychotiques aigus liés à la pandémie COVID-19. Ann Med Psychol (Paris). 2022;180(5):410. doi:10.1016/J.AMP.2021.03.008
28. Loehde LW, Novakovic M. Acute and Transient Psychotic Disorder induced by fear of coronavirus infection. Eur J Psychotraumatol. 2021;12(1). doi:10.1080/20008198.2021.1954777
29. Valdés-Florido MJ, López-Díaz Á, Palermo-Zeballos FJ, et al. Clinical characterization of brief psychotic disorders triggered by the COVID-19 pandemic: a multicenter observational study. Eur Arch Psychiatry Clin Neurosci. 2022;272(1):5-15. doi:10.1007/s00406-021-01256-w
30. Nestgaard Rød Å, Schmidt C. Complex PTSD: what is the clinical utility of the diagnosis? Eur J Psychotraumatol. 2021;12(1). doi:10.1080/20008198.2021.2002028
31. Compean E, Hamner M. Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges. Prog Neuropsychopharmacol Biol Psychiatry. 2019;88:265-275. doi:10.1016/J.PNPBP.2018.08.001
32. Compean E, Hamner M, Johnson RH. Posttraumatic Stress Disorder with Secondary Psychotic Features (PTSD-SP): Diagnostic and Treatment Challenges HHS Public Access. Prog Neuropsychopharmacol Biol Psychiatry. 2019;88:265-275. doi:10.1016/j.pnpbp
33. Forero-Peña DA, Hernandez MM, Mozo Herrera IP, et al. Remitting neuropsychiatric symptoms in COVID-19 patients: Viral cause or drug effect? J Med Virol. 2022;94(3):1154-1161. doi:10.1002/JMV.27443
34. Hardy A. Pathways from trauma to psychotic experiences: A theoretically informed model of posttraumatic stress in psychosis. Front Psychol. 2017;8(MAY):697. doi:10.3389/FPSYG.2017.00697/BIBTEX
35. Perlini C, Donisi V, Rossetti MG, Moltrasio C, Bellani M, Brambilla P. The potential role of EMDR on trauma in affective disorders: A narrative review. J Affect Disord. 2020;269:1-11. doi:10.1016/J.JAD.2020.03.001
36. Wilson G, Farrell D, Barron I, Hutchins J, Whybrow D, Kiernan MD. The Use of Eye-Movement Desensitization Reprocessing (EMDR) Therapy in Treating Post-traumatic Stress Disorder-A Systematic Narrative Review. Front Psychol. 2018;9(JUN). doi:10.3389/FPSYG.2018.00923
37. Notaras M, van den Buuse M. Neurobiology of BDNF in fear memory, sensitivity to stress, and stress-related disorders. Mol Psychiatry. 2020;25(10):2251-2274. doi:10.1038/S41380-019-0639-2
38. Abdallah CG, Averill LA, Akiki TJ, et al. The Neurobiology and Pharmacotherapy of Posttraumatic Stress Disorder. 2019;59:171-189. doi:10.1146/ANNUREV-PHARMTOX-010818-021701
39. Krystal JH, Neumeister A. Noradrenergic and serotonergic mechanisms in the neurobiology of posttraumatic stress disorder and resilience. Brain Res. 2009;1293:13-23. doi:10.1016/J.BRAINRES.2009.03.044
40. Mittal VA, Walker EF. Advances in the neurobiology of stress and psychosis. Schizophr Res. 2019;213:1-5. doi:10.1016/J.SCHRES.2019.08.030
41. Debbané M, Salaminios G, Luyten P, et al. Attachment, neurobiology, and mentalizing along the psychosis continuum. Front Hum Neurosci. 2016;10:22. doi:10.3389/FNHUM.2016.00406/BIBTEX
42. Smith CM, Gilbert EB, Riordan PA, et al. COVID-19-associated psychosis: A systematic review of case reports. Gen Hosp Psychiatry. 2021;73:84-100. doi:10.1016/j.genhosppsych.2021.10.003
43. Brown E, Gray R, lo Monaco S, et al. The potential impact of COVID-19 on psychosis: A rapid review of contemporary epidemic and pandemic research. Schizophr Res. 2020;222:79-87. doi:10.1016/j.schres.2020.05.005
44. Berliner Lucy, Bisson Jonathan, Cloitre Marylene, et al. Posttraumatic Stress Disorder Prevention and Treatment Guidelines Methodology and Recommendations ISTSS PTSD Guidelines-Methodology and Recommendations | 2.; 2015. Accessed January 4, 2023.
45. Astill Wright L, Horstmann L, Holmes EA, Bisson JI. Consolidation/reconsolidation therapies for the prevention and treatment of PTSD and re-experiencing: a systematic review and meta-analysis. Transl Psychiatry. 2021;11(1). doi:10.1038/s41398-021-01570-w
46. Bisson JI, Olff M. Prevention and treatment of PTSD: the current evidence base. Eur J Psychotraumatol. 2021;12(1). doi:10.1080/20008198.2020.1824381
47. Miao XR, Chen QB, Wei K, Tao KM, Lu ZJ. Posttraumatic stress disorder: From diagnosis to prevention 11 Medical and Health Sciences 1117 Public Health and Health Services 11 Medical and Health Sciences 1103 Clinical Sciences Alexander V. Libin. Mil Med Res. 2018;5(1). doi:10.1186/s40779-018-0179-0
48. Visser E, Gosens T, den Oudsten BL, de Vries J. The course, prediction, and treatment of acute and posttraumatic stress in trauma patients: A systematic review. Journal of Trauma and Acute Care Surgery. 2017;82(6):1158-1183. doi:10.1097/TA.0000000000001447
49. Murray RM, David AS, Ajnakina O. Prevention of psychosis: Moving on from the at-risk mental state to universal primary prevention. Psychol Med. 2021;51(2):223-227. doi:10.1017/S003329172000313X
50. Westhoff MLS, Ladwig J, Heck J, et al. Early detection and prevention of schizophrenic psychosis—A review. Brain Sci. 2022;12(1). doi:10.3390/brainsci12010011