The Connection Between OCD and Schizophrenia
Distinguishing between obsessive-compulsive disorder (OCD) and schizophrenia can be challenging due to the potential overlap in symptoms.
Obsessive-compulsive disorder is identified by the presence of recurring obsessions and intrusive thoughts, as well as compulsions that entail repetitive and specific actions that one feels compelled to carry out.
Meanwhile, schizophrenia typically looks like:
- hallucinations: seeing or hearing things that don’t line up with reality
- delusion: beliefs that don’t match up with reality
- speech patterns that can be difficult to understand
- atypical behaviors
- a state or unresponsiveness
- such as lack of expression or interests
Recognizing the symptoms and their relevance to oneself or a loved one could be a crucial step in identifying the condition they might be experiencing.
How is OCD associated with schizophrenia?
These disorders are categorized differently, with one being a spectrum disorder and the other having its own category in the DSM-5. Nonetheless, there are symptoms that are shared across the two disorders, and people with either OCD or schizophrenia may exhibit behaviors that are similar and hard for an outsider to tell apart. Moreover, these diseases may cause powerful thoughts that other people may find odd.
It is not uncommon for individuals to experience both schizophrenia and OCD simultaneously, especially if either disorder runs in the family. Research suggests that around 30% of people with schizophrenia may exhibit symptoms of OCD, and up to 14% of individuals with schizophrenia may also have co-occurring OCD. (Sources: source 1, source 2, source 3)
Differences and similarities between OCD and schizophrenia
While there are shared symptoms between these two conditions, there are also significant differences. The following outlines where their symptoms intersect and diverge:
| Schizophrenia | OCD | |
| Thoughts or beliefs that are disconnected from reality | X | X |
| Repetitive behaviors | X | X |
| Hallucinations | X | |
| Disorganized speech, or speech that doesn’t follow usual patterns | X | |
| Compulsions | X | |
| Anxiety about unwanted thoughts or urges | X |
Delusions vs. obsessions
The distinction between schizophrenia and OCD can sometimes be unclear, making it difficult to differentiate between the two. Delusions, which are beliefs that are not grounded in reality, and obsessions, which are intrusive thoughts that can be distressing to the individual experiencing them, are examples of how the two conditions can be confused.
Delusions are typically perceived as genuine by those who experience them. On the other hand, individuals who have obsessions are more likely to resist or oppose these thoughts, as per a 2022 study. Therefore, identifying an obsession may be less challenging than identifying a delusion.
This suggests that identifying an obsession may be comparatively simpler than identifying a delusion.
Insight
It might be challenging to gain self-awareness or insight into one’s symptoms and condition. Let’s use the case of someone who has a severe phobia of snakes to provide an illustration. This person experiences severe anxiety every time they go outside.
- If the person is highly perceptive, they might realize that their fear is unfounded and that they are not likely to be bitten by a snake when they go outside. Nonetheless, people could become frustrated by the recurrence of these irrational beliefs that they are aware of but are unable to control.
- The prospect of being harmed by snakes may seem real to someone who has little to no understanding of their phobia. They may continue to have this belief for all or most of the time, which prompts them to try and persuade others that being outside is dangerous.
Can schizophrenia and OCD be similar?
Several researchers have shown that obsessions and delusions, as well as OCD and schizophrenia, may coexist when there is little to no understanding into the preoccupation.
Obsessions without insight
Obsessions that appear without insight feel quite genuine to the person experiencing them. The individual may be unaware that their passion is causing a schism between them and reality.
Psychosis
In rare situations, patients with OCD may also suffer from, which includes hallucinations and delusions and may appear to be schizophrenia.
Catatonia
OCD can sometimes be confused with schizophrenia when combined with catatonia, which is defined by:
- lack of movement or response
- repetitive behaviors
- restlessness or agitation
Despite the fact that catatonia is more frequently associated with schizophrenia, a 2017 study found that persons with OCD may suffer catatonia more frequently than those without a mental health problem.
Also, a person with OCD and obsessions without understanding may act similarly to a person with schizophrenia since both OCD and catatonia can result in repeated motions.
Can OCD trigger schizophrenia?
It is improbable that OCD will lead to the development of schizophrenia. Yet, while OCD may not always result in schizophrenia, it does increase the likelihood of suffering it.
A sudden onset of OCD symptoms may also be connected to the development of conditions involving psychosis, like schizophrenia.
OCD symptoms that appear out of the blue may potentially be linked to the emergence of illnesses like schizophrenia that involve psychosis.
So does either condition cause the other? The answer is still unclear. According to 2019 research on co-occurring schizophrenia and OCD symptoms:
So, does one circumstance lead to the other? The answer is still a mystery. According to a 2019 study on the co-occurring symptoms of schizophrenia and OCD:
- 40% of people experienced symptoms of OCD first
- 40% of people experienced symptoms of schizophrenia first
- 20% of people started experiencing symptoms of both at the same time
Schizo-obsessive disorder: A new diagnosis?
In 2016, research suggested that experiencing symptoms of OCD and schizophrenia together may not necessarily indicate two separate conditions occurring simultaneously. Instead, they may indicate the presence of a single condition known as schizo-obsessive disorder. Although this disorder has not been officially recognized by the DSM, further research is needed to establish its validity.
Can OCD lead to schizophrenia?
Although the relationship between OCD and schizophrenia is not yet fully understood, it is possible that OCD could contribute to a diagnosis of schizophrenia in a few different ways.
According to a 2019 study, there is evidence to suggest that receiving a diagnosis of OCD may increase the likelihood of developing schizophrenia at a later time. Additionally, OCD may also heighten the risk of experiencing hallucinations and delusions, even in the absence of a schizophrenia diagnosis.
Furthermore, individuals with a parent who has OCD may have an increased risk of developing schizophrenia.
Treatment options
The treatment of OCD and schizophrenia typically involves different approaches, and managing both conditions simultaneously can be challenging.
OCD treatment
If you are living with OCD, your treatment may focus on helping you manage your obsessions and compulsions and their impact on your daily life. This may involve the use of:
- Therapy can be an effective tool in managing OCD. Certain types of therapy, such as cognitive-behavioral therapy (CBT) or exposure and response prevention (ERP), may be used to help you challenge and build tolerance to obsessions and compulsions.
- Medication can also be a useful component of OCD treatment. Your doctor may prescribe medication, such as selective serotonin reuptake inhibitors (SSRIs), to help manage symptoms of OCD that may be difficult to treat with therapy alone.
Schizophrenia treatment
Treatment for schizophrenia may also involve a combination of therapy and medication, but the therapeutic approaches and medications used may be different than those used to treat OCD.
- One class of medications commonly used to manage symptoms of psychosis in schizophrenia is called antipsychotics.
- In addition to medication, some people with schizophrenia find that therapy can also be helpful in managing their symptoms. Therapeutic approaches such as Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy for Psychosis (CBTp) may be used to help individuals develop coping strategies for handling symptoms when they arise.
- Support groups can also be a helpful resource for individuals living with schizophrenia. Connecting with peers who have experienced similar challenges can provide a sense of understanding and validation, and may offer practical advice and coping strategies.
Treatment for co-occurring OCD and schizophrenia
Researchers are still learning how treatment can best support people living with both OCD and schizophrenia. So far, findings indicate:
As researchers continue to study the co-occurrence of OCD and schizophrenia, there is ongoing investigation into how treatment can best support individuals with both conditions. Current findings suggest that:
- Studies have suggested that antipsychotic medications may be helpful in managing symptoms of both schizophrenia and OCD in individuals who experience both conditions.
- In some cases, psychiatrists may consider prescribing both an antipsychotic medication and an antidepressant to manage both OCD and schizophrenia. However, combining these medications can carry the risk of serious side effects, such as seizures, and should only be done under close medical supervision.
- Cognitive-behavioral therapy (CBT) is a type of therapy that may be helpful in managing a combination of OCD and schizophrenia symptoms. However, more research is needed to confirm its effectiveness in treating these co-occurring conditions.
Next steps
If you are uncertain whether you or a loved one is experiencing OCD, schizophrenia, or both, managing symptoms can feel overwhelming. However, with the right treatment and support, both of these conditions can be effectively managed. It’s important to seek help from a healthcare professional who can provide an accurate diagnosis and guide you towards appropriate treatment options. With the right care, it is possible to lead a fulfilling life while managing symptoms of these conditions.
A helpful first step towards understanding your symptoms may involve consulting with a therapist or doctor, who can conduct screenings to help determine the underlying cause of your symptoms. These screenings can provide valuable information and help guide appropriate treatment options. It’s important to be open and honest about your experiences and concerns with your healthcare provider, as this can help ensure an accurate diagnosis and effective treatment.
Treatment plans for both conditions often consist of a combination of:
- therapy
- medication
- self-care and lifestyle changes
Like all mental health conditions, it may take some time, along with trial and error, to find the most effective treatment approach for managing symptoms of OCD, schizophrenia, or both.
Involving loved ones who can offer support can also provide a sense of security as you navigate your condition and explore treatment options.
With patience, persistence, and the right care, it is possible to successfully manage symptoms and improve overall quality of life.
10 sources
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com/science/article/abs/pii/S0010440X14002715 - Diagnostic and statistical manual of mental disorders (5th ed.). (2013). Arlington, VA: American Psychiatric Association.
- du Montcel CT, et al. (2019). Obsessive-compulsive symptoms in schizophrenia: An up-to-date review of literature.
archives-ouvertes.fr/hal-03148763/file/OCD%20Psychosis%20-%2026%20version%20de%CC%81f.pdf - Peralta V, et al. (2017). Motor abnormalities: From neurodevelopmental to neurodegenerative through “functional” (neuro)psychiatric disorders.
oup.com/schizophreniabulletin/article/43/5/956/4004840?login=true - Rasmussen AR, et al. (2022). What is obsession? Differentiating obsessive-compulsive disorder and the schizophrenia spectrum.
com/science/article/pii/S0920996422000834 - Remberk B, et al. (2020). What exactly is catatonia in children and adolescents.
pl/uploads/images/PP_4_2020/ENGver759Remberk_PsychiatrPol2020v54i4.pdf - Scotti-Muzzi E, et al. (2016). Schizo-obsessive spectrum disorders: An update.
org/core/journals/cns-spectrums/article/abs/schizoobsessive-spectrum-disorders-an-update/7E08BCB7D3C023B032EB3DA4E7AF5433 - Sharma LP, et al. (2019). Obsessive–compulsive disorder comorbid with schizophrenia and bipolar disorder.
nlm.nih.gov/pmc/articles/PMC6343407/ - Tundo A, et al. (2016). Cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence.
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