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 struggling with different conditions, from misdiagnoses to unwarranted fears that they have schizophrenia. We spoke with Dr. Patrick McGrath, psychologist and head of clinical services at NOCD, to shed some light on these two conditions and answer common questions about both.
What is OCD?
OCD is a mental health condition that affects around 1 in 40 adults. It is characterized by unwanted images, thoughts, beliefs, feelings, and urges that cause distress or anxiety (called obsessions) as well as behaviors or mental actions carried out to relieve this distress or avoid negative outcomes (called compulsions).
Common OCD Fears:
Obsessions and compulsions tend to cluster around particular topics of concern. Some of the more common issues involve:
- Contamination: Involves obsessions and compulsions related to germs and illnesses
- Self-harm: Characterized by intrusive thoughts of harming oneself
- Relationships: Occurs when individuals with OCD are focused on worries about intimate relationships, romantic or otherwise
- Sexual orientation: Involves intrusive thoughts about one’s sexuality
- Religion/morality: People with OCD sometimes experience unwanted thoughts and thoughts related to violations of religious or moral rules
What is Schizophrenia?
Schizophrenia is a psychotic disorder characterized by a constellation of symptoms that involve disturbances in thought, emotional responsiveness, belief formation, and behavior.
Key Symptoms
Schizophrenia is characterized by five main symptoms that can impact people to varying degrees. These include:
- Delusions: Delusions are irrational beliefs that are unresponsive to counterevidence. They typically involve particular common themes, such as feelings of persecution or grandiose beliefs. Delusions often have a bizarre nature, meaning they are implausible or hard for others to understand.
- Hallucinations: Individuals with schizophrenia may see or hear things that are not there. Often they are clear and vivid, just like regular perceptions.
- Disorganized speech or thought: This refers to the tendency for people with schizophrenia to 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.
Are OCD and Schizophrenia Related?
Though OCD and schizophrenia are significantly different disorders, there can be some overlap in symptoms, causes, and underlying biology.
Symptoms: Delusions and Intrusive Thoughts
Individuals 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. McGrath notes that “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.”
Consequently, you may wonder if individuals with schizophrenia can 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.
Causes and Triggers
Both OCD and schizophrenia are complicated conditions with an array of potential causes. On a general level, though, both can be triggered by the same sorts of things. For example, both can be brought on by intense environmental stressors—one study found that forty-three percent of individuals with acute-onset schizophrenia experienced a stressful life event in the preceding three months.
They also tend to appear early on in life. “Often you see OCD either begin in childhood or later adolescence,” says Dr. McGrath. “That’s close to when schizophrenia typically starts, which is from the ages of 19 to 26.”
Biology
Though we still have much to learn about both conditions, we know both have biological components. For example, studies have found that both conditions are associated with reduced gray matter (the part of the brain with neurons) in several regions of the brain. Both may also involve abnormal levels or responses to neurotransmitters (chemical messengers in the brain) such as serotonin, dopamine, and glutamate.
Can You Have Both OCD and Schizophrenia?
Yes, it is possible to have both conditions. However, OCD is more common among those with schizophrenia than the other way around. Estimates suggest that 12 to 23 percent of people with schizophrenia have OCD. On the other hand, individuals whose primary diagnosis is OCD are unlikely to have or develop psychotic symptoms, with studies suggesting that it occurs in only 1.7 percent of patients.
Can OCD Lead to Schizophrenia?
There is no known evidence of OCD causing schizophrenia. However, some research suggests that individuals with OCD are at a slightly higher than average risk of developing schizophrenia later on in life, though this link remains unconfirmed.
Can OCD involve fears about Schizophrenia?
Sometimes, individuals with OCD are plagued with unwanted intrusive thoughts about having or developing schizophrenia. For example, they may wonder if they’re experiencing delusions and paranoia, or persistently worry about their connection to reality. This can result in compulsions done to alleviate anxiety and eliminate uncertainty. According to Dr. McGrath, this may involve activities like:
- Going online and researching the symptoms of schizophrenia
- Asking friends and family if they have noticed any strange behaviors
- Filming themselves to make sure they are in touch with reality
- Checking clocks to make sure they didn’t miss anything or that they weren’t hallucinating
- Repetitively visiting professionals for reassurance about their mental state
As with all subtypes of OCD, these obsessions and compulsions can result in significant distress and impairment, sometimes resulting in major disruptions in school, work, and relationships.
How Can I Tell if I Have OCD or Schizophrenia?
Despite some superficial similarities, there are several ways of assessing whether you may be suffering from OCD or schizophrenia. Here are four key signs that you might have OCD, rather than schizophrenia:
1: You Engage in Compulsions
Unless they also have OCD, people with schizophrenia don’t engage in compulsions. So, if you are performing activities to alleviate the anxiety associated with your obsessions or to prevent some bad outcome, it’s more likely that you have OCD.
2: You Have Some Level of Awareness or Insight
As noted earlier, people with OCD typically have some degree of insight, meaning that they know their thoughts and actions are irrational. This is generally not the case with schizophrenia, in which people fully believe their irrational thoughts and views.
3: Your Intrusive thoughts Are Experienced as Intrusive or Unpleasant
As Dr. McGrath noted, while people with OCD experience their intrusive or negative thoughts as unwanted and unpleasant, this is much less often the case with schizophrenia.
4: You Aren’t Acting On Your Intrusive Thoughts
Though individuals 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.
While there are several ways for you to learn whether you may be struggling with OCD or schizophrenia, it is best to consult with a medical professional with specific training in order to receive the correct diagnosis.
How Are OCD and Schizophrenia Treated?
OCD is treated with either talk therapy, medication, or both. By far the most popular and effective form of treatment is called exposure and response prevention therapy (ERP). In ERP, patients work with their therapist to trigger a fear or obsession (e.g., by touching something dirty) without engaging in their usual compulsion or avoidance response (e.g., repeatedly washing their hands). Over time, preventing compulsions in response to obsessions and anxiety allows people with OCD to habituate to uncertainty and distress, decreasing their anxiety in the long run and increasing their tolerance for uncertainty.
In addition to ERP, OCD treatment can be complemented with selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft. These medications block the reuptake of serotonin, a chemical messenger in the brain associated with the symptoms of OCD. For more severe cases of OCD, medication can allow therapy members to be more receptive to ERP treatment.
Medications tend to be a much more central component in treatment for schizophrenia. While individuals with OCD may experience significant improvement without medication, this is generally not the case with schizophrenia. “People with OCD can learn very good behavioral techniques to manage their symptoms,” shares Dr. McGrath, “But you’re not going to see as much of that with schizophrenia.” Instead, physicians typically prescribe a category of medications called antipsychotics.
Some forms of therapy may still be helpful add-ons, such as cognitive behavioral therapy (CBT), cognitive enhancement therapy, social skills training, family education, and more.
Can You Recover from OCD?
Yes, it’s perfectly possible to recover from OCD. Studies have shown that over 80% of people with OCD achieve a reduction in symptoms through ERP therapy. Even those who cannot eliminate their symptoms entirely can learn to manage them long-term and enjoy significant improvement in quality of life.
Can You Recover From Schizophrenia?
According to the World Health Organization (WHO), complete remission is slightly less common for people with schizophrenia, achieved by around a third of individuals with the condition. That said, recovery in a broader sense is still possible. As with OCD, proper treatment, especially with medication, can help people with schizophrenia reduce the degree to which their condition interferes with their goals and quality of life.