Characters who suffer from extreme psychosis (not at all to be confused with psychopathy, which are, in fact, opposites). Psychosis itself is not an actual condition but rather a symptom of many other illnesses, the most common conditions associated with high-levels of psychosis include dissociative disorders and schizophrenia. Psychosis can also be caused by drug or alcohol abuse, brain injury or trauma. People who suffer from psychotic conditions often become more violent, unstable or ill if they engage in drug and/or alcohol misuse.

Psychotics are very insane, having little to no understanding of what they are exactly doing or the severity of their actions; to qualify as a psychotic, a character must be shown to have the following patterns in most media they appear in:

• False beliefs: Psychotics will hold false beliefs that are nevertheless seen as fact, this means they often see the world in a very different manner to others and may hallucinate a wide array of phenomena. This makes them often appear to exist in their own world.
• Unpredictable behavior: Due to lacking an understanding of reality versus fiction, many psychotics will have extremely unpredictable behavior, this can be seen as one of the key differences between psychosis and psychopathy. While psychopaths can control their behaviors, a psychotic can not, thus they are much more notably ill or unstable and would be classed as "insane" in most settings.

IMPORTANT: Do not use this category for any and all "mentally ill" villains, only use it for characters who display all the signs and symptoms of someone who is suffering extreme psychosis, for any ill-defined or otherwise questionable behaviors that do not fall under extreme psychosis, use "Mentally Ill". In fact, do not add the psychopath, mentally ill or dissociative categories on the same villain as the three categories are different types of mental illnesses and adding them all on the same page would be redundant.

Psychotic villains can be tragic since horrible experiences from the past at any age can also drive these villains insane and push them away from reality as it is too painful to grasp (e.g. Joker (2019), Tomura Shigaraki, Josh Washington, Teru Mikami, Goro Akechi, Jinx and Michael Myers (remake)). Since some of these types of characters are suffering from immense psychosis on a daily basis to the point it can be considered a sympathetic factor if these villains suffer with mental health more than the average mentally ill villain.

However, some can be Pure Evil , if they lack redeeming qualities and have enough moral agency (e.g. Patrick Bateman, Nui Harime, Junko Enoshima, Art the Clown, William Wharton, Dr. James Sheridan, Black Noir, Lord Commander, Norman Daniels, Kefka Palazzo and Carnage (Marvel)).

A psychopath/sociopath will never fall under this category because they are always aware of reality, are in control of their own actions and are extremely calculating while a psychotic is most often in very poor control of their own actions and have a twisted perception of reality (though psychotics can’t be judged by our systems much like barbarians or ferals and as the formers may also be intelligent enough to hit the Mastermind category).

Examples are most versions of The Joker, Enmu, Sal, Frank Booth, Jeff the Killer, Yuno Gasai, Eddie Low, Edmund Lowry Jr., Psycho, Zazz, Himiko Toga, Quackerjack, Annie Wilkes, The Batman Who Laughs, Eddie Gluskin, Trevor Philips, Tuco Salamanca, Spamton G. Spamton, Norman Osborn (2017), Quentin McNeil, the Master, and Red Guy.