If you often feel afraid that you have schizophrenia, even though you show no symptoms of the mental health condition, then you may be dealing with obsessive-compulsive disorder (OCD). All themes of OCD—including fears of schizophrenia—can be effectively treated with exposure and response prevention (ERP) therapy.
If you’re dealing with unwanted thoughts about losing your mind, going into psychosis, or developing schizophrenia, you may actually be dealing with obsessive-compulsive disorder (OCD). Even if you’re not showing any actual symptoms of schizophrenia, OCD can cause you to constantly question your state of your mind.
“Constant self-doubt is one of the hallmarks of OCD,” says NOCD therapist Mary Beth Overstreet, MA, LPC. “This can lead to a loop where a person wonders if they’re actually experiencing psychosis, or if they can trust their perception of reality.”
While health anxieties can be overwhelming—and even debilitating—fears about schizophrenia don’t have to rule your life. Effective treatment for OCD can help you get a handle on your anxieties. Read on to get a better sense of how OCD can trigger fears about schizophrenia, and how you can learn to manage these symptoms more effectively.
Why am I having fears about schizophrenia?
“It is common for someone with OCD to fear that they might develop psychosis,” Overstreet says. “Because OCD often involves a lot of catastrophic thinking—believing that something terrible will happen, even if there’s no evidence to support it.”
Because OCD often involves a lot of catastrophic thinking—believing that something terrible will happen, even if there’s no evidence to support it.
Mary Beth Overstreet, MA, LPC
If you’re unfamiliar with OCD, the condition is known for two main symptoms: obsessions and compulsions. Obsessions are recurrent and unwanted intrusive thoughts, sensations, images, feelings, or urges that cause distress. OCD obsessions can center on anything, but often seize on the themes that matter to you most. So, if you’re someone who cares a lot about your mental health, you might find yourself consumed by obsessive fears that you’re losing your mind—or that you can’t trust your perception of reality.
When intrusive thoughts about schizophrenia or mental health strike, you might feel intense anxiety, fear, or even physical sensations, such as dizziness—which can, in turn, stoke further concerns that you’re losing your grip on reality. Overstreet says these thoughts “can often be very convincing and real-feeling, which leads to intense distress.” In some cases, your thoughts might be so consuming that they start to impact your ability to manage daily tasks, leading to obsessive concerns about your capacity to hold down a job, or engage in healthy relationships.
In response to these anxieties, people with OCD enact compulsions, which are repetitive behaviors or mental acts done in an attempt to ease discomfort, neutralize distressing thoughts, or prevent a feared outcome from occurring. With schizophrenia-related fears, you may find yourself searching for certainty that your perception of reality is correct. This might entail compulsive research about mental health conditions and treatments, or excessive reassurance seeking from loved ones who you think can confirm that your perceptions match up with reality. You might even find yourself avoiding certain places, people, or activities that you believe trigger your intrusive thoughts about mental health.
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Signs of Schizophrenia OCD
If you’re having intrusive thoughts about developing schizophrenia, you might start to feel highly self-conscious in social settings, or become hyperaware of physical sensations. You might also find it especially hard to interact with themes related to mental health—whether that’s being around friends who talk about these topics, or engaging with TV shows or books that focus on these subjects.
Other situations that may trigger fears of schizophrenia include:
- Not remembering details of events or what was said in conversations.
- Feeling lightheaded or dizzy.
- Difficulty falling asleep.
- Feeling as if others are watching you or laughing at you.
- Feeling out of control.
- Experiencing coincidences.
- Feeling the sensation of déjà vu.
- Feeling overstimulated, such as by loud noises, or crowded places.
Common obsessions related to fears of schizophrenia include:
- “Am I losing my mind?”
- “What if I can’t live my life ‘normally’ ever again?”
- “Am I able to take care of myself?”
- “How can I even tell if this is real life?”
- “What if my memories aren’t actually real?”
- “Will I always live in a state of fear?”
- “What if I can’t continue my friendships or relationships?”
You may be aware that your worries or thoughts aren’t rational, but your anxiety persists. You may begin to wonder if your doubts themselves are a sign of psychosis or schizophrenia. In response to this confusion, you may engage in compulsions to try to find certainty.
Common compulsions related to fears of schizophrenia may include:
- Reviewing social interactions, reviewing any possible symptoms you have been experiencing, or reviewing others’ reactions to your behaviors.
- Excessively researching symptoms of schizophrenia.
- Seeking repeated reassurance from medical professionals, friends, or family.
- Avoiding situations that might seem overstimulating or stressful.
- Checking to see if you are thinking “correctly” about something.
- Attempting to cope with anxiety and fear by using substances.
OCD vs. schizophrenia
At the end of the day, you might also truly be unsure about what you’re experiencing. While it’s important to refrain from excessive research, it can be helpful to nail down some key differences between OCD and schizophrenia, so you have a better sense of what you’re dealing with.
One main distinction is that schizophrenia and related conditions tend to be characterized by limited insight into one’s symptoms and situation. When people with schizophrenia experience paranoid delusions, they generally struggle to distinguish these events from reality. This means if you’re excessively worried your perception of reality may not be correct, it’s unlikely you’re actually dealing with psychosis or schizophrenia.
People with OCD, on the other hand, are more likely to experience intrusive thoughts about issues that may not actually be impacting them. If you have OCD, you’re also more likely to have greater insight into the fact that your fears aren’t entirely rational. So, if you find yourself thinking, “I don’t think I’m dealing with psychosis, but how can I be sure?” It’s more likely you’re dealing with OCD. Your desire to achieve total certainty is a classic symptom of OCD.
It’s also important to understand that OCD can cause you to feel disconnected from reality, even if you are not experiencing psychosis. “Many people with OCD experience derealization or depersonalization, which can lead to a feeling of being disconnected from themselves or their surroundings,” Overstreet adds. “These feelings might seem like a sign of losing touch with reality but are actually a manifestation of anxiety and OCD, not psychosis.”
If you’re truly in doubt about what you’re experiencing, reach out to a therapist trained in OCD. They will likely ask:
- Are you experiencing repeated and unwanted thoughts or worries about your mental health, schizophrenia, or psychosis?
- Do these thoughts cause anxiety or distress?
- Do you engage in mental or physical compulsions in an attempt to minimize anxiety, find certainty, or avoid a feared outcome?
If the answer to all three of these questions is “yes,” it’s likely that you’re dealing with OCD focused on the theme of schizophrenia. OCD is unique in that obsessions trigger compulsions.
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Treatment for Schizophrenia OCD
Schizophrenia-related OCD can be debilitating, but it is highly treatable. By doing exposure and response prevention (ERP) therapy with an OCD specialist, you can learn to face your fears around mental health, and live more freely. ERP therapy is a specialized form of cognitive behavioral therapy (CBT) designed for OCD, and it’s highly effective at reducing—regardless of the topics your intrusive thoughts center on.
In ERP therapy, you will start by identifying intrusive thoughts, compulsive behaviors, and any situations that tend to trigger these symptoms—ranking them by the level of anxiety they cause. Your therapist will then work with you to create a treatment plan that helps you gradually and intentionally face these fears, so you can learn to respond differently. Over time, you will practice purposely putting yourself in situations that trigger your worries about schizophrenia, without trying to alleviate anxiety by engaging in compulsions.
Instead, you will learn to sit with uncertainty, potentially repeating non-engagement messages like, “maybe I am schizophrenic, or maybe I’m not.” This process will allow you to learn that you can tolerate anxiety and uncertainty, without trying to find total certainty. In time, you’ll learn to manage distress with more ease, and your intrusive thoughts will start to feel like little more than background noise.
Key takeaways
- Intrusive fears about developing schizophrenia or psychosis are a common theme in OCD.
- Unlike OCD, schizophrenia is rarely accompanied by self-awareness that you may be experiencing irrational fears.
- ERP therapy is a highly effective way to treat fears of schizophrenia related to OCD, because it teaches you how to tolerate intrusive thoughts without compulsively seeking total certainty.