OCD and schizophrenia are two distinct mental health conditions. They have some overlapping symptoms but differ in their core characteristics and treatment.
Though they are vastly different mental health conditions, obsessive-compulsive disorder (OCD) and schizophrenia are sometimes perceived as being very similar. In some cases, OCD is even mistaken for schizophrenia. This confusion can lead to all sorts of problems for people with OCD, from misdiagnoses to unwarranted fears that they have schizophrenia.
Although both conditions can cause significant anxiety and impair daily functioning, it is important to understand the differences between them. This understanding is crucial for accurate diagnosis and providing the most effective treatment.
Key symptoms of OCD
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by a cycle of obsessions and compulsions. Obsessions are recurrent and intrusive thoughts, urges, feelings, sensations, or images that cause distress and compulsions are repetitive behaviors or mental acts that are done to alleviate anxiety or prevent a feared thing from happening.
Obsessions can look like:
- An extreme need for perfection, symmetry, or for things to be “just right”
- Unwanted thoughts about harming yourself or others
- Intense fears about contamination or contaminating others
- Doubts about your “true” sexuality
- Consistent worrying about violating religious, ethical or moral beliefs
- Doubts and fears surrounding relationships—either romantic and platonic
- Recurring doubts about memories or past events
- Fixations on bodily sensations or involuntary bodily functions such as breathing, swallowing, and blinking
In response to obsessions, someone with OCD performs compulsions. These can look like:
- Checking: repeatedly making sure of something, like if the stove is off or the door is locked.
- Tapping/touching: tapping your arm a certain number of times in order to feel “okay” or “just right”.
- Reassurance seeking: asking your loved ones questions about whether or not you would do something bad, affirmations about your relationship, or if something really happened.
- Avoidance: refusing to go places, see people, or be in situations that may trigger your intrusive thoughts.
- Excessive washing/cleaning: handwashing, showering, or disinfecting surfaces multiple times a day.
- Rumination: going over the same thoughts over and over again, even for hours a day.
- Mental reassurance: giving yourself reassurance that you wouldn’t do something, such as “I would never do anything like that because I’m not a bad person.”
- Thought-replacing or thought-stopping: replacing a “bad” thought with a “good” thought or ignoring thoughts.
Can OCD cause fears of schizophrenia?
OCD itself doesn’t lead to schizophrenia, but some people with OCD have obsessions about the possibility of developing schizophrenia or psychosis. This could involve thoughts like, “What if I don’t have OCD and I actually have schizophrenia?” or “What if my obsessions are actually delusions?”
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Key symptoms of schizophrenia
Schizophrenia is a psychiatric condition that affects how a person thinks, feels, and behaves. It is characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Schizophrenia is considered a spectrum disorder, meaning symptoms and severity can vary widely from person to person.
Key symptoms of schizophrenia include:
- Delusions: These are defined as false beliefs that are not grounded in reality and are not supported by any evidence, despite being strongly held by someone. People with schizophrenia may have delusions of persecution, or the belief that someone is trying to harm them, which can lead to distorted perceptions.
- Hallucinations: These are sensory experiences that aren’t based in reality. These can include hearing voices, seeing things that aren’t there, or feeling sensations on the skin.
- Disorganized speech or thought: People with schizophrenia may switch between seemingly unrelated topics to such a degree that it becomes difficult to follow a consistent train of thought.
- Abnormal movement: Schizophrenia can cause unusual activity in a variety of ways. For example, while some individuals stop moving entirely (i.e., become catatonic), others may frequently fidget or appear agitated.
- Negative symptoms: Negative symptoms in schizophrenia refer to decreases in emotional expressiveness, feelings of pleasure or happiness, and motivation.
Is OCD associated with schizophrenia?
Despite being distinct conditions, OCD and schizophrenia share some traits. Both are severe and chronic mental health conditions that are linked to structural and functional changes in the brain which can impact perception, thought processes, and behavior. Additionally, OCD and schizophrenia can impact daily functioning such as work, academic performance, relationships, and physical, mental, and emotional well-being.
While people with OCD are no more likely than the general population to develop schizophrenia, people with schizophrenia are more likely to experience OCD symptoms. A 2018 study found that there is a much higher prevalence of both OCD symptoms (25%) and diagnosed OCD (12%) in patients with schizophrenia.
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OCD and schizophrenia overlap
Delusions and obsessions
People with OCD are often concerned about things that are highly unlikely to be true or are unsupported by reasonable evidence. They may also believe that they can prevent bad outcomes by performing actions that have no apparent connections with them.
To some, this might suggest that individuals with OCD have delusions, just like those with schizophrenia. However, this is not accurate. The main reason why is that individuals with OCD are often aware, at least to some degree, that their beliefs and actions are irrational. This is called insight. Dr. Patrick McGrath, Chief Clinical Officer at NOCD, explains, “most people with OCD have a good to fair level of insight. The vast majority of people look at their OCD and say, logically, that they understand it doesn’t really make sense.” However, this isn’t always the case: “Some people fall in the no level of insight category, and that’s called delusional OCD—they believe their OCD so much and so intently that it almost reaches the delusional level.”
According to a 2020 study of 117 patients with OCD, around 50% of participants had excellent insight about how irrational their obsessions are, whereas 15% had little to no insight.
“There are delusions that are more associated with schizophrenia, which are different kinds of delusions than those experienced by people with OCD,” says NOCD therapist Tracie Ibrahim, MA, LMFT, CST. “An example of a delusional belief someone with OCD might experience is believing that your partner is cheating on you, even though there is no evidence to support it.” In this example, the person with OCD realizes that their delusion is causing problems in their relationship, and that their fears are most likely irrational.
On the other hand, someone with delusions related to schizophrenia may involve things that are highly improbable, if not impossible. For example, they could believe that aliens have implanted a chip in their brain to control them. Despite clear evidence that would counter this argument, such as receiving an MRI of their brain, this person would continue to have this false belief.
You may also wonder if people with schizophrenia experience intrusive thoughts, which commonly become obsessions in people with OCD. The answer is yes, but it’s less likely, and it can be quite a bit more complicated. “The problem is that in schizophrenia, you may not recognize these thoughts as intrusive,” shares Dr. McGrath. In other words, they are less likely to be experienced as unwelcome or distressing representations of reality, meaning they might not count as intrusive thoughts at all.
Hallucinations
While hallucinations are typically associated with schizophrenia, they can also occur in OCD. “People with OCD can have sensory experiences including hallucinations that are auditory, tactile, olfactory, or gustatory,” says Ibrahim. “That means hearing things, feeling things, smelling things, or tasting things that are not actually present.”
Quasi-hallucinations can also occur in schizophrenia or OCD, referring to an experience that feels similar to a hallucination but does not fully meet the criteria of one. Someone experiencing quasi-hallucinations may have a heightened or distorted perception such as seeing or hearing things that are not actually there. However, they know that these are not based in reality.
In OCD, quasi-hallucinations are centered around obsessive thoughts that may feel very real—for example being so anxious about contamination you feel like you can “see” germs on a dirty surface. On the other hand, someone with true hallucinations cannot distinguish whether or not their perceptions are based in reality.
Differences between OCD and schizophrenia
Perception of reality
OCD may cause symptoms that resemble schizophrenia, such as intense, intrusive thoughts or compulsions that feel out of control. However, the perception of reality—what someone believes to be true about the world around them—is a key area where OCD and schizophrenia differ.
In OCD, people typically understand that their obsessive thoughts and compulsive behaviors are irrational, even if they feel compelled to act on them, whereas people with schizophrenia often experience a distorted perception of reality as a result of delusions or hallucinations.
Reaction to intrusive thoughts
Though people with OCD are often very worried that they’ll act on their obsessions (e.g. harming someone because of an intrusive thought involving knives), they don’t do it. Instead, they engage in compulsions in an attempt to avoid acting on their obsessions or prevent their triggers at all costs.
Compulsions
Compulsions are also what set OCD apart from schizophrenia. While OCD is characterized by the presence of compulsive behaviors aimed at managing obsessive thoughts, schizophrenia typically does not involve compulsions.
Can you receive a diagnosis of both OCD and schizophrenia?
Yes, you can receive a diagnosis of OCD and schizophrenia. This can involve having symptoms of both conditions, such as intrusive thoughts and compulsive behaviors from OCD, along with hallucinations, delusions, and disorganized thinking from schizophrenia. Each condition would be treated separately, but would address both sets of symptoms.
Treatment for OCD
Exposure and response prevention (ERP) therapy is the most effective treatment option for OCD. In partnership with a trained therapist, you’ll work to carefully confront your intrusive thoughts and triggers while resisting the urge to respond with compulsions to ease anxiety. Instead, you’ll sit with the distress that these intrusive thoughts and triggers may cause.
For example, if one of your fears is having schizophrenia, you may worry that you have symptoms or that you will develop them in the future. During this process, instead of engaging in compulsions—such as seeking reassurance from others, researching schizophrenia online, or avoiding situations that might make you feel more anxious—you would learn to sit with the discomfort and uncertainty that you may or may not have schizophrenia.
Over time, these exposures become more challenging, but you’ll learn to tolerate increasingly difficult situations or thoughts. The goal is not to eliminate anxiety altogether, but to help you build the resilience to manage it more effectively.
In addition to ERP, medications such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) may be prescribed to help manage OCD symptoms. These medications work by increasing levels of serotonin in the brain, which can help reduce anxiety and the intensity of intrusive thoughts.
Treatment for schizophrenia
The first-line treatment for schizophrenia is medication, specifically antipsychotics. Typically, antipsychotics help manage symptoms of psychosis, such as delusions and hallucinations, and improve overall functioning. However, it’s important to note that only a licensed healthcare professional can diagnose someone with schizophrenia—a formal evaluation is essential to ensure that the treatment plan is tailored to their specific needs.
In addition to medication, treatment can also include cognitive behavioral therapy (CBT), a type of therapy that helps identify and challenge distorted or unhelpful thought patterns. CBT for schizophrenia focuses on helping people understand their symptoms and gain more control over their thoughts and behaviors. This may also involve learning to recognize the early signs of symptom flare-ups, as well as strategies for coping with delusions and hallucinations.
Bottom line
Although OCD and schizophrenia may share symptoms like anxiety, functional impairment, and delusional thinking, they are fundamentally different. Schizophrenia often involves a disrupted perception of reality, where individuals may have difficulty distinguishing what is real from what is not. People with OCD are typically aware that their intrusive thoughts and compulsive behaviors are irrational, but feel driven to perform them to reduce anxiety or prevent a feared outcome.
If you’re experiencing symptoms you believe may be related to OCD or schizophrenia, it’s important to reach out to a mental health professional. By getting an accurate diagnosis, you can receive the best treatment to manage your symptoms.
Key Takeaways
- Obsessive-compulsive disorder (OCD) is a chronic mental health condition characterized by a cycle of obsessions and compulsions. Schizophrenia is characterized by a disrupted perception of reality, including symptoms like hallucinations, delusions, and disorganized thinking, which make it difficult for people to distinguish what is real from what is not.
- Although OCD and schizophrenia have overlapping symptoms including anxiety, sensory experiences, and unwarranted fears, treatment for the conditions are typically tailored to address their distinct characteristics.
- Exposure and response prevention (ERP) therapy is the most effective treatment option for OCD, while treatment for schizophrenia typically involves antipsychotic medications to manage delusions and hallucinations.
