Explainer: Schizophrenia, Bipolar Disorder, OCD and Complex Trauma

Schizophrenia affects roughly one in a hundred people over a lifetime. It involves periods of psychosis — hallucinations or delusions — alongside changes in motivation, thinking and social contact that often matter more for daily life than the psychosis itself. It is not a split personality, and the large majority of people with schizophrenia are never violent. Treatment combines antipsychotic medication with psychosocial support; in Germany early-intervention services and Soziotherapie can be prescribed, and in the UK Early Intervention in Psychosis teams take referrals from GPs and A&E.

Bipolar disorder involves episodes of depression alternating with mania or hypomania — periods of elevated mood, reduced need for sleep, rapid thinking and risk-taking. It is commonly mistaken for unipolar depression for years, partly because people seek help in the depressed phase. Mood stabilisers, structured sleep and psychoeducation are the core of treatment. Both AWMF S3 and NICE guidance emphasise long-term relapse prevention rather than episode-by-episode crisis management.

Obsessive-compulsive disorder is not tidiness. It is a loop of intrusive thoughts that provoke intense distress, followed by compulsions performed to reduce that distress. The themes are often frightening and shameful, which is why people wait an average of years before disclosing them. The first-line treatment is cognitive behavioural therapy with exposure and response prevention, sometimes combined with SSRIs.

Complex trauma, listed in ICD-11 as complex post-traumatic stress disorder, follows prolonged or repeated trauma from which escape was difficult — childhood abuse, domestic violence, trafficking, war. Alongside classic PTSD symptoms it involves problems with emotion regulation, a persistently negative self-concept and difficulty sustaining relationships. Because ICD-11 is the classification used across Germany and the EU, complex PTSD is formally diagnosable here in a way it is not under the American DSM-5.

What these four have in common: each is treatable, each is routinely misdescribed in public conversation, and each carries a stigma that delays help. Delay is the part we can change.

If any of this describes you, the practical next step in Germany is a psychotherapeutic consultation hour via 116 117, or a psychiatric outpatient clinic (Institutsambulanz) for more complex presentations. In the UK, ask your GP for a referral to secondary mental health services and say plainly that you are describing psychosis, mania, OCD or trauma symptoms — naming it shortens the route.