Spatial Avoidance Related to War Experience Among Individuals with Psychosis: A Conservative Clinical Reading for Distinguishing Trauma-Related Responses from Persecutory Beliefs

Avoidance is a central feature of post-traumatic stress disorder; however, its emergence in some individuals with psychosis after exposure to war-related experiences does not, by itself, allow for direct diagnostic certainty. Avoidance is one of the core components of post-traumatic stress disorder, as individuals tend to avoid places, situations, or cues that reactivate the traumatic event. Yet this behavior may also appear in some individuals with psychosis for different reasons, which raises the problem of distinguishing trauma-related avoidance from behavior driven by persecutory beliefs. The present article asks the following question: to what extent can spatial avoidance related to war experience among individuals with psychosis be interpreted as an indicator of a trauma-related response, and what boundaries separate this interpretation from persecutory beliefs of psychotic nature?

The relationship between psychological trauma and psychosis has received increasing attention in recent years. Many studies have shown that exposure to traumatic events may be associated with a higher likelihood of psychotic symptoms or may shape their content and severity. In settings affected by war and armed conflict, understanding this overlap becomes especially important because of the high burden of traumatic exposure and its complex psychological consequences. Recent literature indicates a meaningful association between trauma-related experiences, threat beliefs, and the severity of positive psychotic symptoms, especially paranoia and persecution. Recent studies have also shown that complex PTSD symptoms may be associated with greater daily-life psychotic symptom severity. Some studies have further suggested that threat- and vulnerability-related beliefs arising from traumatic experiences may contribute to the formation and persistence of psychotic experiences, particularly paranoia and persecutory thinking.

individuals with psychosis who have been exposed to war-related experiences, and clinicians assessing such patients

This article adopts a narrative theoretical review approach to analyze recent literature on the relationship between psychological trauma and psychosis, with a particular focus on spatial avoidance related to war experience as a possible clinical marker of trauma-related responding. The reviewed studies addressed: (1) the relationship between PTSD and psychotic symptoms, (2) the role of trauma-related beliefs in the development of persecutory experiences, and (3) the impact of complex PTSD symptoms on the severity of psychotic symptoms. Priority was given to recent studies, systematic reviews, and meta-analyses published between 2020 and 2025.

No empirical dataset was collected or described in this paper. The article is a narrative theoretical review drawing on published literature.

A trauma-based interpretation becomes more plausible when avoidance is limited to places directly associated with war events or earlier threats, and when the patient reports a clear reduction in anxiety or a sense of relief after leaving those places. This may suggest that the behavior serves a regulatory function by reducing the emotional arousal linked to traumatic memory. By contrast, persecutory beliefs may extend to multiple places not directly linked to the traumatic event, and feelings of threat may persist even after leaving the location. In such cases, the breadth and persistence of fear may support a psychotic interpretation more than a purely trauma-related response. Nevertheless, this distinction should not be treated as a definitive diagnostic rule, given the possible overlap between the two conditions and the influence of other factors such as anxiety, depression, environmental stressors, and cognitive interpretations of threat.

1. Spatial avoidance limited to locations directly linked to war experience, especially when accompanied by reduced anxiety after leaving those places, may support a trauma-based interpretation more than a fixed persecutory belief.
2. Persecutory beliefs may extend to multiple places not directly linked to the traumatic event, and feelings of threat may persist even after leaving the location, which may support a psychotic interpretation.
3. Spatial avoidance should be viewed as a non-specific clinical marker that must be interpreted within the patient's psychological and temporal context.
4. Complex PTSD symptoms may be associated with greater daily-life psychotic symptom severity.
5. Future studies are needed to directly test the discriminative value of spatial avoidance in differentiating trauma-related responses from persecutory beliefs among individuals with psychosis.