The genre emerged from literary Gothic traditions, but its first cinematic articulation arrived in the late 1960s with films like ‘Repulsion’ that prioritized claustrophobic perception over visible threats. Critics of the era noted a shift: terror was now rooted in psychological breakdowns, setting a template that future directors would expand upon.

By the 1990s, directors such as David Fincher and Darren Aronofsky introduced narrative structures that blurred reality and hallucination, using color palettes and sound design to externalize inner turmoil. This period solidified the definition of psychological horror as a blend of narrative ambiguity and visceral mood, a formula still echoed in contemporary works like ‘Hereditary’ and ‘Midsommar’.