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, and The Variants). since many of these types of characters can barely understand what they are doing and suffering from immense psychosis on a daily basis can be considered a sympathetic factor if these villains suffer with mental health more than the average mentally ill villain.

A psychopath/sociopath will almost 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.). The exception to a psychopath qualifying is if they're also somehow driven to psychosis, but the categories should not be intermingled.

Examples are Kefka Palazzo, most if not all versions of The Joker, Enmu, Tomura Shigaraki, Junko Enoshima, Sal, William Wharton, Frank Booth, Jeff the Killer, Yuno Gasai, Carnage, Eddie Low, Himiko Toga, Jinx, Ash Graven, Trevor Philips, Patrick Bateman, Tuco Salamanca, Spamton G. Spamton, Joshua Washington and Quentin McNeil.