Psychological horror is a subgenre of horror and psychological fiction that relies on mental, emotional and psychological states to frighten, disturb, or unsettle readers, viewers, or players. The subgenre frequently overlaps with the related subgenre of psychological thriller, and it often uses mystery elements and characters with unstable, unreliable, or disturbed psychological states to enhance the suspense, drama, action and paranoia of the setting and plot and to provide an overall unpleasant, unsettling, or distressing atmosphere.
Psychological horror usually aims to create discomfort or dread by exposing common or universal psychological and emotional vulnerabilities/fears and revealing the darker parts of the human psyche that most people may repress or deny. This idea is referred to in Jungian psychology as the archetypal shadow characteristics: suspicion, distrust, self-doubt, and paranoia of others, themselves, and the world.
The genre sometimes seeks to challenge or confuse the audience's grasp of the narrative or plot by focusing on characters who are themselves unsure of or doubting their own perceptions of reality or questioning their own sanity. Characters' perceptions of their surroundings or situations may indeed be distorted or subject to delusions, outside manipulation or gaslighting by other characters, emotional disturbances, and even hallucinations or mental disorders. In many cases, and in a similar way as the overlapping genre of psychological thriller, psychological horror may deploy an unreliable narrator or imply that aspects of the story are being perceived inaccurately by a protagonist, thus confusing or unsettling viewers or readers and setting up an ominous or disturbing overarching tone. In other cases, the narrator or protagonist may be reliable or ostensibly mentally stable but is placed in a situation involving another character or characters who are psychologically, mentally, or emotionally disturbed. Thus, elements of psychological horror focus on mental conflicts. These become important as the characters face perverse situations, sometimes involving the supernatural, immorality, murder, and conspiracies. While other horror media emphasize fantastical situations such as attacks by monsters, psychological horror tends to keep the monsters hidden and to involve situations more grounded in artistic realism.
Plot twists are an often-used device. Characters commonly face internal battles with subconscious desires such as romantic lust and the desire for petty revenge. In contrast, splatter fiction focuses on bizarre, alien evil to which the average viewer cannot easily relate. However, at times, the psychological horror and splatter subgenres overlap, such as in the French horror film High Tension.
The novel Silence of the Lambs written by Thomas Harris, Robert Bloch novels such as Psycho and American Gothic, Stephen King novels such as Carrie, Misery, The Girl Who Loved Tom Gordon, The Shining and Koji Suzuki's Ring are some examples of psychological horror. Shirley Jackson's We Have Always Lived in the Castle is often viewed as one of the best examples of psychological horror in fiction.
Psychological horror films generally differ from the traditional horror film, where the source of the fear is typically something material, such as grotesque or horrifying creatures, monsters, serial killers or aliens, as well as the splatter film, which derives its frightening effects from gore and graphic violence, in that tension in psychological horror films is more frequently built through atmosphere, eerie sounds and exploitation of the viewer's and the character's psychological fears. Psychological horror films sometimes frighten or unsettle by relying on the viewer's or character's own imagination or the anticipation of a threat rather than an actual threat or a material source of fear portrayed onscreen. However, some psychological horror films may in fact contain a material or overt threat or a physical source of fear, as well as scenes of graphic gore or violence, yet still rely or focus mainly on atmosphere and the psychological, mental, and emotional states of the characters and viewers to frighten or disturb. For instance, some psychological horror films may portray psychotic murderers and scenes of graphic violence while still maintaining an atmosphere that focuses on either the villain's, protagonist's, or audience's psychological, mental, or emotional status.
Roman Polanski directed two films which are considered quintessential psychological horror: Repulsion (1965) and Rosemary's Baby (1968). Stanley Kubrick's 1980 film The Shining, adapted from the aforementioned Stephen King novel, is another particularly well-known example of the genre. The Silence of the Lambs (1991) directed by Jonathan Demme is another example of psychological horror, whilst also incorporating elements of the thriller genre.
The Italian film genre known as giallo often employs psychological horror or elements of the psychological horror subgenre. The subgenre is also a staple in Asian countries. Japanese horror films, commonly referred to as "J-horror", have been noted to be generally of a psychological horror nature. Notable examples are Ring (1998) and the Ju-on series. Another influential category is the Korean horror films, commonly referred to as "K-horror". Notable examples are A Tale of Two Sisters (2003), Hansel and Gretel (2007) and Whispering Corridors (1998). A landmark film from the Philippines, Kisapmata (1981), is an example of psychological horror. Darren Aronofsky's Black Swan (2010) is another fine example of the genre.
While video game genres are based upon their game-play content, psychological horror as narrative is used in some video games. A few successful video game franchises have spawned from using psychological horror as a main form of creating fear, the most well known being Silent Hill. Other psychological horror games include: Alan Wake, Alien: Isolation, Amnesia: The Dark Descent, Anna, Corpse Party, Cry of Fear, Dead Space, Deadly Premonition, Doki Doki Literature Club!, and to some extent, Dark Souls, The Evil Within, The Evil Within 2, F.E.A.R, The Swapper and The Last Door. Eternal Darkness: Sanity's Requiem, Hellblade: Senua's Sacrifice, Ib, Lone Survivor, Manhunt, Nocturne,  Condemned: Criminal Origins, Outlast 2,  Soma, The Suffering, and Yume Nikki.
- Psychological thriller
- psychological novel
- Plot twist
- Unreliable narrator
- Existential dread
- Existential despair
- Existential nihilism
- Lovecraftian horror
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