OCD & Schizophrenia: What Is the Link?

What Is OCD?

OCD is the fourth most common mental health disorder in the world.² It is linked to a reduced quality of life, impaired functioning, and an increased use of healthcare services.^3,4,5Recent studies have linked obsessive symptoms with complex childhood stressors and PTSD, as well as insecure attachment.^6,7

OCD is an anxiety disorder. The hallmark symptoms of OCD involve patterns of obsessive thinking and compulsive behaviors. These obsessions and compulsions are short-term avoidance strategies to deal with the anxiety triggered by unprocessed emotions.⁸

The key characteristics of OCD include:

• Compulsions: OCD compulsions are repetitive actions that an individual feels driven to perform as a way of minimizing their momentary experience of anxiety. However, in the long term, these compulsions begin to harm the individual as they rely on them unwaveringly as the sole way to combat their anxiety.
• Obsessions: Obsessions are repeated, persistent, and unwanted thoughts, urges, or images that feel intrusive and cause distress to the individual.

What Is Schizophrenia?

Schizophrenia is a psychotic disorder in which functioning deteriorates as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities.⁹ It comes from the root word “schiz,” meaning “split” and “phrēn,” meaning “soul/spirit/heart.”¹⁰ Psychosis is a word designated to describe a state in which an individual loses contact with reality in key ways. Schizophrenia affects 24 million people worldwide.¹¹ Despite these staggering numbers, the public often stigmatizes it, and many clinicians are pessimistic about the results of its treatment options.¹²

The symptoms of schizophrenia typically include hallucinations, delusions, and disorganized speech and behaviors. These symptoms are grouped into three clusters: positive symptoms, negative symptoms, and cognitive symptoms.

Symptoms of schizophrenia include:

• Hallucinations: Hallucinations are sensory perceptions that occur without any external stimulus affecting any of the five senses: sight, hearing, taste, smell, and touch. These perceptions feel real to the person experiencing them but are not generated by external stimuli.
• Delusions: Delusions are false beliefs that persist despite evidence to the contrary. These beliefs are held strongly and are not based on cultural or religious norms.
• Catatonia: Catatonic schizophrenia occurs when an individual experiences a range of motor abnormalities. People with catatonia might experience a variety of symptoms, including stupor (a state of unresponsiveness), muscular rigidity, mutism (inability or refusal to speak), posturing (assuming and maintaining unnatural body positions), and repetitive or purposeless movements. It can occur in a variety of mental health conditions but is common to schizophrenia.¹³
• Negative symptoms: Negative symptoms refer to symptoms that reflect some deficiency from what is commonly associated with ‘normality.’ This includes reduced affect expression, apathy, inability to feel pleasure, and other symptoms commonly associated with more depressive features.
• Disorganized speech: Disorganized speech is a major sign of schizophrenia. It shows difficulty organizing thoughts and causes speech that doesn’t make sense or jumps between different ideas. In disorganized speech schizophrenia, an individual’s speech may often go off-topic, change ideas suddenly, or suddenly stop speaking. People might speak in a way that’s hard to understand, with words that don’t fit together well.
• Disorganized behaviors: Disorganized behavior in schizophrenia refers to actions or behaviors that seem unpredictable, erratic, or without purpose. It can involve difficulty completing daily tasks, problems with personal hygiene, acting inappropriately in social situations, or displaying unusual or odd behaviors. Disorganized behaviors commonly occur because the individual is out of touch with reality in some way.

How Are OCD & Schizophrenia Related?

OCD and schizophrenia can exhibit overlapping symptoms, leading to diagnostic challenges. Some individuals with schizophrenia may experience obsessive-compulsive-like symptoms, such as intrusive thoughts or compulsive behaviors, resembling aspects of OCD. These shared features might complicate accurate diagnosis and treatment planning, requiring careful evaluation by mental health professionals. Proper treatment will address the underlying structure causing the symptoms, not just address the outward visible symptoms.¹⁴

Similarities between OCD and schizophrenia include:

Delusions & Intrusive Thoughts

Based upon the repetitive and intrusive nature, delusions and intrusive thought obsessions appear quite similar. Both involve persistent, unwelcome ideas or beliefs that intrude upon a person’s thinking. However, delusions typically involve fixed false beliefs despite evidence to the contrary. In contrast, intrusive thoughts/obsessions in disorders like OCD involve repetitive, distressing thoughts that cause anxiety but are recognized as irrational by the individual experiencing them.

In delusions about psychosis, there is a certainty about their nature i.e. the person is fully convinced they are being persecuted by someone or something. In obsessional thinking, there is not the same certainty, but there is a level of doubt.¹⁵ The person does not fully believe their behaviors are necessary but still feels driven to perform them because of their anxiety.

Potential Causes

The causes of both schizophrenia and OCD are unknown. There is evidence to suggest high levels of adverse childhood experiences and/or childhood trauma play a role in the development of both disorders.¹⁶ Most clinicians emphasize pharmacotherapy for both disorders. While this is undoubtedly helpful in some cases, it is similar to treating pain with Aspirin. It reduces the immediate effects but does not address the underlying personality structure.¹⁷

Biological Factors

OCD and schizophrenia share certain biological components despite being distinct disorders. Both conditions have shown alterations in brain structure, such as reduced gray matter volume in specific brain regions like the prefrontal cortex. Additionally, abnormal neurotransmitter activity, particularly involving dopamine, glutamate, and serotonin, is implicated in both OCD and schizophrenia.¹⁸ These shared biological factors suggest some overlap in the underlying neural mechanisms contributing to these conditions. However, the precise interactions and implications for each disorder’s symptomatology remain areas of ongoing research and exploration.

Psychotic Symptoms

People with OCD or schizophrenia may experience psychosis, which involves a person losing touch with reality. The outward “symptoms” of schizophrenia and OCD do not tell us much about the underlying causes. This is the danger in strict adherence to surface-level diagnostic procedures. Someone with OCD may have a psychotic episodes if anxiety levels rise above a certain threshold.¹⁹ This may or may not lead to schizophrenia. Depending on the duration, it could be classified as a brief psychotic disorder.

Catatonia

Catatonia, characterized by a range of motor abnormalities and behavioral disturbances, can occur in individuals with schizophrenia or, less commonly, in those with severe OCD. In schizophrenia, catatonia may emerge during acute psychotic episodes involving stupor, rigidity, or repetitive movements. Catatonic features in OCD are rare but can manifest during severe cases or when comorbid with other conditions. In OCD, catatonia may present as mutism, stupor, or extreme agitation, usually during periods of heightened anxiety or stress, but its occurrence in OCD is notably infrequent compared to its association with schizophrenia.¹³

Schizophrenia Spectrum Disorders

Studies show the co-occurrence of OCD alongside psychotic disorders like schizophrenia or schizoaffective disorder, with varying prevalence rates.²⁰ These perspectives emphasize that psychotic symptoms in OCD are seen more often than one would think, confirming the need for a better understanding of the overlap between conditions rather than simply diagnosing based on rigid criteria.

OCD Vs. Schizophrenia: How They’re Different

Schizophrenia and OCD differ significantly in their core characteristics. Schizophrenia primarily involves disruptions in thought processes, leading to hallucinations, delusions, and disorganized thinking. Individuals with schizophrenia often lack insight into their condition, frequently believing their hallucinations or delusions are real. In contrast, OCD revolves around anxiety-provoking intrusive thoughts and compulsive behaviors aimed at alleviating distress. Those with OCD usually possess insight into the irrationality of their obsessions and compulsions, recognizing them as excessive or unwarranted, although this recognition might not eliminate their distress.

However, there is an inclusion in the DSM-V to reflect when an individual has “absent insight/delusional beliefs”. This inclusion represents a marker of the overlap between the conditions and generally indicates a more difficult treatment process.²¹

Anxiety plays a central role in both disorders, but in schizophrenia, it’s often related to the symptoms themselves, while in OCD, it stems from the fear associated with obsessions and the urge to perform compulsions to mitigate anxiety.

A proper understanding of the function and level of anxiety present in each individual case is important.¹⁴ What causes OCD to get worse can depend on the individual, but often, the continued use of compulsions leads to continued worsening of symptoms.

Can OCD Turn Into Schizophrenia?

OCD does not directly cause or trigger schizophrenia, as they are distinct conditions. Plus, the cause of psychosis is unknown, so it is difficult to say anything “triggers” it. However, some research suggests a potential link between severe or untreated OCD and an increased risk of developing schizophrenia later in life. Experiencing persistent and severe untreated OCD symptoms might potentially worsen distress, impacting overall mental health and possibly contributing to the development or exacerbation of psychotic symptoms associated with schizophrenia in susceptible individuals.¹⁹

Can You Have Both OCD & Schizophrenia?

An individual can have both OCD and schizophrenia. When someone experiences symptoms of both disorders concurrently, it’s known as having comorbid OCD and schizophrenia. This coexistence can present unique challenges in diagnosis and treatment due to the overlapping presentations. Managing both conditions often requires a comprehensive treatment approach that addresses both the obsessions and compulsions associated with OCD and the hallucinations, delusions, or disorganized thinking characteristic of schizophrenia.

How Are OCD & Schizophrenia Diagnosed?

Mental health professionals use standardized criteria outlined in the DSM-V to make diagnoses. For OCD, the clinician is looking for obsessions causing distress and compulsions aimed at alleviating anxiety. Diagnosis involves considering the duration, frequency, and impact of symptoms on the individual’s functioning. Schizophrenia diagnosis entails examining the presence of hallucinations, delusions, disorganized speech or behavior, and negative symptoms lasting at least six months.

Clinicians assess the duration and severity of symptoms, ruling out other potential causes for psychotic symptoms. Distinguishing between OCD and schizophrenia involves careful evaluation of the specific nature of obsessions and compulsions versus psychotic symptoms like hallucinations and delusions. A thorough psychiatric evaluation, including detailed patient history and observation of symptoms, aids in differentiating between the two disorders or providing a dual diagnosis when both conditions coexist.

Treatment for OCD & Schizophrenia

The typical treatment for OCD often involves a combination of psychotherapy, particularly cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP), and medications such as selective serotonin reuptake inhibitors (SSRIs) to alleviate symptoms by reducing obsessions and compulsions.²² On the other hand, treatment for schizophrenia typically involves antipsychotic medications to manage symptoms like hallucinations and delusions, along with psychosocial interventions such as therapy, family education, and social support networks to enhance coping skills and improve functioning in daily life.

The combination of medication and psychosocial interventions aims to alleviate symptoms, prevent relapses, and support individuals in managing their condition effectively. There is evidence from other countries that community care is effective at improving quality of life and preventing relapses.²³

Therapy Options

Therapy is recommended for both conditions. A skilled therapist can help a patient understand the underlying dynamics of their condition and begin treating them. For OCD, treatment helps address the underlying anxiety so that an individual no longer has to rely on their obsessions and compulsions to provide relief from anxiety in the short term. For schizophrenia, treatment helps stabilize an individual and provide them with necessary social support that is often a contributing factor to development of the disorder.

Therapy options for OCD and schizophrenia may include:

• Cognitive behavioral therapy (CBT): CBT can be helpful for OCD in breaking the automatic bond between obsessions and compulsions by training you to avoid ritualizing when you’re feeling anxious. Some research suggests CBT may be effective for some of the positive symptoms of schizophrenia.
• Exposure and response therapy (ERP): Exposure therapy may be helpful initially for OCD. Online and self-guided options for ERP exist for people with OCD, like NOCD. Generally, exposure is not recommended for psychotic conditions.
• Eye movement desensitization and reprocessing therapy (EMDR): EMDR as a treatment option for OCD, shows promise in reducing symptoms by addressing underlying trauma or distress that might exacerbate obsessive-compulsive behaviors. However, EMDR is not commonly recommended for schizophrenia due to its focus on trauma processing, which might not be directly applicable or beneficial for the primary symptoms of schizophrenia such as hallucinations or delusions.
• Support groups: Support groups can be valuable for individuals dealing with OCD or schizophrenia. Organizations like the International OCD Foundation (IOCDF) offer support groups, online forums, and resources specifically tailored for individuals with OCD, providing a space to share experiences and coping strategies. For schizophrenia, groups like the National Alliance on Mental Illness (NAMI) provide support groups and educational programs for individuals living with schizophrenia and their families, offering a supportive environment and information about the condition and its management.
• Rational emotive behavior therapy (REBT): Rational Emotive Behavior Therapy (REBT) can be beneficial as a part of the treatment approach for OCD, focusing on challenging and changing irrational beliefs and thought patterns associated with obsessive-compulsive behaviors. However, REBT might have limited effectiveness as a standalone treatment for schizophrenia, as it primarily targets cognitive distortions and emotional disturbances, which might not directly address the core symptoms of schizophrenia such as hallucinations or delusions.
• Modified Psychodynamic Therapy: Certain forms of dynamic psychotherapy have proven to be beneficial to deal with the underlying causes of pathology across levels of severity.¹⁴ Addressing the emotional factors helps stabilize a person and build their own capacities for dealing with symptoms.

OCD Medication

The typical medications for OCD include selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, sertraline, or fluvoxamine. These medications may help alleviate obsessions and compulsions by affecting serotonin levels in the brain. Individuals should be aware that SSRIs may take several weeks to show full effectiveness, and side effects like nausea or increased anxiety can occur initially. Individuals should be cautious of any mental health practitioner who recommends medication alone to address the full range of symptoms.

Schizophrenia Medication

In schizophrenia, antipsychotics such as risperidone, olanzapine, or aripiprazole are commonly prescribed to manage symptoms like hallucinations and delusions. It’s important for individuals to know that these medications can help control psychotic symptoms but may have side effects such as weight gain, sedation, or movement disorders. Monitoring for potential side effects and regularly communicating with a healthcare provider is crucial. There are online psychiatrist options that allow individuals to access professional guidance and medication management remotely through various telemedicine platforms or online mental health services. However, when dealing with medications, in person visits are encouraged.

4 Tips for Coping With OCD & Schizophrenia

There are coping strategies you can use to relieve the symptoms of OCD or schizophrenia. It is important to understand that symptoms present in OCD are often themselves coping mechanisms. Compulsions and obsessions are coping strategies to manage anxiety. Therapy becomes helpful to change these coping habits that were at one point helpful, but now leave the individual stuck in patterns of avoidance and ritualizing.

For both OCD and schizophrenia, having a support group and getting family involved in treatment is beneficial. No condition occurs in isolation. So, addressing the family dynamics is essential to find some relief.

Below are some healthy coping mechanisms for OCD and/or schizophrenia:

1. Journal: Keep a journal to track symptoms, triggers, and feelings, aiding in identifying patterns and discussing them with healthcare providers. You can do this in a physical journal or using a symptom tracking app like Bearable.
2. Education: Educate yourself and your support network about the conditions to foster understanding and effective communication.
3. Support system: Develop a strong support system of family, friends, or peer groups to share experiences and seek guidance during challenging times.
4. Self-compassion: Practice self-compassion and be patient with yourself, acknowledging progress and setbacks in managing symptoms.

When to Seek Professional Help for OCD or Schizophrenia

Individuals experiencing symptoms that significantly disrupt daily life and those diagnosed with schizophrenia should seek professional help. A local therapist directory or online therapy platform specializing in OCD and/or schizophrenia treatment offers accessible options to find licensed mental health professionals. Consulting a therapist skilled in addressing the overlapping dynamics of OCD and schizophrenia is crucial, and in some cases, medication might complement therapy. Seeking advice from a psychiatrist for medication evaluation is advisable, especially when considering new medication. These are things to keep in mind when finding the right therapist.