Is My Brother Psychotic?

By Kristina Randle, Ph.D., LCSW

I’ve talked with my younger brother recently ( he’s 19 ) and he has been telling me some issues that are going on in his head and then there are things I notice him do to. He always checks multiple times that everything is secure ( car, house lock, etc. ). Sometimes he randomly clenches his fist or does some weird movement with his arm as if venting anger waves. He is super down to earth and loves chatting up with random strangers, but his anger is a ticking time bomb. Things he has told me he does ( when no one’s home ) are talking to himself carrying on a two way conversation ( acting is a passion of his ), he’ll run around the house pretending he’s doing different things, and sometimes just spends a full hour or two doing nothing but walking around the house picking up things at times then putting them down and he hates how he does it but it’s just natural for him ( always daydreaming ). If he doesn’t have a hard days work he has insomnia symptoms. One serious issue is when he was younger he made up an imaginary younger brother, gave him a “life” / characteristics and even told friends about him. Eventually he “died” by murder of some enemies, and my brother actually would cry about it and feel pain + tell the story. Currently he has an imaginary boyfriend. To sum it up into my conclusion, he lives in a Fantasy world part time and reality the other. He also has Extremely unusual thoughts / fears and tells me he only is able to tell me this because it has been getting worse and worse every year since he was younger ( we had heavy financial issues, and he went to 4 Elementary schools, 2 middle, and 6 high schools. ). He tells me he feels disturbed and is scared that he will randomly snap and lose control mentally, but he tells me he would never want to kill someone innocent. He is extremely intelligent, optimistic, tenacious, and hard working he feels like a psychotic mess. Any idea what he is coming down with?

A. Your brother’s symptoms are concerning but without meeting him in person, I can’t identify a specific diagnosis. Over the Internet, it’s impossible to diagnose psychological conditions.

He checks multiple items to ensure that “everything is secure.” How often does this occur? If he checked his car and house locks once, or even several times a day, that would be normal. If he checked them 30 times a day, that would be abnormal and potentially a sign of obsessive-compulsive disorder.

I’m not sure I fully understand what you mean when you say that he randomly clenches his fists and moves his arms as if he is “venting anger waves.” Perhaps that is his way of physically expressing his overwhelming feelings of anger and rage.

His insomnia, his realization that his symptoms are worsening, and his belief that he is “disturbed and scared that he will randomly snap and lose control,” are all deeply concerning. Those may be signs of psychosis but he might be simply on the verge of losing control, perhaps due to anger and rage.

Determining the reason why he’s about to lose control is less important than preventing a violent incident. What matters most, at this point in time, is that he receives immediate help.

Your brother has told you that he fears that he may lose control. That means he’s on the verge of potentially harming someone and legitimately fears that it will happen. This is a warning sign. He is asking for help.

If he’s willing to be evaluated by a mental health professional, then take him immediately. He should also be evaluated by a physician to rule out a physical cause.

If you believe that he may be in imminent danger of hurting himself or someone else, then take him to a hospital or call 911. They can protect your brother from harming himself or someone else. Don’t hesitate to call the authorities if necessary. The best option may be to call the local mental health crisis team. They can come to the home, assess his behavior and determine the appropriate course of treatment.

Please be safe and don’t hesitate to write again if you have additional questions. Please take care.

Dr. Kristina Randle

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Last reviewed: By John M. Grohol, Psy.D. on 2 Nov 2013

APA Reference
Randle, K. (2013). Is My Brother Psychotic?. Psych Central. Retrieved on December 19, 2014, from http://psychcentral.com/ask-the-therapist/2013/11/02/is-my-brother-psychotic/